How do you Claim?
Your medical service provider will more than likely process your claim on your behalf, requiring you only to sign the invoice after consultation or treatment. The service provider will then send the claim to MomentumTYB for processing and approach you for any member portion due.
Should you have paid the amount directly to the service provider, please forward the proof of payment as well as the service provider's invoice to MomentumTYB for processing and reimbursement to you. Please ensure that all your membership details are correct on the invoice which must be signed and forwarded to:
P O Box 1672
Please note that there is a four month claim submission limit (from date of treatment).
Explorer and Shuttle plans
Suremed Shuttle is managed by Prime Cure. This means that all benefits and services, whether in- or out-of-hospital, are provided through the Prime Cure Network and all claims must be submitted to Prime Cure for processing.
Suremed Explorer’s day-to-day benefits and services are managed by Prime Cure and the hospital and specialist benefits are managed by Momentum TYB. This means that day-to-day claims for doctors’ visits, dentists, optometrists and pharmacy benefits out of hospital need to be submitted to Prime Cure for processing. Specialist claims and any hospital claims must be submitted to Momentum TYB.
The following applies to claims that are managed by Prime Cure:
- When you visit a Healthcare Provider that is in the Prime Cure Network, you don't have to worry about paying them directly. Prime Cure will pay them for you when they submit their claims to us.
- If you go to a Healthcare Provider who is not part of the Prime Cure Network, like a Specialist, you may have to pay upfront and then submit a claim to Prime Cure within 120 days (3 months) to get a refund. You can submit your claim through email to [email protected]<mailto:[email protected]>, by completing a form on the Prime Cure website at www.primecure.co.za<https://www.primecure.co.za/refund-request-form/>, or via the Suremed Shuttle app for Shuttle members.
- To request a refund, you need to provide certain documents, including a copy of your ID, the account (bill) from the provider, your receipt showing proof of payment, and for refunds over R3 000, proof of your bank details.
- Prime Cure will process your refund within 14 days once we have all the required information. If you don't provide proof of your bank details, Prime Cure will not be responsible for any payments made to the wrong account.