How to Claim

How to Claim

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)