How it works
How Lion Health
medical insurance works
A considered process designed to help you and your family choose, apply for and access quality healthcare cover with confidence.
Health insurance, not a medical scheme. Benefits are paid as stated amounts.
Access health insurance cover
Choosing your medical insurance plan
Choose your cover
Choose the healthcare cover that best suits your needs and budget, whether you need support for everyday healthcare, unexpected medical events, or both.
Complete your quote request
Complete a quote request and one of our consultants will contact you to discuss the cover options available to you and your family.
Access your benefits
Once your cover is active, our team will assist you with authorisations and support, helping you access your benefits with confidence.
Choose your cover
Choose the healthcare cover that best suits your needs and budget, whether you need support for everyday healthcare, unexpected medical events, or both.
Complete your quote request
Complete a quote request and one of our consultants will contact you to discuss the cover options available to you and your family.
Access your benefits
Once your cover is active, our team will assist you with authorisations and support, helping you access your benefits with confidence.
Quick reference
How it works, at a glance
| Step | What you do | What happens next | Typical member outcome |
|---|---|---|---|
| 1. Choose your cover | Pick Day-to-Day, Hospital or Combined cover for your family and request a quote. | A Lion Health consultant contacts you with the best-fit option for your needs and budget. | Cover is activated once your first premium is paid. |
| 2. See a private doctor | Visit a private doctor in the national PAMC network as often as your family needs (pre-authorisation after the third visit). | Everyday care — GP visits, the 24/7 nurse line and medication from the R1,340/year pool — is delivered through the network. | Everyday care that doesn't run out mid-year. |
| 3. Get your hospital benefit paid | If you're admitted, authorisation is required; submit your claim and supporting documents after discharge. | Lion Health pays a stated benefit — to the hospital under the Guarantee of Payment issued on approval, or to you after discharge on a valid claim. | Stated benefit: R10,000 for day 1, up to R53,000 over 21 days. |
| Benefit | Day-to-Day | Hospital | Combined |
|---|---|---|---|
| Everyday private-doctor care | Included — network private doctor, 24/7 nurse line, medication | — | Included |
| Hospital benefit (stated, authorisation required) | — | Up to R10,000 day 1 → R53,000 / 21 days | Included |
| ICU benefit | — | R15,000 / day (max 5 days) | Included |
| Best for | Everyday care your medical aid leaves you paying for | Hospital benefit when you're admitted | Everyday care and hospital benefits together |
| Monthly premium | R644 | R477 | R969 |
Health insurance, not a medical scheme. Hospital benefits are stated amounts and do not reimburse your hospital bill. Limits, waiting periods and terms and conditions apply. Premiums effective from 1 January 2026.
Member support services
Using the 24/7 nurse line
Your member app
Download the Pan-African Managed Care member app to find healthcare providers, view waiting periods that may apply and access your membership card.
Using your benefits
Access quality healthcare providers and services through the PAMC member app, or contact our support team for assistance.
We are here to help
Our support team is available to assist you and your family in accessing the care you need.
Phone: 087 085 0933
Email: info@lionhealthsa.co.za
24/7 WhatsApp Nurse Line: 060 550 4337
Your healthcare cover
Seeing a private doctor in the PAMC network
Find a private doctor or approved provider
Find a private doctor or approved provider in your area using the PAMC member app.
Download the PAMC member app
Pre-authorisation and waiting periods
Where access to a medical service requires pre-authorisation, members can contact Pan-African Managed Care on 087 943 9612 or email auth@pamc.co.za. As Lion Health is an insurance product and not a medical scheme, pre-authorisations are generally processed telephonically or through direct liaison with your treating healthcare provider.
| What needs pre-authorisation | How to request | Contact |
|---|---|---|
| GP visits after the 3rd visit | Call PAMC before the visit. | 087 943 9612 · auth@pamc.co.za |
| Hospital & ICU admission | Authorise before admission (emergency: within 48 hours). | 087 943 9612 · auth@pamc.co.za |
| Chronic medication | Register the condition and medicine. | 086 011 9553 · preauth@mediscor.co.za |
| Emergency transport | Pre-authorised via Africa Assist. | Africa Assist — see your membership card |
Chronic medication registration
For chronic medication registration, call 086 011 9553 or email preauth@mediscor.co.za. You will be transferred to and assisted with the chronic medication registration process.
Check whether your medication is covered
Before requesting pre-authorisation, you can check whether your medication is included on the approved medicine list by visiting: the Lion Health formulary lookup.
Follow these steps:
- Under Option, select DAY-DAY for chronic medication.
- Select Lion Health ACUTE if you are checking acute medication.
- Search by Product or Condition.
- Click Submit.
- The system will indicate whether the medication is included on the approved medicine list.
If your pre-authorisation relates to a hospital admission or procedure
Please have the following information available:
- Patient's name, date of birth and ID number
- Lion Health membership number
- Treating doctor's name, contact number and practice number
- Hospital or day clinic name, telephone number and practice number
- Planned admission or procedure date
- Diagnosis (ICD-10) code
- Procedure (CPT/tariff) codes supplied by your doctor
Please note: Pre-authorisation does not automatically guarantee payment. Once approved, a Guarantee of Payment (GOP) may be issued in accordance with your policy terms and benefit limits. Always keep your confirmation reference number or Guarantee of Payment for your records.
Reimbursement for medical expenses
To claim out-of-pocket medical expenses on your Lion Health plan, you must email your detailed invoices, Proof of Payment, and a completed Claim Form to claims@pamc.co.za. Reimbursable payments generally take between 7 to 14 working days to process and reflect into your nominated bank account.
Ensure your submission is valid by taking the following steps:
Required Documentation: You must attach the itemized invoice (reflecting the correct diagnostic ICD-10 and tariff codes) and your receipt/EFT proof of payment.
How to submit a claim
- Submit to Admin: Email all documents to claims@pamc.co.za (administered by Pan-African Managed Care - PAMC)
- Specialist consultations are available on referral from your network doctor. Where a specialist submits claims directly, there’s nothing further for you to do. Where they don’t, simply pay the account and submit your claim for reimbursement.
- Processing Time: Standard expense claims and refunds typically take between 5 to 14 days to be assessed, approved, and processed
- Deadlines: Ensure you submit your claim within four months of the treatment date; claims submitted after this period become "stale" and are generally rejected
- Support: For immediate queries, you can reach the Lion Health claims and support line directly at 087 943 9612
Quick reference
Member support channels
| Channel | Use it for | Contact |
|---|---|---|
| Member app (PAMC) | Virtual nurse consults, find network doctors, membership card. | Download the PAMC app |
| 24/7 nurse line | Clinical guidance any hour, when your doctor is closed. | 060 550 4337 |
| Pre-authorisation (PAMC) | Authorise admissions and chronic medication. | 087 943 9612 · auth@pamc.co.za |
| Policy amendments | Update or change your policy. | 087 085 0930 · policyamendments@lionhealthsa.co.za |
| General enquiries | Quotes and questions. | 087 085 0933 · info@lionhealthsa.co.za |
Why it works
Designed around you
Healthcare that meets your routine day-to-day needs as well as those unexpected medical events we never plan for.
Ongoing support
Support for you and your family throughout your healthcare journey.
Flexible options
Day-to-Day, Hospital and Combined plans designed around different healthcare needs.
Health insurance, not a medical scheme. Hospital benefits are stated amounts and do not reimburse your hospital bill. Limits, waiting periods and terms and conditions apply.
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