How to claim

Value Care Plan members belong to a network plan and may only use Prime Cure facilities or Prime Cure network healthcare providers, or both. Prime Cure pays these healthcare providers to provide you with healthcare services. You do not have to pay any accounts unless you have not complied with the Rules or use a healthcare provider outside the network in an emergency. If you receive healthcare services outside the network for an emergency, submit your claim and proof of payment to the address below:

Email: anglo@primecure.co.za
Post: Prime Cure Health Claims, Private Bag X13, Rivonia, 2128

What you may not claim for

General Scheme and Value Care Plan exclusions

The following are some of the Scheme exclusions (for a full list please refer to the Rules). These you would need to pay:

  • Frail care
  • PET scans
  • Deep brain stimulator devices for Parkinson’s disease or epilepsy
  • Implant devices for chronic pain management
  • Polysomnogram and CPAP titrations
  • Facility fees
  • No cover for medicine not found on the medicine list
  • Injury or illness that occur beyond the borders of the Republic of South Africa
  • Dental extractions for non-medical purposes
  • All costs related to radial keratotomy and refractive surgery
  • Contact lenses, sunglasses and accessories

The following medicines are specifically excluded unless part of a PMB treatment and authorised:

  • Erythopieitin (unless the beneficiary is eligible for renal transplantation)
  • Interferons
  • Biologicals and bio technological substances
  • Immunoglobulins

Third-party claims

Anglo Medical Scheme Rules state that claims for costs that are recoverable from a third party (for example, the Road Accident Fund, or any other insurance fund) are not payable by the Scheme or Prime Cure. However, Anglo Medical Scheme is aware that the time taken for these claims to be finalised can vary from a couple of months to years after the accident or incident.

As a result, Prime Cure will agree to settle these accounts after requesting a letter of undertaking from you. Prime Cure will manage the case with the relevant attorneys and service providers.

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