How to submit a medical insurance cover claim?
In most cases, you simply present your Unity Health membership card and ID to the provider and the provider will submit the claim directly to us for processing and payment.
In isolated cases, if you did pay the provider directly you may fill out a reimbursement form and email us with all supporting documentation within 4 months from the date of treatment. We will assess and reimburse you in respect of all valid claims. See below for more information regarding reimbursements.
Nomination of Beneficiaries Form
The Nomination of Beneficiaries form allows you to nominate one (1) beneficiary to receive benefits payable under your Elixi Medical Insurance Accidental Death Plan as a result of your death.
Please note: As the member, if you choose not to nominate a beneficiary using this form, any payments payable under your policy as a result of your death will be made to your estate. It is vital this form is completed and sent to us. Please download this here and return your completed beneficiaries form to or fax it to 011 706 5568.
Refer to your policy document for full terms and conditions.
I paid the Provider Directly. What do I do?
Should you ever need to submit a claim, the claims process is simple and easy to follow. Submissions are to be made directly to Unity Health, the underwriting managers administering the policies sold under Elixi Medical Insurance, within 4 months from the date of the event of your claim. Failure to notify a claim within this time may lead to the claim being rejected as a stale claim. You may be required to complete a claim form and produce documentary proof substantiating your claim. T&C’s apply.
Members making use of their unlimited GP visits to a network doctor should not be required to make a claim as these are settled directly with the provider.
Step-by-Step Member Reimbursement Process:
In isolated cases, if you did pay the provider directly, follow the below steps.
Step 1 – Click here to download the member reimbursement form. Or email Unity Health’s client services on and request a copy of the member reimbursement form – within 120 days of the event (4 months).
Step 2 – Submit a copy of the main member’s ID, proof of bank details stamped by the bank (either a banking details verification form or a copy of a bank statement).
Step 3 – Submit proof of payment of the claim. i.e. receipts/a fully detailed account/statement of account.
Step 4 – Submit the provider account or tax invoice provider statement.
Step 5 – Complete and sign the reimbursement form and forward to with all the above relevant documentation.
Step 6 – Refunds are processed within seven working days, depending on whether all information has been received and completed accordingly.
Don’t forget, all member reimbursement claims must be submitted with:
  1. ID copy
  2. Proof of payment
  3. Actual account from the service provider
  4. Bank stamp
  5. Reimbursement form
Process for a Claim Enquiry
Contact Unity Health’s client services call centre on 086 136 6006.
Process for a Rejected or Unpaid Claim
Contact Unity Health claims division via email: Please keep your query or workflow number received as it provides proof claims were received and be retrieved easily or fax the claim: 011 706 5568
The claims department has a 48-hour turnaround time and payments of claims are done within 7 – 10 working days.
If you wish to dispute a claims assessment, what procedures need to be followed and within what time frame?
A claim may be disputed by:
Making representation to Unity Health or the Insurer indicated in the Disclosure Notice attached to the policy wording within 90 days of receipt of the benefit /rejection letter. Unity Health or the insurer is obligated to provide the member with feedback within 45 days.
The member should first aim to resolve their dispute with Unity Health before contacting the Insurer. The member may also contact the Financial Service Ombudsman indicated in the Disclosure Notice attached to the policy wording should they not be satisfied with the response of the Insurer.
  • The FAIS Ombudsman may also be contacted for any complaints against the member’s broker.
  • The Ombudsman for Short-Term Insurance may also be contacted for any complaints against the insurer.
The member may also constitute legal action should the matter not be resolved by either the insurer or the relevant Ombudsman. The claim will prescribe 6 months after the expiry of the 90-days indicated above (no further claims will be payable for the specific claim).
Accidental Death Claim
In order to deliver on our promise to you, we have partnered with Guardrisk and Ambledown who not only share our values and vision, but also our passion for ensuring that every South African is given the opportunity to access quality, private healthcare.
This is NOT a medical scheme and will not be a substitute for medical scheme membership. It fills the GAP between what is covered by your medical aid, and the actual amount charged by your medical practitioner for in-hospital procedures.
For more info click on the below logos.
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