your claims

Make sure that your claims reach us on or before the last workday of the fourth calendar month after the month in which the service was rendered. If the claim is rejected because of omitted or incorrect information, you have 60 days from the date of rejection to resubmit the claim.

Medihelp claim dates

Most healthcare providers submit their claims directly to Medihelp and you need not submit these again. However, you are able to submit claims in the following ways:

Member secured websiteMedihelp member appEmail us

Medihelp Medical Scheme email detail


     IStore Medihelp Medical Scheme     Playstore Medihelp Medical Scheme     Windows Medihelp Medical Scheme

Use the Medihelp member app (available on iStore, Google Play and Windows Store)

 Medihelp Medical Scheme email detail     



  • You remain responsible to ensure Medihelp receives claims – even those submitted by healthcare providers.
  • Check your monthly statements regularly to keep track of your claims.

Required information on claims

Make sure that the following information is available on your claims:

  • Membership number
  • Name and surname of beneficiary
  • ICD-10 codes
  • Date on which the service/ procedure was rendered

Medihelp tariff

Medihelp tariff  refers to the tariff paid by Medihelp for different medical services, and can include for example the contracted tariff for services agreed with certain groups of service providers such as hospitals, the Medihelp Dental Tariff for dental services, and the single exit price for acute medicine. The various tariffs are defined in the Rules of Medihelp and approved by Medihelp’s Board of Trustees.

Doctors and other service providers may charge tariffs that differ from the Medihelp tariff. If this happens, you’ll have to pay the difference to the service provider.

Negotiate with your doctor
Remember that, as with any other service, you may negotiate a discount with the supplier. It is advisable to determine in advance how much the service provider will charge and how much Medihelp will pay for a specific service. By doing so, you can calculate your co-payment (if any) in advance in order to prevent any unexpected medical expenses.

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