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Funding Protocols

As part of Medscheme’s new innovative HBM Model, we are in the process of developing funding protocols related to hospital authorisation requests. This is being done in collaboration with the relevant Specialist Societies.

The funding protocols will be published on this web page as and when they are implemented. Funding protocols implemented to date are reflected below.Read more


Medscheme is developing a new, innovative Hospital Benefit Management (HBM) model. Once fully implemented, the new model will significantly improve efficiency for all stakeholders, reducing administrative burden and speeding up turnaround times.

One of the ways in which this will be achieved is through systematic application of pre-determined funding protocols, which are currently being developed collaboratively with healthcare professionals. It is important to note that although the funding protocols are designed around an evidence-based clinical approach, they are solely for funding purposes and do not aim to replace any clinical guidelines. Furthermore, funding protocols will only be implemented once they have been reviewed and endorsed by the relevant Specialist Society and Key Opinion Leaders. We will inform the relevant healthcare providers as and when this happens.

The funding protocols will be implemented in a phased approach, starting with the ‘manual’ implementation of selected funding protocols. This is to ensure that proper testing and user experience is undertaken by the relevant stakeholders, and will assist healthcare providers (healthcare professionals and hospitals alike) to familiarise themselves with our new process.

Medscheme will make the latest versions of the funding protocols available on this web page. If the documents are printed and distributed, Medscheme and its client medical schemes will not be held liable or responsible for any invalid or inaccurate reliance on the outdated information and the treatment or procedure being declined as a result. Please ensure that the updated documentation is obtained at all times.

For any questions regarding the HBM Programme, please email HBMQueries@medscheme.co.za

Contact Medscheme

+27 11 671 2000

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