Q. Who can be a dependant on my medical aid?
A. Your spouse or partner, dependant children or other members of your immediate family, in respect of whom you are liable for family care and financial support.
Q. Who cannot be a dependant?
A. You may not be a member of more than one medical scheme, either as principal member or dependant. This means that your spouse or dependant may not be a member of another scheme and register as your dependant at the same time.
Q. Pro-rating of benefits?
A. If you have not been a member of Hosmed Medical Scheme from 1 January, then the annual benefits, to which you are entitled, may be pro-rated relative to your period of membership in the year of the claim.
Q. How do I make changes to my membership?
A. Advise Hosmed of any changes (such as address, marital status, birth of a child) by completing the necessary additional dependant form available from Hosmed within 30 days.
Q. How to ensure problem-free administration?
A. There are few things more annoying than wondering where your claim refund is, or not knowing what you are allowed to claim. Please read this guide carefully, as it will answer most of the questions you may have. If the guide does not answer your questions, or you are still unsure, please talk to us on our share call number which is 0860 00 00 48
Q. How do I submit my accounts?
A. Please mail or deliver your account to Thebe Ya Bophelo (Pty) Ltd as quickly as possible. If your company submits claims in bulk, use this system, it is likely to be more efficient. The Scheme does not accept faxed accounts unless there is an emergency. Only claims received within four months of treatment date will be paid.
- Electronic submission of accounts is encouraged ? please advise your doctor.
- Send the first account you receive. Do not send statements.
- If you have already paid the account, please attach your receipt and clearly mark the account "paid".
- Should you or a dependant have suffered an injury, Hosmed needs to be advised how the injury happened and whether there could be a claim from alternative insurance.
- The Medical Schemes Act obliges the scheme to obtain from the supplier of service the following details:
We would really appreciate your assistance in making sure these details are included.
- your name and initials
- your medical aid number
- the treatment date
- name of patient (to match your card)
- tariff code where applicable
Q. What are the guidelines for claiming?
A. The list of guidelines below must be followed:
- Check that prescriptions for medicines show all your details. If the details are omitted, Hosmed cannot process your claim.
- If you have paid the supplier then payment will be made to you, at Hosmed NHRPL rates. The same applies to accounts charged above Hosmed rates. You will be reimbursed at Hosmed rates and you are responsible for payment in full, to the service provider.