Before a planned hospital admission, Genesis members need to obtain a hospital admission reference number 72 hours prior to such admission, check your medical aid benefits, follow your doctor’s fasting and medication instructions, and pack the documents and personal items you will need. Also check that all procedure dates, ICD-10 codes and admission details are correct to avoid unexpected claim problems.
Planned hospital admissions can feel overwhelming, especially if it is your first time preparing for surgery or treatment in a hospital. There are medical, financial and administrative steps to manage before the day of admission and missing one of them can lead to delays or unexpected out-of-pocket expenses.
This guide explains what to prepare before going to hospital, what a hospital admission reference number is, and which Genesis-specific funding rules members should keep in mind.
Key Takeaways
- Obtaining a hospital admission reference number is important, but it is not always a guarantee of payment.
- You must notify Genesis immediately if your procedure date, procedure details or ICD-10 codes change.
- Your doctor makes clinical decisions, while your medical scheme is responsible for the funding of medically appropriate treatment in line with your selected benefit option.
- Hospital admission requirements usually include pre-admission forms, identity documents, medical aid details and your doctor’s instructions.
- Hospital timing matters. Checking in too early or staying longer than clinically needed may lead to additional charges not covered by the Scheme.
- Members should track claims after discharge to catch unpaid or partially paid accounts early, and to take the necessary action as guided by the Scheme (if any).
Planned Hospital Admission Checklist
| Preparation Step | What It Involves | Who Is Responsible | Typical Timing Before Admission |
|---|---|---|---|
| Obtain a hospital admission reference number | Requesting a hospital admission reference number from the Scheme using the procedure details, admission date, treating doctor information and ICD-10 codes. | Patient or doctor | Not less than 72 hours prior to admission |
| Pre-admission registration | Completing hospital or medical service provider(s) forms through the admissions office or online platforms, if any. | Patient and hospital admissions office or medical service provider(s) practice(s) | Several days before admission where possible |
| Fasting and dietary restrictions | Following your doctor or anaesthetist’s nil-by-mouth instructions before surgery. | Patient, on doctor’s instruction | Usually several hours before surgery |
| Medication review | Confirming which medication to stop, pause or continue before admission. | Patient and treating doctor | A few days before admission, or as advised |
| Packing your hospital bag | Bringing ID, medical aid details, admission documents, medication, toiletries and comfortable clothing. | Patient | Day before or morning of admission |
| Financial and co-payment arrangements | Checking benefit limits and possible shortfalls/co-payments before admission. | Patient and medical aid | Before admission |
Hospital Timing And Logistics
The timing of your hospital admission is important, as the Scheme has specific rules around admission and discharge times.
Genesis funds a morning admission only where theatre is scheduled before 2 pm. If your procedure is scheduled for theatre after 2 pm, admission is only funded after 12 pm on the same day. Checking in earlier may result in additional costs that are not covered by the Scheme.
Discharge timing also matters. Afternoon discharges should be clinically indicated for funding to apply. If you stay longer than medically required, you may be responsible for additional costs.
Pre-operative tests and consultations can also affect your bill. If tests, procedures or special investigations are done on the day before admission and do not require a hospital facility, these expenses may be at your own cost. Always check your benefits with the Scheme first.
Out-Of-Pocket Expenses And Limits
A planned hospital admission does not always mean that every related cost will be paid in full. One of the most common reasons for shortfalls is the difference between what a doctor charges and what the medical scheme pays.
Genesis reimburses hospital, doctor and other service provider claims according to the Scheme Rules and the benefits and Scheme Tariff applicable to your selected benefit option. If a doctor or other service provider charges more than the Scheme Tariff, or the benefits applicable to your benefit option, the shortfall will be for your own account.
There may also be specific (stated) limits on certain items or procedures. For example, Genesis applies specific limits to internal medical or surgical prostheses, such as artificial joints.
