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Navigating the Claims Process with TRA

Navigating the Claims Process with Total Risk Administrators

As a trusted gap cover provider across South Africa, TRA continues to stand out as a reliable industry expert, helping individuals and families bridge the financial gaps left by traditional medical aid schemes.

Understanding how to navigate the claims process with TRA is paramount to ensure you get the best experience with us and every product or service we offer. We’re here to guide you through the process and ensure you receive the financial support you need when it matters most.

How To Claim With TRA

Upon receiving medical treatment or incurring medical expenses it is vital to first submit all of these claims to your medical aid so that they can process their share of the claim. Once done, you must submit claims for shortfalls that are covered by your TRA gap cover policy as soon as possible. Delaying your claim submission may lead to complications and potential rejection. TRA often has specific timeframes within which you must report claims, so be sure to adhere to these deadlines.

Complete the Claim Form

TRA provides our clients with a nifty online claim submission portal to simplify the process. The digital claims form can be filled out with your details, along with the submission of the required documents to kickstart the claiming process.

This claims form serves as your official request for reimbursement. Ensure that you complete it accurately and honestly. Any discrepancies or omissions could result in delays or claim rejection. If you’re unsure about any part of the form, don’t hesitate to seek assistance from TRA’s customer support.

Await Claim Approval

After submitting your claim, TRA’s claims department will review your documentation and assess your eligibility for reimbursement. This process may take some time, so please be patient. You can inquire about the status of your claim with TRA’s customer support if needed to stay on top of the process.

Receive Your Reimbursement

Once your claim is approved, TRA will process your reimbursement. The funds will be deposited into the bank account linked to your TRA gap cover policy. TRA has three payment runs per week and this financial support will help you cover the medical expenses you incurred, ensuring you are covered every step of the way. 

Understanding Your TRA Gap Cover Policy

Before starting the claims process, thoroughly understanding your TRA gap cover policy is essential.

Depending on the type of gap cover product selected, policies will vary in terms of coverage, waiting periods, and exclusions. Review your policy documents carefully or contact TRA’s customer support to clarify any doubts you may have. Knowing your policy inside and out will empower you to make informed decisions when submitting your TRA claims.

Types of Claims

Depending on the type of claim being submitted, various documents are needed to have the claim submitted, approved, and finalised. These can be found as follows:

Gap Cover Claim

  1. Doctor’s Account
  2. Medical Aid Statement

Sub Limit Claim

(for Internal Prostheses, MRI/CT/PET scan, Colonoscopy and Gastroscopy claims only)

  1. Hospital Account
  2. Doctor’s Account
  3. Medical Aid Statement
  4. Medical Aid Authorisation Letter

Global Fee Claim

  1. Hospital Account
  2. Doctor’s Account
  3. Medical Aid Statement
  4. Medical Aid Authorisation Letter

Co-Payment Claim

  1. Doctor’s Account
  2. Medical Aid Statement
  3. Medical Aid Authorisation letter (or first two pages of the hospital account)
  4. Very Important – Receipt showing payment to service provider

Casualty Claim

  1. Doctor’s Account (for treatment that occurred in the casualty unit)
  2. Medical Aid Statement

Required Documents

Before starting the claims submission process, be aware of what required documents you will need. This will help you feel as prepared as possible when submitting your claim and have everything in order for both your reference and that of TRA.

Keep Your Documentation in Order

When it comes to making a claim, documentation is your best friend. To ensure a smooth claims process, keep all relevant documents organised, readily accessible, and on hand. Key documents you may need include:

  • Your TRA policy details
  • Copies of medical invoices, statements, and receipts
  • Original medical aid scheme statements (if applicable)
  • Specialist reports and referrals
  • Any other documents that TRA may require

By having these documents at your fingertips, you will expedite the claims process and reduce the likelihood of errors or delays.

Claim Rejection Codes

In the case of a claim being rejected, there will be a stated code corresponding to a valid reason from TRA. These claim rejection codes can be explored and better understood to navigate the claims submission process easily and conveniently.

Trouble Shooting Along The Way

If you are finding the process tricky or just need assistance along the way, policyholders may also make use of the online claims submission facility. Any queries in this regard can be directed to claims@totalrisk.co.za for further clarification.

If you are looking for an interactive outlining of the claims process, watch our video on How To Claim to be brought up to speed. We also offer policyholders an interactive chat facility in which they can easily seek answers to their questions and receive help when needed.

For those looking to have direct access to all things TRA on their mobile phone, the “TRA Assist” application is available for download on the App Store, Google Play, or AppGallery, depending on what type of mobile phone policyholders have.

TRA: Dedicated To You

Total Risk Administrators is dedicated to our valued clients with the utmost peace of mind and trusted financial security to them and their families. Understanding how to claim from TRA is crucial for maximising the benefits of your gap cover policy and ensuring your health, budget, and needs are put first.

By following the steps outlined in this article, you can ensure a hassle-free claims process and receive the support you need when facing unexpected medical expenses. Remember, TRA is here to assist you throughout the process, so don’t hesitate to reach out for guidance or clarification whenever necessary. Explore our website to learn more about TRA, or contact us if you have any questions.

Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on and matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.

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