Everything you need to know about submitting a claim
We understand that many of you are new and may not be familiar with the claiming process. Here's a simple guide to help you understand how to claim.
Claiming from the Scheme
If your healthcare provider does not submit claims on your behalf, you will need to do it yourself. Here's how:
- Paying in Advance: If the practice is not a Designated Service Provider (DSP), you might need to pay the provider for the service upfront. Always check with your provider regarding their billing or payment requirements.
- Submitting Your Claim: After paying, you can claim the benefit from the Scheme. Make sure you submit all the necessary documents, such as the invoice and proof of payment. You can find the steps to submit your claims here.
- When you submit a claim, the Scheme will refund you at the LA Health rate. You will receive notifications about your claims via email.
Keep Your Contact Details Updated
Ensure that we have your correct contact details on file. This way, you will be informed of any important information such as claims reimbursements to you or your provider, or if there is any outstanding amount over and above the Scheme rate, which you need to pay to the practice.
Using DSPs to Save Money
Using Designated Service Providers (DSPs) can help your Medical Savings Account (MSA) last longer and reduce your out-of-pocket payments. DSPs have agreed to charge rates that are covered by the Scheme, reducing the amount you need to pay yourself.
By following the steps outlined above and using DSPs, you can ensure that your claims are processed smoothly and your MSA lasts longer.
Protect your Health and Wallet - Say "No" to Fraud
Using your medical aid benefits for anything other than the purposes for which they are allocated, constitutes fraud. That means you cannot claim for items that are not listed as part of your benefit option or for treatments or products that you never received. If someone steals from the Scheme they steal from you - the money lost due to medical aid fraud ultimately impacts your monthly payments.
If you think someone is misusing their scheme benefits (like letting someone else use their membership), or suspect a doctor of fraud (for example, the doctor sends us claims for treatment you didn't get), please let us know. You don't even have to give your name.
- Email discovery@tip-offs.com
- Toll-free phone number: 0800 00 45 00
- Toll-free fax: 0800 00 77 88
- Post: Freepost DN298, Umhlanga Rocks 4320