Medical Insurance Claims

Medical Insurance Claims

How does claim payments work?

If your Unity Health Network GP has already sent us your claim, you do not have to send us a copy.

If you have paid for the services provided, you can submit it to Unity Health in any of these ways:

• E-mail your claim to claims@unityhealth.co.za
• Scan and submit your claim via the Unity Health App

Post your claim to – PO Box 1862, Cramerview, 2060

How are claims settled?

In most cases, you simply present your Unity Health membership card and ID to the provider and the provider will submit the claim directly to Unity Health for processing and payment.  In isolated cases, if you have paid the provider directly, they may fill out a reimbursement form and e-mail Unity Health at claims@unityhealth.co.za with all supporting documentation within 4 months from the date of treatment.  Unity Health will assess and reimburse you in respect of all valid claims.

How do I access information regarding the status of a claim or if I need to search for a service provider?

Unity Health encourages our members to access Unity Health’s online web portal to access the following:

1. Membership certificate;
2. The member’s information loaded on Unity Health’s system;
3. Claims received, processed and paid;
4. Communication, policy document and brochures.

If the member is not registered on Unity Health’s online web portal, please register here. If the member requires more information regarding the use of the online web portal, please contact Unity Health Call Centre on 0861 366 006.

If you wish to dispute a claims assessment, what procedures need to be followed and within what time frame?

A claim may be disputed by:

Making representation to Unity Health or the Insurer indicated in the Disclosure Notice attached to the policy wording within 90 days of receipt of the benefit /rejection letter. Unity Health or the insurer is obligated to provide the member with feedback within 45 days.

The member should first aim to resolve their dispute with Unity Health before contacting the Insurer. The member may also contact the Financial Service Ombudsman indicated in the Disclosure Notice attached to the policy wording should they not be satisfied with the response of the Insurer.

• The FAIS Ombudsman may also be contacted for any complaints against the member’s broker.
• The Ombudsman for Short-Term Insurance may also be contacted for any complaints against the insurer.

The member may also constitute legal action should the matter not be resolved by either the insurer or the relevant Ombudsman. The claim will prescribe 6 months after the expiry of the 90-days indicated above (no further claims will be payable for the specific claim).