Hospital admission and emergencies

Emergencies are covered in full. You can go straight to the hospital in an emergency. If you need emergency medical transport, you can call Emergency Assist on 0860 999 911.

What we pay for

We pay for all of the following medical services that you may receive in an emergency:

• the ambulance (or other medical transport)
• the account from the hospital
• the accounts from the doctor who admitted you to the hospital
• the anaesthetist
• any other healthcare provider that we approve.

We may ask you or your treating provider for additional information to confirm the emergency.

Hospital Risk Management

The programme ensures that you receive appropriate, quality healthcare while you are hospitalised. The pre-authorisation process ensures that the planned procedure or treatment is both necessary and appropriate.

The rules of the Scheme require you to obtain pre-authorisation before any of the following:

• all planned hospital admissions
• admissions for mental health and drug or alcohol dependency
• confinements (childbirth)
• CT, MRI and radioisotope scans
• dental surgery and all dental services that require admission
• hospital admission for basic dentistry for children under the age of eight years (the dentist will be paid from the advanced dentistry benefits)
• organ transplants