Frequently Asked Questions (FAQs)
How to submit a claim?
Scan a clear copy of your claim and send it via email to [email protected] (member refunds) and [email protected] (provider refunds) OR fax your claim to 041-3964476 OR post your claim to: RUMED, P.O.Box 1672, Port Elizabeth, 6000, OR hand-deliver your claim to the HR department, Rhodes.
What are the requirements for submitting a claim?
Your claim must reach RUMed within FOUR months from the date that you received treatment.
The following information must appear on the account:
- Your surname and initials or full names
- Your RUMed membership number
- The date of service
- The name of the patient (dependant) who received treatment
- The doctor/service provider’s practice number
- The tariff codes for each treatment received
- The amount charged per tariff code
Should you need to pay the provider upfront and claim back from RUMed, please include your receipt as proof of payment.
What are PMB's?
PMB’s are a set of defined benefits in the Medical Schemes Act aimed at ensuring that all medical scheme members have access to certain minimum health services. They ensure cover for the costs related to the diagnosis, treatment and care of: Any medical condition which meets the Act’s definition of an emergency
What is required for Hospital Pre-Authorisation?
Always call 0860 434 003 or 041-395 4481 for an authorization number at least 48 hours before a planned hospital event and ensure that you are aware of the rate that your provider is charging. RUMed pays providers at 100% of Scheme rate. Remember to ask and negotiate with your provider to ensure that you are aware of any difference in tariffs (this is applicable for providers seen out of hospital as well). In the case of any emergency please ask one of your dependants to contact us on the first business day after the admission.
How do you update your Chronic Medication?
If your doctor changes your chronic medication, or if your chronic medication authorisation expires, your doctor or pharmacist may fax a copy of the new prescription, indicating the changes as well as the diagnosis, to PROVIDENCE.
Who should I contact for an account query?
You can contact the customer care line on (041) 395 4476 where you can access all the relevant departments by selecting the appropriate number – the Hospital Utilisation Management department, Pharmacy Benefit Management department as well as a customer care consultant can be reached by dialing this number.