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Pre-Authorisation / 24hr Emergency

0861 11 00 33

South Africa’s Leading Medical Insurance Provider

Customer Resources

How to submit a claim

Pre-authorisation is required prior to the utilisation of benefits.

GPs & Dentists

 

Network providers will submit accounts directly to Affinity Health for payment.

 

Out-of-network GPs, provided this benefit is on your plan, will have to be paid upfront and members will have to submit a claim for reimbursement subject to benefit limits per plan.

 The following documents are required:

  • Proof of payment.
  • Detailed Statement.
  • Completed and signed Reimbursement Form.

Specialists

 

Specialists may submit claims directly to Affinity Health or opt for members to pay upfront and claim back from Affinity Health according to the benefit limits.

Pharmacies

 

Pharmacies will process and submit claims directly to Affinity Health according to the Affinity Health medications formulary. All medication that is not on the formulary will be for the member’s own account.

Hospital

 

Once pre-authorisation has been received, the service providers or the member may submit all accounts to Affinity Health for payment processing. Cover will be issued according to the Affinity Health benefits.

 

Pre-authorisation must be obtained in all instances including emergencies prior to admission. Pre-authorisation can be obtained by contacting Affinity Health via telephone on

 

0861 22 22 77/94

or by sending a please-call-me to

082 359 9754 or 076 909 7382.

Upfront payments are available to all treating hospitals.

Family Funeral Benefit Claim

 

The following documents will be required to submit a Death Claim:

  • Affinity Funeral Claim Form
  • Department of Home Affairs BI 1663 Form
  • Certified copy of Death Certificate
  • Certified copy of Deceased ID
  • Certified of Main member’s ID
  • Certified copy of Beneficiary’s ID
  • Certified copy of Beneficiary’s Bank Statement with bank stamp
  • Police Report form needed for Unnatural Deaths.

Affinity Health Tax Deductions

For companies

  • The Medical Insurance premiums can be claimed back from SARS as it is considered a fringe benefit that a company provides to employees. The company may only claim back from SARS the % of contribution provided to staff members by the company.
  • The benefit must be captured under SARS Benefit Code 3801 for employees who are on Affinity Health.

For members

  • Please be advised that Affinity Health is not tax deductible as it is a Medical Insurance and not a Medical Aid.