Your guide to
Health4Me Claims

This is used to settle selected outstanding transactions on payable accounts and to settle transactions on client accounts with a credit balance.

Below are the payment run dates for Health4Me.

The hospital cash and funeral benefits require submission of the below claim forms. Please take note of the claim requirements as noted below.

Hospital Cash

Claim Requirements

• Fully completed Health4Me hospital cash claim form.
• Proof of hospitalisation (hospital account) stating admission and discharge dates.
• Medical certificate by treating doctor/physician/specialist stating reason for hospitalisation.
• Certified (by a commissioner of oaths) copy of the insured life’s identity document/passport/birth certificate.
• Certified (by a commissioner of oaths) copy of the child’s birth certificate (maternity lump-sum benefit).
• Copy of the insured life’s bank statement (not older than 3 months) or a cancelled cheque.
• Please note that ATM or internet statements are not acceptable.
• Additional information may be required.
• Claims not submitted within four months of the claim event will be rejected.
• Please submit the completed and signed form and any supporting documents, via email to health4meinsuranceclaims@momentum.co.za, or via fax to 031 580 0500.

Funeral

Claim Requirements

• Fully completed Health4Me funeral claim form.
• Certified (by a commissioner of oaths) copy of the insured life’s identity document/passport/birth certificate.
• Certified (by a commissioner of oaths) copy of the insured life’s death certificate.
• Certified (by a commissioner of oaths) copy of the BI 1663 (obtainable from the doctor who certified the death).
• Certified (by a commissioner of oaths) copy of the beneficiary’s/claimant’s identity document/passport/birth certificate.
• If the deceased child does not bear the same surname as the member, proof in the form of an affidavit of the relationship.
• If the deceased is a spouse, a certified (by a commissioner of oaths) copy of the marriage certificate.
• If the marriage certificate is not available, proof in the form of an affidavit that a permanent life partnership existed.
• Copy of the beneficiary’s/claimant’s bank statement (not older than 3 months) or cancelled cheque. Please note that ATM or internet statements are not acceptable.
• Additional information may be required.
• Claims not submitted within four months of the claim event will be rejected.
• Please submit the completed and signed form and any supporting documents, via email to health4meinsuranceclaims@momentum.co.za, or via fax to 031 580 0500.

Please refer to the below table for the Health4Me claims and queries response process.

First point of contact: Reference number provided
Second point of contact: When feedback isn’t received within response time. Reference number needed.

All Claims Queries

Required information:
Member Number
Practice Number
Date of Service

First Point of Contact
Response TimeQueries will be responded to within 2 business daysHealth4me@momentum.co.za

Second Point of Contact
Tel: 0860 10 29 03
WhatsApp: 0860 10 29 03

Day-day and Accident Claims submissions only

Please refer to the first tab, “Information required for claims”Please refer to our payment runs for 2023.

First Point of Contact
Claims will be reimbursed on Momentum Health4Me payment runs for 2023Health4meclaims@momentum.co.za

Second Point of Contact
Health4me@momentum.co.za
0860 10 29 03

Cash-back and Funeral Claims submissions only

First Point of Contact
Claims will be refunded between 5-7 business days from the date that all documentation is receivedHealth4meInsuranceClaims@momentum.co.za

Second Point of Contact
Health4me@momentum.co.za
0860 10 29 03

Member Refunds submissions only

Required information
Request to pay to principal member:
Details invoice (with member number)
ID copy of principal member
Receipt or proof of payment
Bank statement not older than 3 months or letter from the bank showing banking details

Request to pay to dependent or another 3rd party:
Details invoice (with member number)
ID copy of principal member
Receipt or proof of payment
Bank statement not older than 3 month or letter from the bank showing banking details
Other party’s ID copy
Principal member’s consent to pay other party

First Point of Contact
Claims will be refunded between 5-7 business days from the date that all documentation is receivedHealth4meRefunds@momentum.co.za

Second Point of Contact
Health4me@momentum.co.za
0860 10 29 03