5.01 What pre-authorisation means

If we pre-authorise your treatment, this means that we will pay up to the limits of your plan provided that all of the following requirements are met:

  • the treatment is eligible treatment that is covered by your plan
  • you have an active membership at the time that treatment takes place
  • your subscriptions are paid up to date
  • the treatment carried out matches the treatment authorised
  • you have provided a full disclosure of the condition and treatment required
  • you have enough benefit entitlement to cover the cost of the treatment
  • your condition is not a pre-existing condition
  • the treatment is medically necessary
  • the treatment takes place within 31 days after pre-authorisation is given

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