How to access services and submit claims

How to access services at Credit Providers

Credit Provider – Electronically Networked

• Present your membership card at the Check-in counter / Reception.
• You will be asked to place your finger on the fingerprint reader. If the card is used for the first time at an electronic networked provider, your fingerprints will have to be registered. You will be asked to place your right hand and left hand index fingers on the fingerprint reader four times to successfully capture your finger prints on the system.
• With the first use by a child younger than 7 years of age, the fingerprint registration will be done by the caretaker of the child. The caretaker may be either of the parents, uncle or aunt, grandparents or older sibling. Two caretakers can enrol their fingerprints on behalf of the child.
• Once the status and eligibility to get services are confirmed, you will be requested to proceed with the desired services. Please ask the provider’s staff for directions in case of any uncertainty you may have.
• Should you require inpatient services, you will be admitted and the provider will contact Strategis for pre-authorisation.
• Check out: Please sign the charge slip/invoice printed only after confirming that the services shown are in fact the ones provided to you. Please return the claim form completed by your doctor to the billing unit of the provider and collect your membership card.
• Once your fingerprints have been registered, you can access services from any electronic networked provider without having to re-register. All you need to do when visiting the provider is to give your membership card to the person at the Check in counter. Your membership number will be entered into the system and you will be asked to provide your fingerprint to confirm your membership status and eligibility for benefits before you proceed to receive the desired services.

Credit Provider – Non-Electronically Networked

• Present your membership card at the Check-in counter / Reception.
• Complete the claim form provided by the healthcare provider.
• The provider will check/verify your eligibility for services against the list of terminated members and members who have exhausted their benefit limits. You will receive the required services should your name not appear on either of the lists.
• Should you require inpatient services, you will be admitted and the provider will contact Strategis for pre-authorisation.
• Check out: Please sign the charge slip/invoice printed only after confirming that the services shown are in fact the ones provided to you.

Credit Provider – Emergency Services

• Once you get to the hospital, the hospital staff will proceed with services depending on the kind of emergency.
• Paper work will follow once the condition has been stabilised.
• Present your membership card to the provider when asked to do so.
• For services that require pre-authorisation, if it is after working hours, the weekend or public holiday, the provider will proceed with the services and contact Strategis for pre-authorisation on the next working day.
• If you have been admitted, please enquire at least a day before discharge if the provider has requested and received authorisation from Strategis. This will avoid delays caused by the provider processing authorisation only after you have been discharged.
• Check out: Please sign the charge slip/invoice printed only after confirming that the services shown are in fact the ones provided to you. Your provider will submit the invoice to Strategis for payment.

NOTE:
In case of Non–Emergency treatment, the provider will only be able to proceed with services after obtaining pre-authorisation/approval from Strategis.

How to access services at Cash Providers

Outpatient Services, Chronic Medication, Dental and Optical Services

• Visit any of our listed cash providers and pay for the services you get.
• Ensure you have collected the doctor’s prescription and the original receipts in order to claim for a refund from Strategis.
• Alternatively, you can go to hospital for the doctor to prescribe your medication and to complete and sign the claim form. In this case, you need to submit the claim form signed by the doctor and the original receipts to Strategis.
• Click here, to find out how to submit a claim to Strategis for refund.

Inpatient Services

• For planned services at cash providers, where an admission is required, please plan it in such a way that the treatment is pre-authorised by Strategis before the admission.
• Ensure you have collected the doctor’s prescription, the discharge summary and the original receipts in order to claim a refund from Strategis.
• Alternatively, you can go to the hospital for the doctor to prescribe your medication and to complete and sign the claim form. In this case, you need to submit the claim form signed by the doctor and the original receipts to Strategis.
• See the information below, to find out how to submit a claim to Strategis for refund.

How to submit a claim for refund

• Complete the Strategis Claim Form (click here to download, or contact your Human Resources (HR) Department).
• Attach the doctor’s prescription and the original receipts to your claim form. EFD receipts are required for compliance reasons as per TRA’s regulations.
• Take copies of the documents and keep them safe for your reference.
• You can either submit the above original claims documents to us through your HR Department for record keeping and tracking purposes, OR you can submit them directly to us.
• Only the principal member or the policy holder has the right to claim for a refund from Strategis for medical expenses incurred.

Claims – Postal address

Strategis Insurance (Tanzania) Limited
PO Box 7893
Dar es Salaam, Tanzania

Physical address

Strategis Insurance (Tanzania) Limited
Plot 48 A, House No. 10
Mkadini Street, Oyster Bay Area
Dar es Salaam, Tanzania

We will process, and pay valid claims

• Strategis will refund valid claims against available benefits by way of an Account Payee Cheque drawn in favour of the principal member or in favour of the policyholder on request/instructions.
• Cheques will be ready within 10 working days from the date that the documents reach the Strategis office.
• Cheques will be delivered to your office through the appointed contact person/HR Department.
• Claims will be processed for payment ONLY if received by Strategis within 90 days following the date on which the service was provided.
• It is the duty of members to submit only medically necessary expenses within reasonable and customary limits. Strategis will only pay up to the reasonable and customary cost should the claim be found to be above the customary cost.
• Members should ensure that claims submitted are genuine and should not be party to any plan or practice which may be prejudicial to Strategis.
• Forgery/fraudulent claims will be investigated and could lead to legal action.

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 weekly statements to providers and members if a claim has been processed for them.