Claims

Settling of claims

Some healthcare providers submit their claims directly to the medical aid, while others prefer the patient to pay them directly after the consultation or treatment. If payment has been made by the patient, the Fund shall reimburse the member based on the acceptance of the claim.

Claims are assessed for validity using benefit rules. If the claim is valid and the benefits are not depleted, the amount is reimbursed directly to the member's or provide's bank account.

The claims statement documents all the claims that have been assessed and sets out the benefits paid and/or the reasons why the claims were not paid.

It the responsibility of the member to ensure that all claims are sent to the Fund within four months of the date of service. If claims are received after the four-month claiming period, the member will be liable for payment of the account directly to the service provider.

  • 1
    Check for the following information on your doctor's/healthcare provider's account.

    Required information

    Practice name Practice number Medical aid Membership number Patient's name Patient's date of birth Patient's dependant code Date of service ICD-10 code Tariff code Treatment cost Referring doctor - name and practice number
  • 2
    Post
    Golden Arrow Employees'
    Medical Benefit Fund
    PO Box 15729
    Vlaeberg
    8018
    OR
    pin_dropHand in
    location_onMedical Office, Montana depot
  • 4
    Once claims are processed, a claims statement will be sent via email or post.
  • 5
    Costs are reimbursed to your or the provider's bank account.