+27 860 102 936 info@medgaponline.co.za

CLAIM APPLICATION FORM (for claims that take place during 2025)

Contact us
Tel: 0860 102 936, Email: claims@medgaponline.co.za

What you must do

SUBMIT YOUR CLAIM TO US WITHIN 180 DAYS OF YOUR CLAIM EVENT OR YOUR CLAIM WILL BE REJECTED

 

1. Fill in and sign the form.
2. Ensure that each section that is relevant to your claim is completed clearly, accurately and completely.
3. Email the form with all required documents to claims@medgaponline.co.za.
4. If you are not able to email your claim to us, print your completed claim form and fax it to 011 263 1419, alternatively, you can post it, with all required documents to:
The MedGap Claims Team, Guardrisk Insurance Company Limited, PO Box 786015, Sandton, 2146.
5. If any details are missing or we need more information or documents, we will contact you. If we do this, please send us the outstanding documents within 28 days of our request or we will close your claim until you provide us with the documents we need. If you do not send us these documents within 12 months of your claim event, your claim will prescribe, and we will close it permanently.

CLAIM APPLICATION FORM - 2024 - MEDGAP
  • Main Member
  • Benefit
  • Patient's details
  • Banking details
  • PART 1
  • PART 2
  • PART 3
  • PART 4
  • PART 5
  • PART 6
  • PART 7
  • PART 8
  • PART 9
  • PART 10
  • PART 11
  • PART 12
  • PART 13
  • PART 14
  • PART 15
  • PART 16
  • PART 17
  • Declarations
  • Annexure A
  • Annexure B
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1 of 24

TELL US WHO IS COMPLETING THIS FORM

Please read and initial each declaration under Claimant / Patient declaration and consent.
Please read and initial each declaration under Broker declaration and consent.

MAIN MEMBER’S DETAILS