How To Claim
Waiting Periods & Standard Rates
A Waiting period is a period in which an Insured Person is not entitled to claim any, or may only claim certain, policy benefits.
Waiting periods are applicable on all newly incepted policies and/or additional dependants added to the current policy, except in the event of an Accident.
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 went to a non-network provider or a specialist and paid cash, you must fully complete and sign a CLAIM FORM.
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 1
Submit all medical scheme statements reflecting payments made relating to the claim to Health_claims@genric.co.za.
