Approval Process

Why Pre-Approvals?

In the event of an outpatient treatment where the cost of treatment exceeds the limit mentioned on the membership card or is pertaining to any of the below mentioned procedure, the provider is required to seek a pre approval before starting the treatment.

Pre-authorization is required for the following:

• In-Hospital Admission
• Extension of Hospital Stay
• Day Care services
• MRI - CT Scan - Doppler - Holter Monitor - Endoscopy
• Physiotheraphy
• Drugs for over two month stock
• All dental, maternity and optical treatment
• Non-emergency out-patient service exceeding the limit

If non-emergency treatment is obtained from a provider outside the network the member should obtain pre-authorization from the Helpdesk. In this case an 'Approval Request' must be sent to the Helpdesk. The Helpdesk will respond to the request as soon as possible and within 30 Minutes of the receipt of the request.

If the original pre-authorization time and benefit is exceeded, a further pre-authorization for the proposed extension period should be obtained.