Endoscopy benefits are also stated benefits, in other words, there may be limits. Gastroscopy and colonoscopy benefits are capped per event, and these limits include both professional and hospital fees for certain benefit options. Pathology linked to endoscopy benefits is also limited.
MRI and CT scans require clinical motivation. To qualify for in-hospital benefits, they must be directly related to the main reason for the hospital admission and supported by a full clinical history and examination findings. The approval of reference numbers for these scans remains at the Scheme’s discretion.
The safest approach is to ask for a written estimate from your doctor, confirm your benefits with Genesis, and understand what may be paid by the Scheme and what could be your responsibility.
Exclusions To Watch Out For
Some treatments, products and investigations may not be covered by the Scheme, even with a hospital admission reference number.
Section 21 drugs, medication, substances, appliances and the like are exclusions. If your doctor recommends a treatment involving any of these, you should ask about alternative options and confirm the funding position before admission.
Diagnostic admissions also require care. If you are admitted for diagnostic tests or examinations and these do not result in the diagnosis or confirmation of an illness or disease that requires surgery, the hospital stay may be for your own account.
The PMB Choice
Prescribed Minimum Benefits, or PMBs, are a defined set of conditions that medical schemes must cover according to the Medical Schemes Act. However, the way those costs are funded can depend on where you choose to receive treatment.
Genesis offers members a choice of funding model for the treatment of PMB conditions. If you choose to be treated in a private hospital, the benefits and limits set out in the Scheme Rules will apply. Any shortfalls, including differences between what doctors charge and the Genesis Scheme Tariff, will then be for your own account.
If you want your PMB claims to be paid in full and in line with the law, then treatment must be obtained from a public hospital at PMB level of care. Genesis has elected to select all public hospitals in South Africa as its Designated Service Providers (DSPs).
You are not forced to use a public hospital just because there is a DSP in your area. However, if you choose private hospital treatment for a PMB condition, you may be liable for the difference between what the doctor charges and what Genesis pays.
If you are unclear about PMB funding, contact Genesis before admission so that you understand your options.
Your Hospital Admission Reference Number Is Not A Blank Cheque
Obtaining a hospital admission reference number is one of the most important hospital admission requirements, but it is often misunderstood.
A hospital admission reference number means the Scheme has reviewed the information provided at the time of the request. It does not guarantee payment or reimbursement of all costs.
Furthermore, the admission reference number is condition and date specific. If anything changes after the reference number is issued, the Scheme must be informed immediately.
This includes changes to:
- The procedure date.
- The type of procedure being performed.
- The ICD-10 / procedure codes provided by the doctor.
- The treating doctor or facility details.
If these details change and Genesis is not updated, the reference number may become withdrawn and void. This could cause claims for the entire admission to be rejected.
It is also important to understand the difference between treatment and funding. Genesis does not provide medical services and does not interfere with clinical decisions made by your attending doctors. The Scheme’s role is to fund qualifying claims in line with the Scheme Rules and your selected benefit option.
Your doctor advises you on treatment. Genesis advises you on benefits, rules and funding.
What To Pack For A Planned Hospital Admission
Packing early can make admission day less stressful. Your hospital may provide its own list, but most patients should prepare the following:
- Your ID document.
- Medical aid membership card or membership number.
- Admission reference number.
- Doctor’s admission letter or booking form.
- Chronic medication in original packaging.
- A list of medication, allergies and medical history.
- Comfortable clothing and sleepwear.
- Toiletries.
- Glasses, hearing aids or mobility aids if needed.
- Phone charger.
- Basic personal items for your stay.
Avoid bringing valuables unless necessary. If you are assisting a child, elderly parent or family member, also pack comfort items, emergency contact details and any documents requested by the hospital.
Fasting, Medication And Lifestyle Rules
Before surgery, your doctor or anaesthetist may give you fasting instructions. These rules are important for your safety during anaesthesia.
