GAP Cover Claims
How and when do I submit a claim?
A claim form can be obtained from your broker or our website. It must be completed in full and emailed to firstname.lastname@example.org with all supporting documentation within 6 months of the first day of treatment / hospitalisation.
To whom will the benefit be paid?
The principal member needs to provide his her own banking details for payment to be made. We do not pay the service provider.
How long will the claims process take?
The claim is assessed within a reasonable time frame from receipt of all supporting documentation. Our service levels require that a claims assessment be completed within 2 weeks of receipt of all supporting documentation.
If I wish to dispute the claims assessment, what procedures need to be followed and within what time frame?
A claim may be disputed by :
- Making representation to the Insurer indicated in the Disclosure Notice attached to the policy wording within 90 days of receipt of the benefit letter / rejection letter. The insurer is obliged to provide you with feedback within 45 days.
- You may also contact the Financial Services Ombud indicated in the Disclosure Notice attached to the policy wording should you not be satisfied with the response of the Insurer.
- The FAIS Ombud may also be contacted for any complaints against your broker.
- The Ombud for Short-Term Insurance or The Ombud for Long-Term Insurance may also be contacted for any complaints against the insurer.
You may also constitute legal action should the matter not be resolved by either the insurer or the relevant Ombud. The claim will prescribe 6 months after the expiry of the 90 day period indicated above. (No further claims will be payable for the specific claim.