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Outpatient / Reimbursement
In the event of a potential OUTPATIENT REIMBURSEMENT CLAIM

In order to make a claim for Outpatient reimbursement:

Complete a FijiCare reimbursement claim form and include;

  • Details such as the full name of Insured, claimant or dependent whichever is applicable with their EDP or FNPF number and date of birth.
  • Submit original receipts and invoices to FijiCare.
  • Breakdown on receipts, diagnosis should be shown on the claim form.
  • On receipt of the above, then FijiCare will process the claim further.

Note: Please ensure that your premium is kept current and up to date, as we cannot process any claim where the premium is in arrears.

Outpatient Claims

Our Outpatient Team does not only provide health services, we also ensure to bestow happiness to our members when giving out their payments/medical cards on time.

  • We offer the best services in handling claims. We always remember that we must pay claims money to the insured/claimant [or their broker] within the maximum period of 7 days. This is subject to all information/documents in order.
  • We also ensure that we process and arrange payment to our Providers [doctors and pharmacies] as and when received.
  • If we decline a claim or offer a settlement that the consumer is dissatisfied with, we always provide reasons for doing so.
  • Refer below on our standard turn around period of issuance of your FijiCare medical cards.

 

Clients coming into the
office
Same time

 

Medium Groups
(below 80 members)
2 – 3 working days max

 

 

 

Small Groups / Individuals
(below 40 members)
1 – 2 working days max

 

Large Groups
(above 80 members)
3 – 5 working days max

All documentations must be in order, for claims to be processed within the timeframe scheduled above. Failure to provide all necessary documentations/receipts/information will further delay the process of the claim.