How To Claim
Waiting Periods
General Waiting Periods
- A 1-month General Waiting Period is applied on all
Out-of-Hospital benefits unless otherwise stated. - A 6-month General Waiting Period will be applied on Dental
and Optical benefits. - A 3-month General Waiting Period will be applied on any
In-hospital related benefits unless otherwise stated. - A 6-month Waiting Period will be applied on Chronic Medication.
Pre-existing Condition Waiting Periods
12-month Waiting Period will be applied on all In-and Out-of-Hospital related pre-existing conditions, diseases, or illness.
These include any conditions, including cancer, which existed prior to inception, or for which an insured person has sought or received medical advice or received treatment by a Registered Medical Professional or exhibited symptoms before inception of the policy.
Failure to disclose and pre-existing condition could render the policy being cancelled.
Policy Specific Waiting Periods
The following conditions are excluded within the first 6 (six) months of the policy cover inception.
- Myringotomy and grommets;
- Adenoidectomy;
- Tonsillectomy;
- Hysterectomy(except where malignancy can be proven);
- Spinal, back, neck and joint related precedures or treatment except in the case of an Accident.
Specific Waiting Periods Applicable To Certain Benefit Categories
- A 12-month Waiting Period for all treatment during the Pregnancy as well as for the confinement related to the birth.
- A 12-month Waiting Period on all pre-existing cancer-related treatments.
- A 3-month Waiting Period is applicable on the Accidental Death Benefit.
How To Claim
If you visited a non-network provider or specialist and paid in cash, you are required to fill out and sign a CLAIM FORM in full.
Claim Process
You should never have to pay claims at a network provider.
In the event you do have to pay and then claim, your claim will only be processed once a completed claim information is received.
This information consists of the following:
Step 1
Fully completed and signed claim form.
Step 2
All hospital and/or related accounts substantiating your claim.
Step 3
Submit all service providers accounts or invoices reflecting payments made relating to the claim to Health_claims@genric.co.za.
New Whatsapp Member Journey
You are now able to chat to a Nurse if you are feeling unwell.
Whatsapp Nurse Hours: Mon – Fri 08:00 – 16:30 (excl. Public Holidays)
STEP 1
STEP 2
STEP 3
STEP 4
Receive an SMS with the cell phone number for National HealthCare Group’s WhatsApp NurseLine.
Save this number to
your phone:
+27 72 815 8226.
Are you feeling unwell?
Open WhatsApp and Text
“Hi” to +27 72 815 8226.
Follow the prompts –
Select “Chat to a Nurse”.
STEP 5
STEP 6
STEP 7
STEP 8
Explain your symptoms to the nurse and the nurse will make an assessment.
The nurse will decide if
you should see a GP or arrange a virtual consultation based on
your symptoms.
If a GP referral is not required and the nurse advises to rather self medicate, a prescription may be issued via Whatsapp.
If the GP provides a
prescription, you may
visit any pharmacy
within South Africa.
