Specialist Prior Approval Form
The Mokopuna Ōranga Pūmau (MOP) health care assistance programme provides funding for specialist treatment and/or urgent hospital costs.
MOP is only available to mokopuna currently enrolled and attending Kōhanga Reo.
Treatment types have included:
- Consultant costs
- Multiple ear, nose and throat ailments
- Eye care for testing and glasses
- Associated dental costs for urgent extractions requiring anaesthetic can potentially be covered following discussion with the designated kaimahi.
- The Government provides FREE primary healthcare for tamariki under 6 years old.
- MOP only provide funding for specialist treatments and / or urgent hospital costs.
- Ask your General Practitioner (GP) to recommend a specialist for your mokopuna.
- Complete this Prior Approval Form with your GP and submit the form for approval.
- When filling out this form for your mokopuna, use the same name that they are registered with at their Kōhanga Reo. Using different names, delays the processing time.
HOW IT WORKS
- The parent, guardian or caregiver must visit their GP with the mokopuna to obtain a specialist referral.
- Together the parent, guardian or caregiver and GP must complete the Prior Approval Form and submit for approval.
- The Trust will review the application.
- If approved, the application will be forwarded onto the specialist and the parent, guardian or caregiver will be advised. This approval is for the costs associated with the initial visit in the first instance.
- If not approved, the Trust will contact the parent, guardian or caregiver and advise as to why the application was declined.
ONCE THE TREATMENT HAS BEEN INITIATED
- The specialist sends the appointment time to the parent, guardian or caregiver at their home address. They should not contact the Kōhanga Reo.
- The invoice for the initial visit should be sent to the Trust for payment.
- The Trust will only pay funds into authorised accounts.
- All queries must be directed to the Trust [email protected].
- After the initial visit, the specialist must provide the Trust further details about the treatment plan and the associated costs. Details are sent to [email protected].
- The Trust reviews the associated costs for the treatment plan:
- If approved, the Trust will confirm this with the parent, guardian or caregiver, and with the specialist. The specialist completes the treatment and invoices the Trust for the approved cost.
- If not approved, the Trust will contact the parent, guardian or caregiver and advise as to why the treatment costs won’t be covered.
- At the conclusion of the specialist treatment or hospitalisation, ensure that the remaining accounts are forwarded to the Trust for payment.