A Guide to Claiming

February 7, 2024 Editor

The answers to your frequently asked administration questions can be found in the details of your benefits structure which is contained herein. Comprehension of how the claim chain at SwaziMed works will assist you in better understanding your claims queries.

How to submit your claims

  • Claims can be submitted using the following: Hand deliver, mail, Email to -claims@swazimed.com,SwaziMed App – claim within 4 months.
  • If you have already paid the account, attach your receipt on the claims invoice and write “paid” on the claim
  • Make sure all documents sent to Swazimed show your membership number
  • Check that your claim shows: Your name and initials; your medical aid number; the treatment date; name of patient (as indicated on the membership card and not a nickname); date of birth; amount charged and the tariff code where applicable.

Tips For Claiming

  • Check that prescriptions for medicine show all your details. If the pharmacy or doctor omits any of these details, Swazimed is unable to process your claim and this may lead to delays. Ensure your banking details are up to date.
  • Dental treatment often requires additional work by a dental technician. The technician then bills the dentist who adds this to your account and attaches a copy of the techician’s account. Please submit both claims and ensure that your name and number are reflected on both.

When Can I Expect Payment?

All valid claims received by Swazimed will be processed within 2 to 4 weeks.

How Will I know What Was Paid?

A claims Transaction Statement will be sent to you if Swazimed has processed an account during that month. This statement will indicate all payments made to you or on your behalf.