Medical Insurance Claims

The benefits in every medical insurance policy are limited. Some policies limit their benefits on a per condition basis, others on a single annual limit.

Check your policy benefits
Wherever possible (when admission to hospital has been pre-scheduled) you should check with your company to confirm what types of hospitals, treatments and wards are covered under your plan.

Step 1

Prepare required documents 

The standard documentation required when submitting a claim are as follows:

  • Original final hospital and/or physician’s medical bills and receipts
  • Hospital discharge summary
  • Medical reports, if any
  • Copy of reimbursement letter/discharge voucher from previous reimbursement, if any.
  • For plans that cover dependants, proof of relationship such as marriage certificate or birth certificate if insured is the spouse/child

In order the claims process to begin, please note it is imperative that the bills and receipts submitted are ORIGINAL since copies are generally not acceptable unless in very special circumstances.

Step 2

Complete relevant claim form

You should obtain and complete the Medical Claim Form. There are usually two parts to a claim form: one part to be completed by the claimant/policyholder and the other part to be completed by the attending physician.

Your insurer may revert with additional queries or requirements on further documentation e.g. a doctor’s report, following the receipt of your claim form.

Step 3

Submit the completed claim form and required documents

You should submit your completed claim form together with your documents to your insurer at the earliest possible time. Delays in submission will in turn cause delays in claims processing.

error: Content is protected !!