Claims Procedure

How to Claim as a Day1 Health Member

Your GP visits, prescribed medication and other listed day-to-day benefits are covered within the approved 1Doctor Health Provider Network & formulary.

Doctor diagnose patient symptoms at the hospital
Day to Day Claims

To claim for out-of-area GP consultations, minor procedures and/or medication, you may download the Reimbursement Form here or you may contact us on 0876 100 600 and request that a claim form be faxed or emailed to you.

The following information must be attached to your completed 1Doctor Health Reimbursement Form in order for it to be processed successfully:

  • Copy of detailed account (invoice/statement)
  • Proof of payment (receipt)
  • Proof of bank details (bank statement / bank letter or cancelled cheque)

Important Notes & Instructions:

Refunds are made by electronic fund transfer (EFT) only. Noting your bank account details is essential to ensure that your reimbursement is processed for payment. Please retain copies of all documents as well as the proof of submission.

Email: reimbursement@1doctor.co.za
Fax: 086 203 6006

Payments are made within 30 days from the date of receipt of the accounts.

PLEASE NOTE: Reimbursements must be submitted within 120 days (4 months) from date of service. Any request received after 4 months from date of service will be rejected as stale.

 

Female patient and dentist, stomatology cabinet
Hospital Claims

Once you have been discharged from hospital (i.e. after your pre-authorised admission), you may either download a claim form here or you may contact us on 0876 100 600 and request that a claim form be faxed or e-mailed directly to you.

The completed Hospital Claim Form must be forwarded to us along with the following documentation to support your hospital claim:

Letter of Authority signed by the Member and detailed hospital invoice, including service date and ICD10 codes from all other Service Providers.

The completed Hospital Claim Form along with supporting documentation is to be sent to:

Email: claimshospital@day1.co.za 
Fax: 086 690 4818

PLEASE NOTE: Any hospital accounts submitted more than 120 days (4 months) after date of service will be rejected as stale. All hospital claims are processed and assessed as per the Terms and Conditions of the Policy Wording.

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