Medical Aid and Gap Cover


Processing of Claims:

Medical Aid & Gap Cover:

Claims need to be submitted for processing within 4 months from the date of the procedure, or else they will be rejected as Late claims and the member will be liable to settle the claims out of their own pockets.

  • Please ensure that the claim is clear and readable.

  • The date of service, procedure codes and amounts need to be visible.

  • Please do not paste your receipt over the Provider’s details or Practice number.

  • Always make sure that your Medical Aid number is on the claim.

Gap Cover Claims need supporting documents to be processed:

  • Gap Cover Claim form

  • Copy of the hospital account

  • Copy of the Medical Aid’s email to the member, authorising the hospital admission.

  • Copy of the doctor’s account

  • Proof of payments, settling your shortfalls with the Providers.

Vitality at home:

  • Vitality Gym:

We have not been informed of any amendments to the Vitality points and status threshold as yet.

Regarding gym visits, during the lockdown period, Vitality members on the gym benefit will not be disadvantaged.

  • They will be placed in the same position they were in prior to the lockdown.

  • Their discounts percentage will stay intact.

  • Attached is the Vitality at home brochure.

Contact one of our advisors for more information.

Phone: 011 803 9686

Email: vivian@pbafsa.co.za

https://www.pbafsa.co.za/

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