Claims FAQs
What information should member fill in when completing a claim form?
Member should fill in:
- Membership number
- Suffix
- Date of Birth
- Member`s signature and Date
ATTACH CLAIM SUPPORTING DOCUMENTS
- Receipt must match amount on Claim
- Prescription for drug claims
- Lab request form for Pathology and Radiology Claims
What information should the provider fill in when completing a claim form?
- Provider number
- Tariff code
- Quantity
- Date (Year, Month, Date)
- Fee charged.
- Diagnosis
- ICD10 Code
- Doctors signature
- Stamp
What are the requirements for local claims?
Medical Claims
- These are claims from General Practitioners, Specialist, Laboratories and Radiographers
- When submitting ensure that all claims sections are fully completed
- Attach receipt or proof of payment matching gross amount
- For all Lab or Radiology claims attach Doctors Request form
Drug/ Pharmacy Claims
- These are claims from Pharmaceuticals which shows all information about medicine acquired.
- When submitting ensure that all claim sections are fully completed
- Attach Doctor`s prescription
- Attach Receipt matching gross amount
Dental Claims
- These are claims for Dental treatment
- When submitting ensure that all claim sections are fully completed
- Attach Receipt matching gross amount
- Attach Lab invoices
Hospital Claims
- These are claims from Government or Pvt Hospital
- When submitting ensure that all claim sections are fully completed
- Attach Receipt matching gross amount
- Attach all supporting documents i.e., Drugs and sundries form
What are the requirements for Foreign claims?
Foreign Claims
- These are claims for all treatments rendered outside Zimbabwe
- When submitting ensure you complete a Cimas foreign claim form
- Attach detailed invoice from service providers
- Attach Receipt matching gross amount
- Attach Pharmacy invoice showing purchased drugs
- Attach itemized breakdown of drugs and sundries for hospital admissions and all supporting documents
- Attach a prescription
How can l submit a claim form?
MANUAL CLAIM SUBMISSION PLATFORMS
- Cimas Claim Boxes
- Walk in Cimas Offices
- Post Office (Cimas Pvt Bag 1243)
DIGITAL CLAIM SUBMISSION PLATFORMS
- claims@cimas.co.zw
- claimsteam@cimas.co.zw
- foreignclaims@cimas.co.zw
- Cimas Claims WhatsApp 0787983949
- Cimas Mobile App
- Biometric system NH263 (For Providers of Service)
- NB: When submitting @claims@cimas.co.zw email send only one complete claim form with supporting documents per email. The email is linked to our claims processing system which can only process one claim transaction per cycle.
How long does it take before claims expire?
- General Practitioners – 3 months
- Specialist Claims – 3 months
- Drug Claims – 3 months
- Government & Mission hospitals – 4 months
- Private Hospital – 3 months
- Foreign Treatment Claims – 4 months
I was treated outside the country three months ago. Can I submit my claims?
Yes, foreign claims are valid for four months from date of treatment.
Why does cimas reject claim forms?
Claims with insufficient information will be rejected, check the remittance for rejected reason and resubmit claim within 60 days for reprocessing.
Why does one sometimes incur shortfalls on claims?
- Benefit exhausted
- Provider charges more than cimas award
- Waiting period
- When treatment rendered is not a benefit
Can one claim the shortfall from Cimas?
No. Shortfalls are not claimable from Cimas but 50% of the shortfall can be claimed as a medical credit from the Zimbabwe Revenue Authority (ZIMRA). When you receive your claim settlement
advice from Cimas, you submit it with the shortfall receipts to ZIMRA or your Human Resources Department.
Where can l send my claim query?
- Drug or Dental claim queries - druganddental@cimas.co.zw
- Medical Claims - specialistandpathology@cimas.co.zw
- Hospital and foreign claims - foreignclaims@cimas.co.zw
- For Service Provider Queries - claimsqueries@cimas.co.zw
- NB: All claim queries must be submitted within 60 days of the date of submission
I am on secure package, can my refund for foreign claims be deposited into my offshore account?
All refunds for Secure packages are deposited into local Nostro accounts
I received treatment outside the country, which is much cheaper than getting treated locally, so why do you not reimburse me in full?
We reimburse 50% for unauthorized treatment and 70% for authorized treatment.
Do you reimburse for airfares and accommodation after returning from Foreign treatment
Non-medical services are not a benefit.
Why did you reimburse me using the exchange rate for the date of treatment instead of the rate for the day I paid for the service provided?
This is according to the Cimas policy.
