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STRATUM CARES
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2018 PRODUCT RANGE
INDIVIDUALS & FAMILIES
Edge 200
Compact 200
GAP COVER 500 RANGE
Base
Co-evolution
Elite
Access Optimiser
COMPARE OUR GAP COVER PRODUCT RANGE
GAP COVER 200 RANGE
Essential Primary Plus
HEALTH INSURE RANGE
CORPORATE EMPLOYER GROUPS
CORPORATE GAP COVER RANGE
Corporate Gap Cover 500
Gap Cover Range 200
Corporate Compact 200
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Corporate Access
CORPORATE HEALTH INSURE RANGE
Corporate Essential
FAQ’S
CLAIMS
NEWS
CONTACT US
DOWNLOADS
APPLY FOR COVER
HOME
STRATUM CARES
PRODUCTS
2018 PRODUCT RANGE
INDIVIDUALS & FAMILIES
Edge 200
Compact 200
GAP COVER 500 RANGE
Base
Co-evolution
Elite
Access Optimiser
COMPARE OUR GAP COVER PRODUCT RANGE
GAP COVER 200 RANGE
Essential Primary Plus
HEALTH INSURE RANGE
CORPORATE EMPLOYER GROUPS
CORPORATE GAP COVER RANGE
Corporate Gap Cover 500
Gap Cover Range 200
Corporate Compact 200
Corporate Elite
Corporate Access
CORPORATE HEALTH INSURE RANGE
Corporate Essential
FAQ’S
CLAIMS
NEWS
CONTACT US
DOWNLOADS
APPLY FOR COVER
HOME
STRATUM CARES
PRODUCTS
-2018 PRODUCT RANGE
--INDIVIDUALS & FAMILIES
--Edge 200
--Compact 200
--GAP COVER 500 RANGE
--Base
--Co-evolution
--Elite
--Access Optimiser
--COMPARE OUR GAP COVER PRODUCT RANGE
---GAP COVER 200 RANGE
--Essential Primary Plus
---HEALTH INSURE RANGE
--CORPORATE EMPLOYER GROUPS
--CORPORATE GAP COVER RANGE
---Corporate Gap Cover 500
--Gap Cover Range 200
--Corporate Compact 200
--Corporate Elite
--Corporate Access
--CORPORATE HEALTH INSURE RANGE
--Corporate Essential
FAQ’S
CLAIMS
NEWS
CONTACT US
DOWNLOADS
Your Online Claim Form
From receipt of your claim to providing feedback, our team of Claims Specialists will attend to your submission with speed and delivery.
1) YOUR PROFILE
PRINCIPAL INSURED DETAILS
Title
*
First Name
*
Surname
*
Identification Type
*
ID Document
Passport
ID Number
*
Passport Number
*
DOB
*
Day
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Month
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Year
2019
2018
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1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Medical Scheme
---
BestMed
Bonitas
Compare
Discovery
Fedhealth
Gems
Genesis
Hosmed
KeyHealth
LAHealth
Liberty
MediHelp
Medshield
Momentum
Profmed
Resolution
SelfMed
Sizwe
SpectraMed
TopMed
Other
Medical Scheme Option
Select Scheme
BestMed Option
*
---
Beat 1
Beat 2
Beat 3
Beat 4
Pace 1
Pace 2
Pace 3
Pace 4
Pulse 1
Pulse 2
Bonitas Option
*
---
BonCap
BonClassic
BonComprehensive
BonEssential
BonPrimary
BonSave
Standard
BonFit
Standard Select
Primary
Compare Option
*
---
Axis
Axis Efficiency Discounted
Dynamic
Dynamic Efficiency Discounted
Mumed
Mumed Efficiency Discounted
Mumed Efficiency Discounted Network
Network Efficiency Discounted
Pinnacle
Pinnacle Efficiency Discounted
Symmetry
Symmetry Efficiency Discounted
Discovery Option
*
---
Classic Comprehensive
Classic Delta Comprehensive
Essential Comprehensive
Essential Delta Comprehensive
Classic Core
Classic Delta Core
Essential Core
Essential Delta Core
Coastal Core
Keycare Plus
Keycare Access
Keycare Access Core
Classic Priority
Essential Priority
Classic Saver
Classic Delta Saver
Essential Saver
Essential Delta Saver
Coastal Saver
Executive Plan
Classic Zero MSA
Smart Plan
Fedhealth Option
*
---
Blue Door Plus
Maxima Plus
Maxima Exec
Maxima Standard
Maxima Standard Elect
Maxima Basis
Maxima Core
Maxima EntryZone
Maxima Saver
Maxima EntrySaver
Gems Option
*
---
Beryl
Emerald
Onyx
Ruby
