How to claim

Process

Most service providers submit their claims directly and are paid directly, which means you do not have to submit your account to the scheme. If you have paid cash, you must submit your fully specified original copy of the account invoice and proof of payment (receipt) to the scheme. All claims (submitted by the service provider or yourself) needs to be submitted within 4 months of the date of treatment.

 

Before submitting your claims, check whether the following information is clearly on the claim:

• Your membership number

• The name of the benefit option (Diamond, Platinum, Copper or Bronze)

• Your surname, initials and postal and email address

• The patient’s first name

• The name and practice number of the supplier

• Name and practice number of the referring doctor (if specialist account)

• Date of service/treatment

• Service provided, cost and treatment breakdown

• ICD-10/Diagnostic and treatment/tariff codes

 

Points to remember:

• Keep a copy for your records

• It is your responsibility as a member to ensure that your claims have been submitted to the scheme and to check whether they have been paid by the Scheme, even if your service provider submits the claims on your behalf.

• If your claim is rejected, you have 60 days in which to submit the correct claim or raise a query.

 

Latest
News

19 August ,2015

LOCATION

We have now moved to the CBD at Zambezi towers. We are next to the

19 August ,2015

BOTSOGO

We are now part of Metropolitan Botswana bridging the gap between Life and health insurance.