Follow the exact instructions given to you. Do not guess or rely on general advice if your doctor has provided specific guidance. If you are unsure whether you may drink water, take medication or eat before admission, contact the doctor’s rooms or hospital before your admission time.
You should also confirm what to do with chronic medication, blood thinners, supplements or any medication that may affect surgery. Some medication may need to be paused, while other medication should be continued.
Smoking and alcohol rules should also be discussed with your doctor before admission, especially where anaesthesia or wound healing may be affected.
The Post-Hospital Homework: Why Your Job Is Not Done When You Are Discharged
After discharge, it is important to track your medical aid claims. Hospital accounts, doctor accounts, anaesthetist accounts, pathology accounts, radiology accounts, etc., will be submitted separately if you were treated in a private hospital.
Genesis encourages members to track claims online through the website or smartphone app. Look out for unpaid or partially paid claims so that you can contact the Scheme or the service provider as soon as possible.
Do not ignore shortfalls or rejected claims. Early follow-up can help you understand whether more information is needed, whether a claim was submitted incorrectly, or whether the amount is for your own account.
A planned hospital admission starts before you arrive at the hospital and continues after you leave. By preparing properly, checking your benefits and keeping Genesis updated, you can reduce stress and avoid common billing problems linked to a hospital admission.
Frequently Asked Questions
What Is A Planned Hospital Admission And How Does It Differ From An Emergency Admission?
A planned hospital admission is a scheduled admission for treatment, surgery or a procedure arranged in advance. It is usually linked to elective or non-emergency care. An emergency admission happens unexpectedly when immediate medical attention is needed – in other words, when there is a sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide such treatment would result in serious impairment of bodily functions, or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy. It is important to remember that the condition must require “immediate” life-saving treatment and not “urgent” treatment.
What Does Pre-Admission Mean In A Hospital Context, And Do I Need To Complete It Before My Admission Date?
Pre-admission means completing the hospital’s / medical service provider(s) registration process (if any) before you arrive for your procedure. This may include your personal details, medical aid information, consent forms, medical conditions, allergies, doctor details and admission documents. Many private hospitals offer online pre-admission. Completing this early can make the admission process faster and smoother.
How Do I Obtain A Hospital Admission Reference Number From My Medical Aid Before A Planned Hospital Admission?
Contact Genesis Medical Scheme with your admission date, hospital details, treating doctor information, procedure codes and ICD-10 codes. Your doctor’s rooms may help provide these details, or contact the Scheme directly. Genesis members must make sure the information is correct, because the admission reference number is condition- and date-specific. If any details change, Genesis must be notified immediately.
How Much Does a Private Hospital Treatment / Admission Cost In South Africa, And What Fees Should I Expect To Pay?
The cost of a private hospital treatment/admission in South Africa depends on various factors, such as the hospital, where you are treated inside the hospital (ICU, High Care or ward), the specific diagnosis or procedure, special equipment that may be used, the doctors involved, anaesthetist fees, scans, tests and prostheses, to name but a few. Even with an admission reference number, you may still have shortfalls if doctors charge above the Scheme Tariff or if limits and exclusions apply in respect of your selected medical aid option. Where possible, ask for estimates before admission and confirm your benefits with Genesis.
What Should I Pack And Bring With Me On The Day Of My Hospital Admission?
Bring your ID, medical aid details, admission reference number, doctor’s admission documents, chronic medication, a medication list, toiletries, comfortable clothing and any personal medical aids you use, such as glasses or hearing aids. It is best to check the hospital’s own packing list before admission and avoid bringing valuables.
Are There Eating, Drinking Or Smoking Rules I Must Follow Before A Planned Hospital Admission?
Yes. Your doctor or anaesthetist may give you fasting, drinking, smoking and medication instructions before surgery. These instructions are important for your safety and should be followed exactly. If you are unsure what you may eat, drink or take before admission, contact your doctor or the hospital before your planned hospital admission.
