Claims

How 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.

  • 1
    Check if the following information is on your doctor's bill/invoice.

    Required information

    Practice name Practice number Medical aid name Membership number Patient's name Patient's date of birth Patient's dependant code Date of service ICD-10 code
  • 2
    Email

     

    OR
    Post

     

    BP Medical Aid Society
    PO Box 532
    Cape Town
    8000
  • 3
    Upon processing claims, a claims statement will be generated and sent via email or post. The claims will be reimbursed in two-week cycles.
  • 4
    Claims are reimbursed into your bank account upon claims processing.

International claims

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.