Track A Claim Made Through Your Nammed Medical Aid Option
We have made the process for tracking your claims as simple and straightforward as possible. If you’ve made a claim through your Nammed medical aid option, please familiarise yourself with the below information.
If you have any further questions, please don’t hesitate to contact us.
When Will My Claim Be Paid?
Nammed medical aid fund makes two payment runs every month to both healthcare providers and members. As a member, you will receive a monthly statement containing the details of all payments made. Nammed will pay any benefit due to a member or service provider within thirty (30) days of receiving the claim relating to the benefit.
Nammed may, by mutual agreement with any supplier or group of suppliers of a service, pay the account or the benefit to which the member is entitled in respect of a service rendered, directly to the supplier.
Where Nammed has paid an account or portion of an account, or any benefit to which a member is not entitled, whether payment is made to the member or to the supplier of a medical service, Nammed will recover the amount overpaid or paid incorrectly from the member or the service provider.
Understanding Medical Aid Claim Terms
Day-to-day benefits cover medical expenses incurred outside the hospital and these benefits are included in all Nammed medical aid options except the Trauma option. Day-to-day expenses are covered at 100% of NAMAF tariff and are limited to the annual day-to-day limits as set out in the brochure for each option.
Major Medical Expenses
Major medical expenses (MME) are most often associated with hospitalisation. All the options, except for the Basic option, cover MME at 100% of NAMAF tariff. All surgical procedures performed in-hospital are covered at 225% of NAMAF tariff and are subject to the overall annual limit.
Some members may have co-payments on day-to-day and MME. These co-payments are derived from the service provider fee being above NAMAF tariff