Cover for planned hospital admissions
We cover you in hospital for emergency and planned hospital admissions. In an emergency, go straight to hospital but call us or get someone to call us within 12 hours. For planned hospital admissions, please call us 48 hours before you go to hospital to confirm your admission.
Before you go to hospital for any planned procedure, you must:
- See your doctor
- Call us on 0860 100 693 to confirm your hospital admission at least 48 hours before you go to hospital. If you do not confirm your admission, we will only pay 70% of the costs that we would normally cover.
When you contact us, give us the following details:
- Your membership number
- When you will be admitted to hospital and how long you will stay
- The date of the procedure
- The name of the hospital or clinic
- Your treating doctor’s name, practice number and phone number
- Your diagnosis (ask your doctor for the ICD-10 diagnosis code)
- The procedure name
- If one of your dependants is admitted, give us their details.
- There is no overall hospital limit on the Anglovaal Plan.
- Limits apply to some healthcare services and procedures.
Cover is subject to our rules
We pay medically appropriate claims. Your cover is subject to our Scheme rules, funding guidelines and clinical rules. There are some expenses that you may incur while you are in hospital that your benefit does not cover, for example private ward costs. Certain procedures, medicines or new technologies need separate confirmation while you are in hospital.
Cover for Prescribed Minimum Benefits
For Prescribed Minimum Benefits, we pay hospital admissions for 270 defined conditions in full at our designated service providers our choice of healthcare professionals.
How we cover your childbirth
We cover childbirth from your Hospital Benefit, including home births done by midwives with valid practice numbers and who are appropriately registered with the Board of Healthcare Funders. You must authorise the childbirth admission to hospital or home birth with us before you go to hospital. Remember to register your baby with us as soon as possible so we can cover the baby.
There are certain limits for childbirth benefits:
| Childbirth service | Limit |
|---|---|
| Pregnancy scans | Two 2D scans for each pregnancy, which we pay from the available money in your Medical Savings Account |
| Normal vaginal deliveries | A stay of three days and two nights in hospital |
| Caesarian sections | A stay of four days and three nights in hospital |
How we cover your healthcare professionals
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates.
If your healthcare professional charges the Scheme Rate, we will pay him or her directly. If your healthcare professional charges more than the Scheme Rate, we will pay you. You will have to make sure you pay your healthcare professionals the full amount.
If your healthcare provider is a provider participating in the Discovery Health network, he or she will be covered in full. You can access the MaPS tool to search for the healthcare professionals who participate in the Discovery payment arrangements.
Your benefits for 2021
All admissions are subject to prior authorisation
Note: Discovery and the Scheme’s in-hospital clinical protocols will be applied
| Hospital Benefit | The limit on this benefit |
|---|---|
| Admission for a Non-Prescribed Minimum Benefit (Non-PMB) |
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| Admission for a Prescribed Minimum Benefit (PMB) |
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| Emergency evacuation (road or air) (Note: this excludes planned transfers) |
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