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
Durban
4000 - 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.
Note:
- 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 | 
