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

CLAIM APPLICATION FORM (for claims that take place during 2020)

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 WE WILL REJECT YOUR CLAIM

 

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 posit 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 - 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
  • Declaration
  • Annexure A
  • Annexure B
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TELL US WHO IS COMPLETING THIS FORM

MAIN MEMBER’S DETAILS