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ClaimSmart Terms & Conditions
1. Services Provided
ClaimSmart assists clients with the preparation, submission, and follow-up of medical aid claims. We act as an intermediary between the client and the medical aid scheme.
2. No Guarantee of Payment
While every effort is made to ensure claims are accurate and compliant, ClaimSmart cannot guarantee approval or payment of any claim. Final decisions rest solely with the medical aid scheme or GAP cover of the client.
3. Client Responsibility
Clients must provide accurate, complete, and timely information, including medical aid details, invoices, and supporting documents. ClaimSmart is not responsible for any delays or rejections resulting from missing or incorrect information. Clients are also required to forward any emails or messages received from their medical aid or GAP cover regarding the status or outcome of their claim.
4. Fees & Payments
- To get started, fees are kindly requested to be paid in full upfront, based on our published pricing guide.
- Discounts apply only where specified (e.g., family discount).
- Fees are payable regardless of whether a claim is approved, partially approved, or rejected.
5. Confidentiality & Data Protection
ClaimSmart respects client confidentiality and will handle all personal and medical information in compliance with POPIA (Protection of Personal Information Act).
6. Limitation of Liability
ClaimSmart will not be liable for any loss, damage, or costs arising from rejected claims, delayed processing, or decisions made by medical aid schemes.
7. Amendments
ClaimSmart may update these Terms & Conditions periodically. Clients will be notified of material changes.