Sapphire
Genesis Option
*
---
Private Choice
Private Comprehensive
Private Plus
Private
Hosmed Option
*
---
Access
Essential
Plus
Value
LAHealth Option
*
---
Active
Comprehensive
Core
Focus
Keyplus
Keyhealth Option
*
---
Equilibrium Option
Essence Option
Gold Option
Origin Option
Platinum Option
Silver Option
Liberty Option
*
---
Complete Plus Option
Complete Select Option
Complete Standard Option
Hospital Plus Option
Hospital Select Option
Hospital Standard Option
Saver Plus Option
Saver Select Option
Saver Standard Option
Traditional Standard Option
Traditional Ultimate Option
MediHelp Option
*
---
Dimension Elite
Dimension Prime 1
Dimension Prime 2
Dimension Prime 3
Necesse
Dimension Prime 1 Network
Dimension Prime 2 Network
Dimension Prime 3 Network
Necesse Student
Plus
Unify
MedShield Option
*
---
MediBonus
MediCore
MediPhila
MediPlus
MediSaver
MediValue
Premium Plus
Momentum Option
*
---
Access
Custom
Extender
Incentive
Ingwe
Summit
Profmed Option
*
---
ProActive Plus
ProActive
ProPinnacle
ProSecure Plus
ProSecure
Resolution Option
*
---
Foundation
Hospital
Millennium
Progressive Flex
Supreme
SelfMed Option
*
---
80
Med Elite
Med XXI
SelfNet
SelfSure
Sizwe Option
*
---
Affordable Care
Full Benefit
Gomomo Care
Primary Care
Savings Care
SpectraMed Option
*
---
Aqua
Azure
Capri
Cobalt
Cyan
TopMed Option
*
---
Active Saver
Hospital
Network
Paladin Comprehensive
Professional
Rainbow Comprehensive
Savings
Other
*
Membership Number
Cellphone
*
Telephone (H)
Telephone (W)
Email Address
*
Email me a copy of my claim submission
*
Yes
No
PATIENT DETAILS
I acknowledge that the below details are not required when the Principal Insured is the Patient
Title
*
First Name(s)
*
Surname
*
Identification Type
*
ID Document
Passport
ID Number
*
Passport Number
*
DOB
*
Day
1
2
3
4
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Month
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Year
2019
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2012
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1932
1931
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1928
1927
1926
1925
1924
1923
1922
1921
1920
Relationship
---
Spouse
Child Dependent
Adult Dependent
Other
Medical Scheme
---
BestMed
Bonitas
Discovery Health
Fedhealth
KeyHealth
Liberty
MediHelp
Momentum
Resolution
SpectraMed
TopMed
Other
Scheme Option
Select Scheme
BestMed Option
*
---
Beat 1
Beat 2
Beat 3
Beat 4
Pace 1
Pace 2
Pace 3
Pace 4
Pulse 1
Pulse 2
Bonitas Option
*
---
BonCap
BonClassic
BonComprehensive
BonEssential
BonPrimary
BonSave
Standard
BonFit
Standard Select
Primary
Discovery Health Option
*
---
Classic Comprehensive
Classic Delta Comprehensive
Essential Comprehensive
Essential Delta Comprehensive
Classic Core
Classic Delta Core
Essential Core
Essential Delta Core
Coastal Core
Keycare Plus
Keycare Access
Keycare Access Core
Classic Priority
Essential Priority
Classic Saver
Classic Delta Saver
Essential Saver
Essential Delta Saver
Coastal Saver
Executive Plan
Classic Zero MSA
Smart Plan
Fedhealth Option
*
---
Blue Door Plus
Maxima Plus
Maxima Exec
Maxima Standard
Maxima Standard Elect
Maxima Basis
Maxima Core
Maxima EntryZone
Maxima Saver
Maxima EntrySaver
Keyhealth Option
*
---
Equilibrium Option
Essence Option
Gold Option
Origin Option
Platinum Option
Silver Option
Liberty Option
*
---
Complete Plus Option
Complete Select Option
Complete Standard Option
Hospital Plus Option
Hospital Select Option
Hospital Standard Option
Saver Plus Option
Saver Select Option
Saver Standard Option
Traditional Standard Option
Traditional Ultimate Option
MediHelp Option
