Dis-Chem Health

Dis-Chem Health Gap Claim Form

Dis-Chem Gap Claim Form 2023
  • Instructions
  • OTP Validation
  • Policyholder Details
  • Payment Instructions
  • Patient and Event Details
  • Declaration
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Please note that this is not an automatic process, and you will be required to submit a separate Claim form to the Claim that has been submitted to your Medical Scheme.
You have six months from the last day that you were hospitalised to submit your Claim and relevant documentation. Any Claim received for the first time after the six month period has expired, will not be honoured.
Claims are assessed on a line by line basis. Each line has a code on your service provider’s account that accumulates to the total amount charged. Your medical aid must pay a portion of the cost per line from your hospital benefit in order for that claim line shortfall to be reviewed by your Gap cover.
Claims flagged as Prescribed Minimum Benefit (PMB) may be investigated with your medical aid or discussed with your service provider. PMBs are a set of defined benefits that medical aids are required to cover by law. This means that as a medical aid member, you shouldn’t incur any out-of-pocket medical expenses related to a PMB.
Processing of insurance information is done in accordance with applicable legislation, as well as our Privacy Policy which can be found in our Compliance and Trust Centre on our website: www.kaelo.co.za and www.centriq.co.za.
When submitting the Claim form, you will need to provide supporting documents as detailed below in the checklist.
Claims can be emailed to dischemgap@kaelo.co.za. Once received, your Claim will be processed and if all requirements have been met, the Benefit amount will be paid within 7 to 14 working days. Please direct all queries to the Dis-Chem Health Service Centre on 0861 493 587. Click here to view the Claims Journey.
Please note that if you are a VAT registered vendor and the loss was incurred in furtherance of your enterprise, this insurance claim settlement could potentially create a liability to pay output VAT to SARS i.t.o. S8 (8) of the VAT Act.

In order for us to assess your Claim without any delays, please ensure you have the following documents:

Claims Checklist Where to get it? Shortfalls & Co-payments Family Booster Hospital Booster Family Protector Contribution Waiver Accidental Casualty & Child Illness Casualty
Claim Form
Hospital Account (not statement) Hospital
Doctor account (not quote) Doctor's Practice
Medical aid statement (including rejection reasons) Medical Aid
Death Certificate Home Affairs
Accident report (if reported to SAPS) SAPS
Letter confirming expected vs actual delivery date Medical Doctor/Doctor's Practice

Please enter your ID, Passport No. or your Dis-Chem Gap Policy No. in order for us to find your policy.

Policy Type
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Please ensure you enter the cellphone number that is linked to your policy. You will receive a OTP to verify your policy and continue with the online submission for your claim.

This is not a Medical Scheme and the cover is not the same as that of a Medical Scheme. This Policy is not a substitute for Medical Scheme membership.

Dis-Chem Health is not a Medical Scheme or an Insurer. The administrator of this product is Kaelo Risk (Pty) Ltd, an authorised Financial Services Provider (FSP 36931). Kaelo Risk (Pty) Ltd holds preference shares in Centriq Insurance Company Limited. Insurance products are insured by Centriq Insurance Company Limited (“Centriq”), a licensed non-life insurer and authorised Financial Services Provider (FSP 3417). The Lifestyle Benefits are Kaelo Offerings. Service Providers are contracted to Kaelo. Terms and Conditions apply. © Centriq Insurance Company Limited. This document may not, in whole or in part, be copied, photocopied, reproduced, translated, simplified, published or distributed in any way without the prior written consent of Centriq Insurance Company Limited.

Insured by Centriq Insurance
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