Procedures

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WELCOME PACK

If any details are missing or if we need any more information for underwriting purposes, we shall contact you.

We shall activate your membership and send you a confirmation sms within 24 hours which will contain your Day1 Health membership number and important contact information.

You will receive your Day1 Health Welcome Pack after your first successful debit order (inclusive of your once-off activation fee).

Your Welcome Pack contains your Day1 Health membership card, welcome letter, Africa Assist (A-A) decal (car) sticker, policy schedule and endorsements (if applicable), product guide and policy wording (applicable to hospital policies only).

Please read your documentation carefully and keep it safe for your records.

Please feel free to contact Day1 Health by email at admin@day1.co.za or contact us on 0876 100 600 if you have any queries regarding your application.

CHRONIC MEDICATION

If you are diagnosed with a chronic condition, however, you need to register on the Day1 Health Chronic Disease Management Programme via your Day1 Health Network GP in order to receive your chronic medication. Chronic medication may be collected from any Clicks, Dischem or Medirite pharmacy nationwide and is subject to pre-authorisation. (In respect of Day1 Health Senior members, an additional administration fee may be levied on all approved chronic medication.)

You may download the Chronic Application Form by clicking on the button below or you may contact us on 0876 100 600 and request that the application form be faxed or emailed to you.

CLAIMS PROCEDURE

How to Claim as a Day1 Health Member

Your GP visits, prescribed medication and other listed day-to-day benefits are covered within the approved Day1 Health Provider Network & formulary.

To claim for out-of-area GP consultations, minor procedures and/or medication, you may download the Reimbursement Form by clicking on the button below or you may contact us on 0876 100 600 and request that a claim form be faxed or emailed to you

The following information must be attached to your completed Day1 Health Reimbursement Form in order for it to be processed successfully:

Copy of detailed account (invoice/statement)
Proof of payment (receipt)
Proof of bank details (bank statement / bank letter or cancelled cheque)

Important Notes & Instructions:

Refunds are made by electronic fund transfer (EFT) only. Noting your bank account details is essential to ensure that your reimbursement is processed for payment. Please retain copies of all documents as well as the proof of submission.

Payments are made within 30 days from the date of receipt of the accounts.

PLEASE NOTE: Reimbursements must be submitted within 120 days (4 months) from date of service. Any request received after 4 months from date of service will be rejected as stale.

HOSPITAL CLAIMS

Once you have been discharged from hospital (i.e. after your pre-authorised admission), you may either download a claim form by clicking on the button below or you may contact us on 0876 100 600 and request that a claim form be faxed or e-mailed directly to you.

The completed Hospital Claim Form must be forwarded to us along with the following documentation to support your hospital claim:

Letter of Authority signed by the Member and detailed hospital invoice, including service date and ICD10 codes from all other Service Providers.

The completed Hospital Claim Form along with supporting documentation is to be sent to:

Email: claimshospital@day1.co.za
Fax: 086 690 4818

PLEASE NOTE: Any hospital accounts submitted more than 120 days (4 months) after date of service will be rejected as stale. All hospital claims are processed and assessed as per the Terms and Conditions of the Policy Wording.

RESERVATION OF RIGHTS

We reserve the right to cancel your policy or that of any of your dependants if you or your dependants:

Provide false information or fail to disclose medical information when applying for primary healthcare benefits or a hospital insurance plan.

Provide false information upon submission of a claim, submit a fraudulent claim or intentionally allow a service provider to do so on your behalf.

Allow any unauthorised person to use your Day1 Health membership card.

Without a good explanation, neglect to inform Day1 Health that it has paid for services or supplies that were not delivered or received.

Commit any other fraudulent act.

Fail to pay monthly contributions and/or premiums.

Day1 Heath reserves the right to cancel your membership/policy at any time by furnishing you with 30 (thirty) days’ notice in writing (or such other period as may be mutually agreed upon).

AFRICA-ASSIST & HOSPITAL PRE-AUTHORISATION

What is the procedure to follow in the event of a medical emergency or illness and you need to go to the hospital?

Always call Africa-Assist: 0861 144 144 Tell the Africa-Assist operator that you are a Day1 Health member. The operator will prompt you or the caller and request all the information that is required to get help to you as quickly as possible.

Have your membership number or ID number readily available.

Useful hints to remember about Africa-Assist and Hospital Pre-Authorisations

Teach your family members to call 0861 144 144 in case of an emergency. In the event of an accident, take note of road names and numbers as this will expedite the emergency response. Please store 0861 144 144 under “Medical Emergency” on your cell phone. For hospital pre-authorisation, please contact 0861 144 144. All admissions for both Accident & Illness must be authorised.35

PROCEDURES

Setting the Standard For Health Insurance Since 2003