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Elixi Medical Insurance
The claims process explained

The Claims Process

How to submit a Medical Insurance 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 6 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 membership@unityhealth.co.za.

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 6 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. You may be required to complete a claim form and produce documentary proof substantiating your claim. T&C’s apply.  Failure to notify a claim within this time may lead to the claim being rejected as a stale claim.

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 claims@unityhealth.co.za and request a copy of the member reimbursement form – within 120 days of the event.

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. ie. 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 claims@unityhealth.co.za 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: claims@unityhealth.co.za. 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.

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