Is Complimed a Medical Aid?
No. Complimed products are defined either, under the definition of “accident and health policy”, in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998.
Does it cover day to day procedures?
No. Complimed covers mainly in-hospital shortfalls and co-payments, together with certain listed procedures that might be performed on an out-patient basis. Complimed also provides death, disability and funeral cover.
Does this cover my whole family?
Adult dependants are not covered in terms of the Complimed Master Policy document. However, they are welcome to apply for cover in their own right.
Does it matter how large my family is?
Certain products limit the size of the family or require certain criteria e.g. all insured members must belong to a Medical Aid.
Is it only hospital procedures that are covered, or are some out-of-hospital procedures, e.g. visits to my General Practitioner, covered?
Out–of–hospital benefits are not covered; however certain listed procedures are covered on an out-patient basis. Refer to the policy document for more comprehensive details.
How long does it take to assess a claim?
Claims are assessed and paid, providing all the relevant documentation is received upfront, within 14 days.
Who gets paid when my claim is settled – the doctors or me?
In order to comply with the definition of “accident and health policy”, in the Short Term Act, service providers MAY NOT be settled directly. All monies are therefore paid to the principal member.
What happens if I am sick/pregnant/about to have an operation when I take out this policy?
A 12 month pre-existing medical exclusion is a standard exception on all Complimed products. Therefore any ailment that was treated 12 months prior to the inception of the policy will not be cover for a period of 12 months. Special terms exist for groups; please contact HDI or Complimed for details.
What is the maximum entry age and how long do I stay on thereafter?
A maximum entry age of 70 applies to all Complimed products. Although there is no cease age applicable the policy is renewed in January of every year.
How do I cancel membership?
A calendar months notice period in writing is required.
Does this plan cover dental procedures?
Certain dental procedures performed in hospital are covered under the Dentistry benefit.
Do you need original accounts?
No, faxed copies are accepted by Complimed’s underwriting department.
Are the premiums Tax deductible?
No, the policies fall under the definition of “accident and health policy”, in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998 and not the Medical Schemes Act, 1998.