How do I claim from Gap Cover?
Claims - Manual and Automatic Processes
It remains the policyholder’s responsibility to ensure that Claims are submitted to and are received by TRA within six (6) months from the date of treatment, as well as ensuring That TRA has the correct banking details into which the Claim must be paid.
Claims - Manual Process
Policyholders need to submit the following:
Claim from the Service Provider.
First TWO (2) pages of the hospital account showing the admission and discharge dates of the hospital event.
The Medical Aid statement showing the payment of the Service Provider claim and reason for short payment.
Claim documents can be emailed to firstname.lastname@example.org, submitted online via our website www.totalrisksa.co.za or submitted via our mobile app, TRA Assist. Alternatively, TRA may be contacted directly on +27 (11) 372 1540. One of our highly qualified and friendly claims specialists will gladly assist.
Claims - Automatic Process
TRA receives claims submitted by selected medical aid schemes on behalf of the Policyholder. Should your medical aid company have such an agreement with TRA, it is not necessary for the Policyholder to submit their claim to TRA. TRA will receive an electronic version of the claim and will process said claim within seven (7) working days of receipt thereof.
Co-payment and sub-limit claims must always be submitted manually by the policyholder(in addition to all the required claims documentation please also provide proof of any direct payment/s made to these service providers). Should a claim be rejected for additional information (e.g. Pre-authorisation letter, medical aid statement, doctor’s Account or first 2 pages of the hospital account) is not received, all the additional information must be submitted to TRA within 30 days from the date of request or the claim will be rejected as late/stale in terms of this policy and will not be paid.