How to file a claim?

Your how-to when filing a claim for medical expenses related to a diving injury or a travel-related medical emergency covered under DAN-SA membership benefits. 

DAN-SA is a public benefit organisation that provides emergency medical advice and assistance for underwater diving injuries, and a wide range of research, education and training programmes that promote safe diving.  DAN-SA is the insured party of a group policy that offers coverage for diving injuries and a limited set of travel-related medical emergencies. DAN-SA members receive the coverage benefits by virtue of this policy. By proxy, DAN-SA is the beneficiary under the policy.

The DAN-SA Group Policy was established primarily to assure essential coverage for the emergency medical assessment, aeromedical evacuation (when medically justified), hospital admission, specialist examination, and recompression chamber treatment for decompression illness (DCI). The group policy also includes other travel medical benefits consistent with the typical needs and activities of divers.

Consequently, group policy terms and conditions were developed carefully and thoughtfully in conjunction with insurance experts to ensure that DAN-SA members have appropriate coverage for managing and treating injuries and accidents associated with diving-related travel and activities for which they need emergency medical services and transportation as recommended, authorised and/or mobilised by the DAN-SA Hotline. The terms and conditions have been adapted over the years to offer the best value for coverage relevant to recreational divers.

With all this in mind, it is very important that DAN-SA members understand how the group policy works. They need to realise what DAN-SA can and cannot authorise on their behalf, by virtue of the DAN-SA Group Policy, when they require or request emergency medical services based on the benefits of the group policy.

Key Concepts 

We would like to highlight the following key concepts relating to membership claims and medical expenses:

Step-By-Step Process

Step 1: Call DAN-SA

The DAN-SA Hotline will make all the necessary arrangements for your treatment and issue GOPs to the service providers, hospitals or healthcare professionals.
From inside South Africa, call us toll free on 0800 020 111. From outside of South Africa, call us on + 27 828 10 60 10. Remember to save these number on your cell phone, especially before travelling abroad.

Step 2: Fill in the claim form

In all situations where coverage is offered under the DAN-SA Group Policy, DAN-SA is required to submit a claim to the insurers on behalf of the member, even in situations where the DAN-SA Hotline authorised these services and provided a GOP directly to the service providers.
In unusual situations where a DAN-SA member needs to claim for expenses incurred for emergency medical services arranged without the direct involvement of the DAN-SA Hotline, the DAN-SA Hotline needs to be notified first to register the event. Call DAN-SA on 0860 242 242, or if calling from outside of South Africa, call us on +27 11 266 4903.
Members can contact a DAN-SA medic either on 011 266 4903 or [email protected] for a claim form.

Step 3: Send the completed claim form to DAN-SA

Submit the completed claim form to DAN-SA, together with any relevant supporting documentation (invoices, receipts, medical reports). Ideally, these should be scanned and emailed to [email protected] Alternatively, the completed forms and documentation can be:

Mailed to:
DAN Southern Africa Claims
Private Bag X197
Halfway House
Midrand
1685
 
Couriered to:
DAN Southern Africa Claims
Rosen Office Park, DAN-SA Building
C/O Invicta and Matuka Close Halfway Gardens
Midrand 1684

Faxed to:
0861 326 329 (from within South Africa)
+27 11 312 0054 (from outside of South Africa) +27 86 512 9091 (fax to email)

Step 4: Await settlement and final reconciliation documents from DAN-SA

DAN-SA will arrange settlement of all services and expenses for covered services, reconcile any short payments with service providers, and arrange for any reimbursements to be paid out to you. We will also send you a final reconciliation so that they can see what the total pay-out was.

Important reminders

Remember these important key concepts:

• Please ensure that your DAN-SA membership is up to date.
• The DAN-SA Hotline must be notified for a claim to be eligible for processing.
• A claim form must be submitted to allow DAN-SA to claim for services rendered under the DAN-SA Group Policy cover.
• DAN-SA will (by law) first attempt to arrange settlement via any relevant medical aid or any other travel insurance that you may have.
• If you receive any invoices/statements directly from service providers, kindly forward these to DAN-SA.
• Notify DAN-SA if you are travelling to remote areas, overseas or if you will be outside your country of residence for a continuous period of more than 90 days.