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Is Complimed a Medical Aid?
No. Complimed products are defined either under the definition of "accident and health policy", in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998. |
Does it cover day to day procedures?
No. Complimed covers mainly in-hospital shortfalls and co-payments, together with certain listed procedures that might be performed on an out-patient basis. Complimed also provides death and disability cover. |
Does this cover my whole family?
Yes, all family members except adult dependants are covered in terms of the Complimed Master Policy document. Adult dependants may apply for cover in their own right, subject to the maximum entry age of 65. |
Does it matter how large my family is?
No, however certain products limit the size of the family, or require certain criteria e.g. all insured members must belong to a Medical Aid. |
Is it only hospital procedures that are covered, or are some out-of-hospital procedures, e.g. visits to my General Practitioner, covered?
Out-of-hospital benefits are not covered; however certain listed procedures are covered on an out-patient basis. Refer to the policy document for more comprehensive details. |
Does this plan cover dental procedures?
Certain dental procedures performed in hospital are covered under this benefit. |
What happens if I am sick/pregnant/about to have an operation when I take out this policy?
A 12 month pre-existing medical exclusion is a standard condition on all Complimed products. Therefore any ailment that was treated 12 months prior to the inception of the policy will not be cover for a period of 12 months. Special terms exist for groups; please contact your Broker or Complimed for details. |
What is the maximum entry age and how long do I stay on thereafter?
A maximum entry of 65 actual age exists on all Complimed products. There is no cease age applicable and the policy is renewed in January of every year. |
How do I apply for cover?
Complimed acts solely as an administrator and do not market to the public directly. Please contact your broker or see our list of accredited brokers in your area who will be able to advise you on the best possible GAP cover, applicable to your medical aid option. |
How do I Claim?
Submit a completed Complimed Claim Form together with the first 3 or 4 pages of the relevant hospital account, the doctors’ accounts and the relevant pages of your medical aid statement, to Complimed. |
Do I need to submit the original accounts when I claim?
No, faxed or emailed copies are accepted by Complimed's underwriting department. |
How long does it take to assess a claim?
Claims are assessed and paid within 14 days of receipt of all the relevant documents. |
Who gets paid when my claim is settled - the doctors or me?
In order to comply with the definition of "accident and health policy", in the Short Term Act, service providers MAY NOT be settled directly. All monies are therefore paid to the principal member. |
How do I update my banking details?
Bank details can be updated by completing & submitting the Complimed Bank Authority Form. |
How do I cancel membership?
A 30 day notice period in writing is required. |
Are the premiums Tax deductible?
No, the policies fall under the definition of "accident and health policy", in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998 and not the Medical Schemes Act, 1998. |
