Important Reminder – Payment of medicals

The next in our series of important reminders relates to the payment of medicals. The initial medical requirement for underwriting of cover in excess of a proof free limit is normally a personal health statement, which is a declaration completed by the member themselves. Capital Alliance, Sanlam and Hollard require this, however, Old Mutual requests full medicals from the start.

The cost of any additional medicals requested by all four of our insurers, including the initial medicals (Blood tests and Short Medical Report) requested by Old Mutual, will be borne by the insurers.

Once the medicals have been completed by the member, the relevant TSA medical person will arrange for payment and collection. Payment will only be processed if the insurer is billed correctly, according to the latest insurance tariff rates/codes or if the insurer is billed less than the tariff rate.

Should any medical requirements be completed by a specialist, the insurers will only pay the insurance tariff for a general practitioner. Any amount in excess will be for the member’s own account.

An exception will be made if the insurer requests a medical from a specialist. This will also only be looked at on a case by case basis.

The broker or member will be kept up to date at all times to ensure that the medical process is as smooth as possible.

Thank you and regards,
The TSA Team

You’ll find all back issues of TSA Connect by visiting our blog.

All information provided is intended to inform and explain, but please remember to always check the current terms on policies when considering options and advising clients.

(Vol 7. Issue 8)

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