ClaimsHow to submit a claim.
Settling of claims
Some healthcare providers submit their claims directly to the Society, while others prefer the patient to pay them directly after the consultation or treatment. If payment has been made by the patient, the Scheme shall reimburse the member based on the acceptance of the claim.
Claims are assessed for validity using benefit rules. If the claim is valid and the benefits are not depleted, the amount is reimbursed directly to the member's bank account. This assessment takes place twice a month, once the assessment is completed, a claims statement will be sent to members via post or email.
1Check if the following information is on your doctor's bill/invoice.
2ORPostBP Medical Aid Society
PO Box 532
3Upon processing claims, a claims statement will be generated and sent via email or post. The claims will be reimbursed in two-week cycles.
4Claims are reimbursed into your bank account upon claims processing.
Claims for services rendered outside the borders of South Africa must be paid for in cash and submitted with proof of payment. Such claims must bear a detailed description in English of each service rendered. Benefits on such claims will be paid at the rate as if the services had been rendered within South Africa.