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Claims Procedure

A. Where medical providers are directly contracted to National Medical Plan:

Many medical providers are directly contracted to National Medical Plan which means that they will submit a bill directly to us. Their accounts will only appear on our statements to you. Please check the following details:

1. The provider's name should be familiar, i.e. you have received services from the provider mentioned.
2. That the services appear under the correct patient's name.
3. That the dates of the services provided are correct and indicate actual visits to that provider.

B. Where medical providers present you with an account:

Medical providers who are not contracted directly to National Medical Plan will present you with an account at the time of the visit, or it will be posted later. Please check/apply the following:

1. That your doctor/pharmacist has your correct Medical Aid information. A claim can not be processed without your Medical Aid information.
2. If you have paid the provider then you must paste your receipt onto the account before posting it to us.
3. That the claims on doctors' accounts sent to you have not been previously paid.
4. That your membership number is correct and clearly stated on the face of each account you are sending in. It is not necessary to include a covering letter.
5. That the dates stated by the provider of service correspond to the actual dates the visit or procedure took place.

Claims Advice   

An explanation of the content of your claims advice is reflected on all claims advices submitted to you.

Claims Submission

  • Submit your original invoice (copies are not accepted) to MMSA (Pty) Ltd - contracted administrators to National Medical Plan. (No claim form is necessary):
    PO Box 2338
  • When visiting the service provider, make sure you have your membership card and I.D. book with you.
  • Please ensure that before submitting an account the following details are correct:
    1. Full name of principal member, spouse or dependants
    2. Membership number
    3. Your signature as acceptance of the accuracy of the account
    4. The treatment date
  • Please ensure that you submit claims promptly as claims submitted after four months of service will not be paid or accrue to threshold.
  • Claims will be processed within two weeks of National Medical Plan receiving them.

- It is important to keep a copy of all claims in the event that the original should get lost.
- National Medical Plan will only pay for claims from your date of admission to the Scheme.
- Claims that are paid at MASA rates will be paid to the member and not directly to the practitioner.
- If you have paid cash prior to submitting your claim, please attach your receipt.
- Always ask your doctor if he/she has submitted your claim.

If you have any queries concerning your claims, PLEASE do not hesitate to contact the Call Centre on (031) 3676800 or e-mail us