How to Claim
In every case the following sections of your claim form must be completed in full:
- The first section must be completed by the member, providing the details of the person undergoing treatment or seeking advice.
- The next section should be completed by your doctor, or treating practitioner. Please check that the MEDICAL HISTORY section is completed, including the (i) date when symptoms were first noticed and (ii) when advice was first sought (without this information your claim cannot be processed).
- If you are going to pay for services, then please make sure that you get a receipt for your payment. Attach the receipt to your claim form and tick the box on page 1 next to “Payment of this claim should be made to: THE MEMBER”. On the reverse of the form, please ensure that you provide us with your bank account details and that the form is signed and dated by you or your legal guardian.
- If you are referred to a specialist, a therapist, scans or for diagnostic tests, then please include a copy of your referral note with your specialist/therapist/scans/testing claim form.
- You must bring the completed form and your receipt to our offices at 7 Fleetwood Road, Alexandra Park, Harare. We cannot accept scanned copies.
- If you do have any queries, please email these to email@example.com
- If you are not paying for the services, but the service provider is going to claim the costs of treatment from us directly, then please make sure that the form is completed and signed before you leave it. Incomplete forms cannot be processed.
- In some cases where the adjudicators feel they require further information, a member may be required to furnish such information to enable continuation of adjudication.
- Claims must be completed in permanent ink at all times and please write clearly! Claims may be rejected on account of illegibility, as such, information on claims should always be clear for the purposes of accurate adjudication.
- For our members travelling outside of Zimbabwe – please do ensure that you carry several copies of our claim form in case you should seek treatment on or during your travels
- Lastly, please consider that any misrepresentation of medical information is a serious offense that may result in immediate termination of membership and members should always seek at all times to be honest and complete in the information provided.
- After your claim has been logged, assessed, processed and paid you will receive a remittance advice listing all of the claims paid. The remittance advice will also list claims that could not be paid, and which have been repudiated. Such non-payments can be queried by sending an email to firstname.lastname@example.org
- Please note that there are no shortfalls or copayments required on your claim. However you may run out of benefits for certain services, or find that the benefits of your plan do not include certain medical services or conditions.
- The complete process of logging, assessing, processing and payment of your claim may take up to 30 days. If your claim takes longer than 30 days, then please do query the delay with us. Email your query to email@example.com
- If your claim has been settled directly with a service provider, then you will not receive a remittance advice.