Hospital Cash Back Claim

Please note that benefits shall be payable for every day spent in hospital from the fourth day of continuous hospitalisation. Econet Life must be notified that a Claim is being made as soon as reasonably on, during or after hospitalisation, but in any event no later than 30 days from date of discharge.

Econet Life reserves the right to call for any additional documentation as may be required from time-to-time to validate the information provided and the Policy Holder or Beneficiary shall supply in writing at his/her own cost any reasonable information that the Insurer may request.

Member Details
Hospital And Doctor Details
Claimant Details (If Different From Member)
Required Documents

Member Details

Surname

First names

ID Number

Date of Birth

Mobile Number

Address

Date of Hospitalization

Time of Hospitalisation

Date of Discharge

Time of Discharge

Reason for Hospitalization

Name of Medical Aid

Medical Aid Number

Hospital And Doctor Details

Name of Hospital

Address of Hospital

Telephone

Name of admitting Doctor

admitting Doctor AHFOZ No

Name of discharging doctor

Discharging Doctor AHFAZ No

Claimant Details (If Different From Member)

Surname

First Names

National ID

Mobile Numbers

Address

Relationship to Policy Holder

Required Documents

Patient Card Choose a file

Max. size: 6.0 GB

Hospital Statement Choose a file

Max. size: 6.0 GB

Other medical records from the hospital Choose a file

Max. size: 6.0 GB

Medical aid card Choose a file

Max. size: 6.0 GB

Receipts for all cash payments Choose a file

Max. size: 6.0 GB

Letter of admission Choose a file

Max. size: 6.0 GB

Letter of discharge Choose a file

Max. size: 6.0 GB

Copy of ID Claimant Choose a file

Max. size: 6.0 GB

Click to agree

I HEREBY IRREVOCABLY AUTHORISE and request any Doctor or other person who may be in possession of, or hereafter acquire, any information concerning my health up to the date hereof to disclose such information to Life (Pvt) Ltd and I agree that, this authority and request shall remain in force after my death as well as prior thereto.