Please update your browser: Your browser isn’t supported anymore. Update it to get the best experience from our website by downloading Google Chrome.
How to claim: Life, Sickness & Disability

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 ongoing 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 top menu for the respective claim forms or scroll down.

2. SUBMIT DOCUMENTS
You will need to submit all the requested claim forms and supporting documents to [email protected]. 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

How to claim: Car and Home

HOME AND ROADSIDE
ASSIST
(EMERGENCY SERVICES)

Tel: 0860 777 784
24/7

 

Tel: 0860 777 784
Mon-Thurs: 8am - 5pm, Fri: 8am - 4:30pm

 

 

 

CLAIMS:

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

To register an incident or claim, please click on the following button and complete the form.

If you have a query regarding your claim, please contact PPS on:
[email protected] | 011 644 4300.

Sickness and Permanent Incapacity

Disability

Critical Illness/or Severe Illness

Life Cover

Frequently Asked Questions

Claims

You can send an email to [email protected] to request claim forms.

Ask your broker to assist.

Alternatively, all the claim forms are available at https://www.pps.co.za/claims, under each product tab.

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.

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

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.

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

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.

Fully completed claim forms may be sent to [email protected].

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.

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.

No, it will not affect either.

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

Complaints continuation process:

Step 1

Should you have a complaint or wish to dispute the outcome of your claim, please use the option below to register a complaint.

Contact details:

Tel:        0860 123 777 or +27 (0) 11 644 4300

Fax:       +27 (0) 11 644 4400

Email:   [email protected]

PPS will then endeavour to resolve the complaint and supply a response within 8 working days from date of acknowledgement of the request.

 

Step 2

You may submit a detailed written appeal to our Independent Internal Arbitrator, Jeff Mc Key, only if you have followed the appeal process and have been unsuccessful in appealing the decision as stated above. Contact details as follows: email: [email protected] or 011 644 4407.

 

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 National Financial Ombud Scheme SA, details provided below.

 

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

 

National Financial Ombud Scheme SA
Telephone: 0860 800 900
Email: [email protected]
Website: www.nfosa.co.za

Physical Address (JHB): 
110 Oxford Road, 
Houghton Estate,
Illovo, 
Johannesburg,
2198

Physical Address (CPT):
Claremont Central Building,
6th Floor,
6 Vineyard Road,
Claremont,
7708

 

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. The prescription period will only commence after all PPS review processes have been exhausted, which may include the periods of appeal to the Independent Internal Arbitrator and the National Financial Ombud Scheme SA.

Should you require any further assistance please contact PPS on e-mail [email protected] or call us directly on telephone 0860 123 777 (international: +27 11 644 4300) and we will gladly assist you.

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 can​celled cheque.

The benefit will be paid once assessed and the claim is accepted as valid.

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.

You can send an email to [email protected];

Alternately contact PPS on 011 644 4300.

Join Login