In the event that a member pays 100% for medical services, PULA will reimburse them according to the Fund rules and agreed tariffs. Claims should be submitted for payment within a period of three (3) months from the date of service.
For all claims submitted, please ensure the following details are correct:
- Member’s first name and surname as written on the membership card.
- Name of the benefit option.
- Membership number
- Name and signature of healthcare professional providing the service
- The date on which service was provided
- Itemised list of all services and their respective individual charges. In the case of a medical practitioner or dentist, a diagnosis of the complaint for which the service was provided, as well as tariff codes for the respective services where applicable.
- All invoices for pathology/laboratory services, speech therapy, physiotherapy, dietetics, occupational therapy, psychology, or any other paramedic/allied/associated health services should be accompanied by a copy of the letter of referral from a medical practitioner or dentist.
- Invoices for medication dispensed by a pharmacy should be accompanied by a copy of the prescription certified by the pharmacist, as a true and exact photocopy of such prescription
- When submitting claims for payment, always attach receipt of payment. We do not accept receipts alone for claims without proof of payment.
- All invoices should be signed by the member or dependent to acknowledge receipt of services being claimed for.
Refunds to members are normally done electronically; therefore we require the following information:
- Account name
- Account number
- Bank name
- Branch number
- Branch code
- Account type (savings, current or cheque)