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Your guide to Health4Me claims

We have created the following guide to help you understand how Health4Me claims work and what information is needed from you to submit a successful health insurance claim.

This guide has answers to the following questions

  1. What information is required to successfully submit a claim?
  2. What are the payment run dates for Health4Me?
  3. Where can I find the claim forms for the hospital cash and funeral benefits?
  4. What is the claim process per department (points of contact and response times)?
  • What information is required to successfully submit a claim?
  • Health4Me payment runs
  • Claim forms
  • Query management

Please take note of the following information needed for a claim to be successfully captured. 

Example medical invoice requirements for submitting a claim

What is a payment run?

This is used to settle selected outstanding transactions on payable accounts and to settle transactions on client accounts with a credit balance.

Below are the payment run dates for Health4Me 2020.

Health4Me Payment Run Dates 2020

The hospital cash and funeral benefits require submission of the below claim forms. Please take note of the claim requirements as noted below. 

Hospital cash

Claim requirements

  • Fully completed Health4Me hospital cash claim form.
  • Proof of hospitalisation (hospital account) stating admission and discharge dates.
  • Medical certificate by treating doctor/physician/specialist stating reason for hospitalisation.
  • Certified (by a commissioner of oaths) copy of the insured life’s identity document/passport/birth certificate.
  • Certified (by a commissioner of oaths) copy of the child’s birth certificate (maternity lump-sum benefit).
  • Copy of the insured life’s bank statement (not older than 3 months) or a cancelled cheque.
  • Please note that ATM or internet statements are not acceptable.
  • Additional information may be required.
  • Claims not submitted within four months of the claim event will be rejected.
  • Please submit the completed and signed form and any supporting documents, via email to health4meinsuranceclaims@momentum.co.za, or via fax to 031 580 0500.

Funeral

Claim requirements

  • Fully completed Health4Me funeral claim form.
  • Certified (by a commissioner of oaths) copy of the insured life’s identity document/passport/birth certificate.
  • Certified (by a commissioner of oaths) copy of the insured life’s death certificate.
  • Certified (by a commissioner of oaths) copy of the BI 1663 (obtainable from the doctor who certified the death).
  • Certified (by a commissioner of oaths) copy of the beneficiary’s/claimant’s identity document/passport/birth certificate.
  • If the deceased child does not bear the same surname as the member, proof in the form of an affidavit of the relationship.
  • If the deceased is a spouse, a certified (by a commissioner of oaths) copy of the marriage certificate.
  • If the marriage certificate is not available, proof in the form of an affidavit that a permanent life partnership existed.
  • Copy of the beneficiary’s/claimant’s bank statement (not older than 3 months) or cancelled cheque. Please note that ATM or internet statements are not acceptable.
  • Additional information may be required.
  • Claims not submitted within four months of the claim event will be rejected.
  • Please submit the completed and signed form and any supporting documents, via email to health4meinsuranceclaims@momentum.co.za, or via fax to 031 580 0500.

Please refer to the below table for the Health4Me claims and queries response process.

Health4me query matrix

 

If you need any help regarding the above, please contact our team and a Bloom consultant will assist.