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Kamohelo M

1 reviews | Active since Oct 2020

21 Jul 2021, 14:12

Elixi Claim process

I got a policy document that says my benefits start date is 1/7/2021, on the 6th of July I called them to find out if I may start using my medical insurance as I needed to see a Dr because of illness, the lady I spoke to told me that yes I can start using my benefits and she did not disclose anything else. I went to see a Dr and unfortunately, the Dr took some blood for blood testing and later on, I received a bill from Lancet about the outstanding bill and I called to tell them to claim from the medical insurance, I then received a communication from Elixi that my claim is rejected due to the fact that my benefits only starts in September, I believe this was some sort of a misunderstanding or error on their side but I am the one to pay. I requested a recorded call since well "All calls are recorded" but none was given to me.

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Replies (3)
Elixi
Elixi's reply21 Jul 2021, 15:02
Official
Dear Kamohelo

Thank you for reaching out to us,

We do apologize for any inconvenience which has been caused. When taking out a policy with us, all relevant documentation is sent via email regarding your policy. It is important to take note of each section, its cover, limitations, waiting periods and excesses payable to ensure you fully understand the unique cover of each section. Our policy wording is generic and must be read in conjunction with your schedule as not all cover may be applicable to the plan or option that you have selected.
We refer you to the below General Conditions as listed on page 4 of 13 of your policy documentation issued to you by email :-

 "GENERAL CONDITIONS

1. Waiting Periods Each Insured Person will have the following waiting periods app**** to their benefits:

a. Two (2) month waiting period applicable to all benefits, except emergency transportation and inpatient or outpatient hospital treatment due to an Accident or Emergency;
b. Twelve (12) month waiting period applicable to chronic medication and optometry benefits;
c. Nine (9) month waiting period applicable to pre-birth maternity benefits.
d. The Company reserves the right to waive waiting periods, fully or partially, at its sole discretion. "

Our Customer support team will reach out to you shortly to discuss the matter and assist you further with your query.

Regards
Elixi team
KM
Kamohelo M's update21 Jul 2021, 15:20
Reviewer Update
I did go through the policy document and the confusion was on the "benefit start date" hence I called in to get a clarification and I was told that I can start using it, funny enough is that later on as I also asked for name correction on the policy document,I received a new updated policy document with the benefit starting date of 1 Sep 2021 but this was only after I have used my benefits.
Elixi
Elixi's reply21 Jul 2021, 15:55
Official
Dear Kamohelo

Thank you for the clarity and we sincerely apologize if there was an inconsistency in the information that was provided to you. 

Our customer support team will engage with you on the matter to ensure that it is resolved at earliest.

Regards
Elixi team