*
---
Dimension Elite
Dimension Prime 1
Dimension Prime 2
Dimension Prime 3
Necesse
Dimension Prime 1 Network
Dimension Prime 2 Network
Dimension Prime 3 Network
Necesse Student
Plus
Unify
Momentum Option
*
---
Access
Custom
Extender
Incentive
Ingwe
Summit
Resolution Option
*
---
Foundation
Hospital
Millennium
Progressive Flex
Supreme
SpectraMed Option
*
---
Aqua
Azure
Capri
Cobalt
Cyan
TopMed Option
*
---
Active Saver
Hospital
Network
Paladin Comprehensive
Professional
Rainbow Comprehensive
Savings
Other
*
Other
Membership Number
2) YOUR CLAIM DETAILS
MEDICAL PROCEDURE DETAILS
Date you first experienced symptoms
*
Day
1
2
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Month
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Year
2019
2018
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2012
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1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Medical procedure that was performed
*
SERVICE PROVIDER DETAILS
Where your medical procedure was performed
*
Hospital
Day Clinic
Practitioner’s Room
Casualty Ward
Other
Admission or Treatment Date
*
Day
1
2
3
4
5
6
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31
Month
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5
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10
11
12
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
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1992
1991
1990
1989
1988
1987
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1985
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1983
1982
1981
1980
1979
1978
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1973
1972
1971
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1969
1968
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1926
1925
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1923
1922
1921
1920
Discharge Date
*
Day
1
2
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Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
NAME AND CONTACT DETAILS OF PRACTITIONERS
General Practitioner
*
Contact Number
*
Treating Practitioner
*
Contact Number
*
BENEFIT CATEGORIES & SUPPORTING DOCUMENTS.
For a hassle-free claims process, please select the appropriate benefit category from which you are claiming and attach the relevant supporting documents as indicated. Waiting periods apply from each insured person’s respective cover start date, unless otherwise specified at acceptance stage. Underwriting details can be found in your policy documentation, from your broker or Stratum Benefits directly.
GAP BENEFIT
Your service provider charged a rate more than what your medical scheme paid from your
hospital -,risk - or major medical benefit.
CO-PAYMENT BENEFIT
Your medical scheme required you to pay an upfront co-payment, deductible or hospital admission fee.
ONCOLOGY BENEFIT
Your medical scheme has only paid a portion towards your service providers’ accounts relating to your approved oncology treatment.
ONCOLOGY OPTIMISER BENEFIT
Your medical scheme applies an overall rand amount limit to your oncology benefit, which you have reached.
DIAGNOSIS BENEFIT
You have been diagnosed with cancer for the first time after your cover start date, and your diagnosis aligns to the qualifying criteria as set out in your policy documentation.
SUB-LIMIT BENEFIT
Your medical scheme applies a rand amount limit to internal prostheses, non-PMB day procedures, renal dialysis and / or MRI & CT scans, and you become liable to pay a portion of, or the full amount of your service provider’s account, as per your gap cover option.
