How to Claim?

A copy of the invoice (contents of invoice detailed below) and a receipt (for members seeking reimbursement).

• the surname and name of the member as written on the membership card.
• Member signature to confirm service rendered
• The name of the patient as indicated on the membership card.
• the name of the benefit option.
• the membership number of the member.
• the practice code, name and signature of the health professional or the service provider rendering the service, where applicable.
  • the date on which the service was rendered.
  • the nature of the service and international classification of disease (ICD) and/ or current procedural terminology (CPT) code or diagnosis code from time to time (Itemised list of all services and their respective individual charges. In the case of a medical practitioner or dentist, a diagnosis of the complaint for which the service was provided, as well as tariff codes for the respective services where applicable)
  • Members should submit invoices written in English Language if not so an official and certified interpretation for that particular invoice should be provided.
• the code number of the item of the recognised tariff, where applicable

All invoices for pathology/laboratory services, speech therapy, physiotherapy, dietetics, occupational therapy, psychology, or any other paramedic/allied/associated health services should be accompanied by a copy of the letter of referral from a medical practitioner or dentist.

Invoices for medication dispensed by a pharmacy should be accompanied by a copy of the prescription certified by the pharmacist, as a true and exact photocopy of such prescription.

• the tariff code in accordance with the scale of benefits for the treatment.
• Treatment Plan indicating the following:
  • the total cost to be charged for the treatment by the orthodontist.
• the duration of the treatment.
• the initial primary amount payable by the member.
• the monthly amount that the member shall pay.

Refunds to members are done electronically; therefore we require the following information:

• Account type (savings, current or cheque)
• Branch code
• Branch number
• Bank name
• Account number
• Account name
• All invoices should be signed by the member or dependent to acknowledge receipt of services being claimed for.

• Upon receipt, processing turnaround is 14 days, at which point, a claims run is done weekly
• For member reimbursement, upon processing completion, you will get an SMS notification about the impending payment, and in the following days, payment will reflect into your account.

• Ensure the details are correct and itemised accordingly.
• We accept both hand delivered and posted original invoices.
  *As a precaution members are encouraged to make copies of all their submissions.