Health Insurance Claims Process

In the event of hospitalisation*, you will need to lodge a claim so that it can be assessed. Claims will be processed upon you being discharged* from hospital*. Waiting periods will apply.

NOTE: Only hospitalisation* recommended by a qualified Medical Specialist, not a GP (general practitioner), will be covered on your Health Insurance.

We have made it simple for you to claim by giving you the option to choose the method you are most comfortable with:

  • SMS the policy number to 43973 (Standard rates apply)
  • Contact our Call Centre on 011 320 3000
  • E-mail claims@clientele.co.za

Waiting periods will apply but if you have had similar cover within the last 90 days with us, or another insurer, and have been through a similar waiting period for a specific condition, the 12 month waiting period will reduce by what you have already been through under your other policy.

The Claims Department will need the following when a claim is lodged:

  • Policy number of the insured person.
  • Name of person in hospital*.
  • Date of admission* and discharge*.
  • Cause of hospitalisation*.
  • Claimant’s fax or e-mail address.

* This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.