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Making a claim

How to make a claim for out-patient treatment on a pay and claim basis

If you need any help or advice, please contact us using the details below.

a) See your medical practitioner, therapist, or specialist in the usual way. Complementary treatment received from a therapist must always be on referral from your medical practitioner or specialist. For more details on Complementary treatment, refer to the section ‘Physiotherapy and complementary medicine for acute and chronic medical conditions’ of your Table of benefits.

b) Pay your bill for the treatment you have received.

c) Make sure you get an original itemised invoice and original receipt as you will need to send these to us with your completed claim form.

d) Make sure that you complete one claim form for each medical condition.

e) Complete sections A-D & F of the medical claim form, sections A-D & F of the dental claim form or sections A, B & D-K of the travel claim form depending on the type of claim you are submitting. You can get a claim form by contacting the claims team. You can also download a claim form.

f) You must ask your medical practitioner to complete section E on the medical treatment reimbursement claim form, section E on the dental treatment reimbursement claim form or section C on the travel claim form.

g) Send your claim to the claims team that administers your plan. You must send the following items to make sure that we can process your claim:

  • the original itemised bill;
  • the original receipt;
  • the fully completed claim form;
  • a copy of the prescription; and
  • a copy of the investigative tests results where relevant (e.g. blood tests, x-rays, ultrasound, etc).

Alternatively, you can scan and email a copy of these items by emailing this to the team that administers your plan: following the ‘scanned claims’ procedure below.

Middle East:
Middle East AAA RI claims:

Send the above items as soon as possible from the first date of treatment. We recommend that you send these within six months of the first treatment date.

How to make a claim for treatment under a direct billing facility

Where direct billing arrangements are in place:

a)    Check that your treatment is covered under the plan — if you are unsure, contact us.

b)    Visit the treatment providers on the list for out-patient treatment.

c)     Show your membership card.

d)     The treatment provider will then deal with your claim administration. Receive your treatment.

e)     You must pay any excess or co-insurance that applies to your plan. This excess or co-insurance will be shown on your membership card.

If after we have paid a claim, it is subsequently found to be ineligible under the terms and conditions of the plan, we have the right to recover the payment from you or the planholder. Payment of any such claim is not an indication of our acceptance of liability for the claim or confirmation that further costs for treatment for the same or any related medical condition(s) will be met. If we refuse to pay a direct billing claim under the terms and conditions of the plan, you will have to pay the cost of the claim within the period specified by the treatment provider upon receiving notice from them.

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