KeyHealth is committed to ensuring that your claims are processed efficiently and without unnecessary delays. To support you, we would like to remind you of the important claims submission timelines and the requirements for Prescribed Minimum Benefit (PMB) funding.
To ensure your claim is considered for payment, it must be submitted within 120 days (4 months) from the date you received treatment. Claims submitted after this period are regarded as stale and may, unfortunately, not be paid.
Claims are generally reimbursed in accordance with Scheme rates. However, in certain cases where a condition qualifies for PMB funding, additional clinical information is required to assess the claim for payment beyond Scheme rates.
To enable PMB funding, you may be requested to provide the following diagnostic reports:
- Histology report
- Radiology report
- Pathology report
Providing these reports allows the Scheme to assess whether your condition meets PMB criteria and ensures that your claim is processed correctly.
If your claim has been rejected or requires correction, you have 60 days from the date of your statement to resubmit it with the necessary supporting documentation. Acting within this timeframe allows us to reassess your claim promptly.
To make your claims experience as smooth as possible, we encourage you to submit your claims soon after treatment, confirm with your healthcare provider whether they are submitting on your behalf, and keep copies of all supporting documents.
Claims can be submitted via the KeyHealth Member App, by email to general@keyhealthmedical.co.za, through online upload, or by post to KeyHealth, PO Box 14145, Lyttelton, 0140.