CASUALTY BENEFIT
You are claiming for a casualty event, where immediate treatment was required for physical injury that resulted from an external force.
TRAUMA COUNSELLING BENEFIT
You are claiming for a consultation fee charged by your registered counsellor, clinical psychologist or psychiatrist for a traumatic event that you witnessed, or were directly affected by.
REHABILITATION OPTIMISER BENEFIT
Your medical scheme applies an overall rand amount limit to your rehabilitation benefit for accidental events, which you have reached.
PREVENTATIVE CARE BENEFIT
You are claiming for a consultation fee charged by your service provider, or the cost of your Pap smear, prostate screening (PSA test) or full blood count (FBC test) to help diagnose certain cancers.
GAP POLICY PREMIUM WAIVER BENEFIT
You are claiming due to the gap cover premium payer’s death, permanent disability or forced retrenchment.
MEDICAL SCHEME CONTRIBUTION WAIVER BENEFIT
You are claiming due to the medical scheme contribution payer’s death or permanent disability.
ACCIDENTAL DEATH BENEFIT
You are claiming the lumpsum amount payable due to the accidental death of the principal insured, spouse or dependant.
ACCESS OPTIMISER BENEFIT
You need a medical procedure that is not covered by your medical scheme, because it is listed as a specific exclusion over and above the general exclusions applicable to your medical scheme option.
HOSPITAL OPTIMISER BENEFIT
Your medical scheme applies an overall rand amount limit to your hospital benefit, which you have reached.
COMPULSORY SUPPORTING DOCUMENTS TO BE SUBMITTED
A detailed hospital account
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
All service providers’ accounts
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Claims transaction history
*
Your medical scheme claims transaction history statement reflecting the amount charged by your service provider and amount paid by your scheme
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Medical scheme membership certificate
*
Latest medical scheme membership certificate confirming updated monthly contribution for the month you are claiming in
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Detailed hospital or radiology account
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
General Amendment form
*
General Amendment form to be completed to update all policy details
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Death certificate or doctor’s confirmation of permanent disability
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Completed Stratum cancer declaration form
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Proof that the claimant was the medical aid payer
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Copy of your approved oncology treatment plan
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
A detailed casualty report and casualty account
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Counsellor’s report and account
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Death certificate
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Confirmation documents
*
Death certificate, doctor’s confirmation of permanent disability, or employer’s confirmation of forced retrenchment respectively
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Proof from bank confirming premium payer
*
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Quotation documents
*
Quotations from all service providers such as the hospital, doctors and specialists
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
Additional Upload (if required)
Accepted file types: jpg, gif, png, pdf.
3) YOUR CLAIM REIMBURSEMENT PROFILE
Stratum Benefits (Pty) Ltd reserves the right to negotiate a discounted rate with the relevant service providers on your behalf to ensure you maintain a favourable risk profile. If granted, payment will be made directly into the respective service provider’s bank account thus rendering Section 3 of the Client Claim Form null and void. Banking details provided as part of your Claim reimbursement Profile will be the only bank account used for claim reimbursements. Stratum Benefits (Pty) Ltd accepts no responsibility and cannot be held liable for any incorrect banking details provided for claim reimbursements.
Please indicate whether claim reimbursements should be made into the same account from which your Stratum Benefits policy premiums will be deducted.
Account Holder
*
Bank
*
Account Number
*
Account Type
*
Cheque
Savings
AUTHORISATION & DECLARATION ACCEPTANCE
I hereby authorise my medical scheme and any service provider whom attended to me or any of my dependants, to furnish Stratum Benefits (Pty) Ltd or its authorised representatives information in respect of any medical condition, the medical history thereof and / or benefit information which may be required for the assessment of my claim. I declare that the details provided, as well as any supporting documents supplied are true and correct and I understand that any non-disclosure or false representation may result in the rejection of this claim and / or cancellation of cover.
*
I accept
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