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For Sickness, Life and Disability Claims

Follow the easy steps below to get your claim processed fast and efficiently:

1. FILL IN THE CLAIM FORMS

Claims for benefits in terms of the PPS Provider Policy should be submitted as soon as possible after the occurrence of the event that gave rise to the claim in order to ensure efficient claims processing. Claims will only be assessed for the period which you are claiming as reflected in the Declaration by Member form. Claims for future dates will only be assessed up to the date the Declaration by Member form is signed.For on-going claims, claim forms should be submitted on a monthly basis, signed and submitted on the 25th of each month. Click on the relevant benefit tab on the left menu for the claim forms.

2. SUBMIT DOCUMENTS

You will need to submit all the requested claim forms and supporting documents to claims@pps.co.za. To assist you, please refer to the FAQ's or the relevant benefit tab on the left menu.

3.WE'LL CONTACT YOU TO NOTIFY YOU OF THE OUTCOME OF YOUR CLAIM

FOR CLAIMS CALL: 011 644 4300

For Car and Home Insurance Claims

CLAIMS

T: 0860 777 784

Monday - Friday

24/7

HOME AND ROADSIDE ASSIST (EMERGENCY SERVICES)

T: 0860 777 784

24/7

CLAIMS:

All claims must be reported within 30 days of the incident
In the case of motor vehicle accidents, notify SAPS within 24 hours of the event
In the event of any crime related incident (e.g. theft), report this to the Police as soon as possible
The Claims Consultants will assist you regarding any further requirements

Sickness, Life and Disability

Where do I get these claim forms?

You can send an email to memberservices@pps.co.za; to request claim forms;
Ask your broker to assist;
Click here to go to PPS Intouch to download claim forms
◦If you have not registered you can register by clicking on the self- register button;
◦You need to have your member number, ID number/Passport number available when you register;
◦Once registered, login using your username and password and you will be taken to the PPS InTouch home page;
◦Click on the claims button at the top of the page and scroll to the bottom where you will find all the claim forms.

Who can complete the Declaration by Doctor Form?

A Medical Practitioner registered with the Health Professions Council of SA (HPCSA) or equivalent medical body outside RSA, and approved by PPS.
A Dental Practitioner registered with the Health Professions Council of SA (HPCSA) or equivalent medical body outside RSA, and approved by PPS for dental related claims.

Who are the approved Medical Practitioners?

Approved Medical Practitioners must have a minimum qualification of the following:

BCh - Bachelor of Surgery
BChir - Bachelor of Surgery
BM - Bachelor of Medicine
BS - Bachelor of Surgery
ChB - Bachelor of Surgery
DCh - Doctor of Surgery
DS - Doctor of Surgery
MBBCh - Bachelor of Medicine and Bachelor of Surgery
MBBS - Bachelor of Medicine and Bachelor of Surgery
MBChB - Bachelor of Medicine and Bachelor of Surgery
MD - Doctor of Medicine
BDS - Bachelor of Dental Surgery
BChD - Bachelor of Dental Surgery
DDS - Doctor of Dental Surgery
DMD - Doctor of Dental Medicine

Would I be required to submit any additional information once the claim forms have been submitted?

Possibly. Additional information may be requested from you or your (or spouse or child) treating doctor once assessed by a claims assessor, especially if the claim period exceeds the number of days the illness is expected to last or with particular conditions claimed.

Will additional requirements be communicated to me?

Yes, you will be notified via email, phone or fax according to your preferred method of communication.

Who will be liable for the costs of additional information?

You will be required to pay for the completion of the Declaration by Doctor Form. Some practitioners may require payment for the completion of this form. PPS will pay for any additional reports requested by us from your doctor.

Where do I send my claim forms to?

Fully completed claim forms may be sent to claims@pps.co.za.

How confidential is my claim information?

All documents, irrespective of the content, are handled as confidential. You can however advise PPS on your claim form to keep your accredited PPS financial advisor informed. This does require your specific consent. If no consent is received, your financial advisor will not be informed regarding the progress of your claim.

How long do I have after my sickness to submit my claim form?

Claims for benefits in terms of the PPS Provider Policy should be submitted as soon as possible after the occurrence of the event that gave rise to the claim in order to ensure efficient claims processing. For on-going claims, claim forms should be submitted on a monthly basis, signed and submitted on the 25th of each month.

If I claim, will this affect my premiums or my Profit Share Account?

No, it will not affect either.

If I'm not happy with the outcome of the assessment of my claim what can I do?

If you are not satisfied with the outcome of your claim follow the appeal process provided below.

Claims appeals process :

Step 1

Submit a written appeal to claims@pps.co.za with reasons or additional supportive information detailing why your claim should be reconsidered.

Step 2

You may submit a detailed written appeal to our Independent Internal Arbitrator, Advocate Thinus Ferreira, only if you have followed the appeal process and have been unsuccessful in appealing the decision as stated above. Contact details as follows: email: arbitrator2@pps.co.za or fax (011) 644 4309.

Step 3

If the complaint is not resolved to your satisfaction after following step 1 and 2 above, you can refer the matter to the Ombudsman for Long-term Insurance, details provided below.

Note: Step 1 and 2 should be followed prior to submitting an appeal to the Ombudsman as their office will refer the matter back to PPS as a ‘Transfer’ matter if the process has not been followed.

Telephone: 0860 OMBUDS (0860 662 837)
Fax: (021) 674 0951
Email: info@ombud.co.za
Web: www.ombud.co.za

Postal Address:

The Ombudsman for Long-Term Insurance
Private Bag X45
Claremont
Cape Town
7735

In terms of the Prescription Act, you have three years from the date on which a final decision has been communicated to you, to institute legal action or declare a dispute. It is however recommended that you lodge any dispute as soon as possible, in order to facilitate a speedy resolution to your concern.

Should you require any further assistance, please contact PPS on e-mail memberservices@pps.co.za or call us directly on telephone 0860 123 777 (international: +27 11 644 4300) and we will gladly assist you.

Which bank account will my payment be paid into and when will this be paid?

The benefit will be paid to your premium paying account, unless you request PPS to pay to a different account. If you want the payment to be made into a different account, you will be required to provide PPS with proof of the account which can be a letter from the bank confirming that the account belongs to you or a cancelled cheque.
The benefit will be paid once assessed and the claim is accepted as valid.

Can I still apply for additional cover after a claim?

Yes you may. Your application will be subject to the standard PPS underwriting policy and PPS will consider the information relating to the claim submitted. In some instances such an application may be deferred for a period of time depending on the medical condition you are claiming for. This will be communicated to you by the PPS Underwriting Department.

What do I do if I have a query regarding my claim?

You can send an email to memberservices@pps.co.za;
Alternately contact PPS on 011 644 4300.

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