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Following a consultation with/or treatment by a healthcare provider, your account should reflect if it has been submitted directly to the Scheme. If you are not sure, please enquire with your healthcare provider. If the account has not been submitted, please follow the procedure below;
- Send only the original account you receive. Do not send statements or duplicate invoices.
- If you have already paid the account, attach your receipt and mark the account “ refund member” as some doctors offer a discount if you settle the account immediately.
- All accounts must show full details of your membership.
Please check that your account reflects the following:
- healthcare provider’s name and practice number
- principal (main) member’s name, initials and medical aid number
- treatment date • patient’s name (as listed on your membership card). If the patient is not the main member, please list their date of birth and ID number as well
- amount charged
- tariff code (the doctor will fill in the ICD-10 code)
- diagnosis made by the doctor or specialist
As proof that you have received the treatment that is being charged for on the account, please sign the account before submitting it to our Scheme. Claims are paid to healthcare providers every week and you will receive a monthly statement that shows all claims received and paid since the previous statement. Pharmacies can submit claims in realtime, online. This means that when receiving your medication at the pharmacy, you will know almost immediately whether our Scheme has accepted your claim. Be sure to submit your claims correctly in order to avoid any delays in payment. Mail or deliver your account as quickly as possible to your nearest Sizwe Medical Fund branch.
- only claims received within four months of date of treatment will be paid.
- why wait for your refund cheque to be sent to you in the mail?
- Sizwe Medical Fund can transfer any money owing to you electronically so that it appears directly in your cheque or savings account.
- To benefit from this Electronic Funds Transfer (EFT) service, please fill in the special EFT form, available at your nearest Sizwe Medical Fund branch or on the website.
