POLMED Claims Submission Process

Name of the Organization : POLMED
Type of Facility : Claims Submission Process
Head Office : Arcadia

Website : https://www.polmed.co.za/members/claims/claims-process/

How To Submit POLMED Claim?

** One does not need a form to submit a claim. Simply submitting a detailed account/statement from the healthcare provider will suffice.

Related : LMS Medical Fund Claim Process : www.southafricain.com/2533.html

The following information needs to be on the account/statement:
** Healthcare provider’s name and practice number, in the case of a group practice, group practice number and the name of the practitioner who provided the service;
** If the beneficiary has been referred to a specialist, the referring doctor’s practice number;
** The beneficiary’s membership number;
** The name of the Scheme (POLMED) and benefit plan (Higher Plan or Lower Plan);

** The main member’s initials and surname;
** The patient’s name, other initials and surname (if it is not the main member), as well as the beneficiary code (as it appears on the back of the membership card);
** Date of service;
** Account/reference number;

** Tariff codes(s) – this is a code that refers to the pricing of a medical service/product;
** ICD-10 codes;
** Cost of each treatment, item or procedure;
** In respect of medicine claims, the name, quantity, dosage and net amount payable by the member should be provided; and
** Proof of payment in the form of a receipt or bank deposit slip if the account has been settled with the provider.

Submit the form to :
Post: Private Bag X16, Arcadia 0007
Hand it in at any of our regional offices
E-mail: claims AT medscheme.co.za
Fax: 0860 104 114

Result :
** Once the claims have been assessed a claims statement will be posted to you that will reflect the outcome of the payment process.
** This letter will also be available if you sign onto the Customer Online area of the POLMED website and on the POLMED mobile application.

Payment :
** If a refund is due to a member, POLMED will pay it at the end of the week.

About Us

South African Police Service Medical Scheme (POLMED), is a closed medical scheme registered under the Medical Schemes Act (Act 131 of 1998). Only employees of the South African Police Service (SAPS), appointed under the South African Police Service Act (Act 68 of 1995), and their dependants are eligible to be members of POLMED. The Board of Trustees is entrusted with ensuring the optimal operation of the Scheme to the benefit of the members. The Board of Trustees comprises of seven individuals that are elected and seven that are appointed by the National Commissioner.

Benefits of POLMED

POLMED offers a range of benefits, which may vary depending on the specific plan and option chosen.

Some of the typical benefits offered by POLMED include:
In-hospital benefits:
Coverage for hospitalization, including accommodation, surgery, medication, and other related services.

Out-of-hospital benefits:
Coverage for outpatient services, such as consultations with healthcare providers, diagnostic tests, and prescribed medication.

Chronic medication benefits:
Coverage for the management of chronic conditions, including ongoing medication and other necessary healthcare services.

Maternity benefits:
Coverage for maternity-related services, such as antenatal care, childbirth, and postnatal care.

Preventive care benefits:
Coverage for preventive care services, such as screenings, vaccinations, and wellness programs.

Emergency medical services:
Coverage for emergency medical services, including ambulance services and emergency room care.