How to submit a claim

How to submit claims

Please ensure that claims are submitted to our administration office by email or post using the following details:

Email address

[email protected]

Physical and postal address

2 Marconi Road
Palmgrove Estate
Lagos

P.O. Box 3880
Mushin
Lagos

We will process, and pay valid claims

We will process the claims received according to your benefits and policy conditions. We pay valid claims within 30 working days of the day that we receive them; provided that we have you or your provider’s banking details on record.

Statements

When we process a healthcare provider claim, a claims statement will be distributed to the healthcare provider by email within five (5) days of payment. We send regular statements to help providers reconcile or track payment of claims.

Claims process

We have made the claims process as simple as possible for you and your treating provider. Below is the list of all the details needed when submitting a claim to us either by you or your treating provider.

Information that must be on the claim:

• Membership number
• Patient’s name and surname
• Patient’s date of birth
• Diagnosis
• Date of service (include admission & discharge dates for hospitalisation)
• A detailed description, per item, of the treatment or service, received/provided (i.e. name of medicine, ward level)
• Quantity (i.e. 30 Disprin, 3 days in General Ward)
• Tariff code (if available)
• Amount charged per service or treatment (as per the contracted Tariff price list)
• Name of the treating healthcare professional
• Facility name (i.e. General Hospital, Africa Medical Clinic)
• Total charged (the sum of the individual amounts charged on the claim)
• Pre-authorisation number (if applicable)
• Proof of payment (receipt or proof of electronic (EFT) payment), in the case of a refund request for the principal member. If the correct proof of payment is not attached, the account will be rejected
• Patient’s name and surname
• Signature of the insured person or principal member if the insured person is a minor
• Signature of the provider
• Date of the account and account reference number