FAQ

Can I make a claim as soon as my Medicare Policy is issued?

Your policy may be subject to waiting periods, exclusions and provisions, which will be outlined in the policy documents. Otherwise, you will be covered for treatment arising from any illness or for any injury caused by an accident that was not an existing condition before the policy started. 

Where do I get a claim reimbursement form?

You can download a copy of the claim form here. You can also contact us on 207 3500 and our customer service representatives will be happy to assist you.

Is there a time-frame for submitting a claim?

All claims must be submitted to us within 90 days from the date of service.

How is payment made? 

We may make payments by cheque, or credit your bank account directly, in which case you will receive a credit advice.

What is excluded from my insurance policy?

The main exclusions are:

• Pre-existing conditions
• Costs incurred in relation to prescriptions issued by anyone other than a registered medical practitioner
• Mental illness, disease or disorder including depression, anxiety, stress, epilepsy, bulimia or other nervous, psychological, psychiatric or psychogeriatric illness, condition or disorder
• Alcoholism, solvent abuse, drug abuse or addictive conditions of any kind
• Vaccinations, preventive treatment, routine health checks
• Repatriation of mortal remains
• Medical evacuations
• HIV
• Kidney dialysis

For full details, please refer to your policy handbook.

Who should I contact with questions about my payment?

You can check the status of your outpatient claim by logging on to our extranet system on https://secure.swanforlife.com/default.aspx, where you find the following information about claim you submitted:

• Date of occurrence
• Amount claimed
• Amount paid
• Status

You can also contact our customer service representatives, who can be reached on 207-3540 or by e-mail on healthclaims@swanforlife.com .
For full details of your policy cover, please consult your insurance policy handbook. 

What is in-patient cover?

You are considered as an in-patient when:

• You stay overnight in a clinic or hospital for the sole purpose of receiving medical treatment, childbirth or undergoing a surgical procedure
• You undergo a surgical procedure on a day-case basis
• You receive treatment after an accident or you undergo a minor surgical procedure in casualty

For plans A and B, endoscopic procedures are not covered under this section
Admission for investigation purposes only are not covered

What procedures do I follow in case of an in-patient claim, for planned and emergency treatments?

There are two types of in-patient treatment: planned and emergency treatment. You must present your admission and identity cards at the hospital or clinic each time you are admitted for treatment

In the event of planned treatment:

• You must provide us with a full and accurate pre-admission report from your treating doctor and/or surgeon. The report must state, among other facts, the diagnosis or medical condition to be treated and the exact nature of the treatment
• If we have sufficient information, we will issue a provisional authorisation for admission to the clinic or hospital to carry out and/or provide any medical and/or surgical treatment, care, operation, examination or investigation. This is subject to terms, limits and conditions on your policy

In the event of emergency treatment:

• We must be notified immediately when possible, or within 24 hours of admission to the hospital
• In the case of an emergency and/or serious accident, we will provide a provisional authorisation to the clinic, as long as the claim falls within the terms and conditions of the policy, and the policy conditions have not been breached

How is an in-patient claim settled?

• If we have issued a provisional authorisation, after you are discharged, the hospital or clinic will send us the original claim documents for us to reimburse costs
• When we are satisfied that the claim falls within the policy terms and conditions, we will settle the bill for you, dealing directly with the clinic or hospital. Alternatively, you can pay all bills directly to the hospital or clinic and submit the original claims to us once you are discharged. We will reimburse you once the claim is approved
• Reimbursements will be made according to the scale of costs agreement with clinics and doctors, and strictly according to the policy terms and conditions. If there are costs that we do not refund because they do not comply with the scale of costs agreement or the terms and conditions of the policy, you will have to settle those costs directly with the hospital, clinic or doctor concerned.

What is Medical and Surgical Catastrophe cover?

• This optional additional cover provides greater coverage limits in case you need major medical or surgical treatment after an illness or accident
• If the required treatment is not available in Mauritius, we will reimburse the necessary costs incurred for the treatment in the nearest regional overseas medical centre or to another overseas centre. These costs can only be claimed if we give our permission in writing for the treatment to proceed. 
• We will reimburse travel fares and accommodation costs for you and also for a family member who accompanies you to the overseas centre
• We will also pay for post-hospitalisation medication for a maximum of two months and post-hospitalisation out-patient treatment for a maximum of 3 months

What is the process for local treatment under the Medical and Surgical Catastrophe cover?

• For planned and emergency treatments carried out in Mauritius, follow the same procedures set out in the in-patient claims section.

What is the process for treatment abroad under the Medical and Surgical Catastrophe cover?
We will cover medical expenses incurred outside Mauritius for the insured person, up to the limits specified in the schedule. You must:

• Inform us about the treatment within 24 hours of confirming that treatment will have to be performed abroad
• Provide us with a full medical report from the treating doctor or specialist, indicating the nature of illness suffered and recommendation for treatment abroad. You must also provide a cost estimate from the referral centre
• In all cases, before we reimburse any costs, you must obtain written authorisation from us confirming that the treatment or operation abroad is formally approved by our medical officer, and that we agree to reimburse costs.

How do I settle a claim under Medical and Surgical Catastrophe cover?

• You must submit all original documents, including medical reports, prescriptions, clinic bills, detailed accommodation invoices, air tickets receipt, etc. when you return so we can proceed to reimburse the costs
• If the treatment or operation is available in Mauritius, we will only reimburse expenses limited to the scale of costs agreement with clinics and doctors in Mauritius, and under the terms of the policy.

What is the scale of costs?
The scale of costs is the nomenclature of the medical services in Mauritius, together with the maximum fee payable to medical practitioners and clinics.

How do I file an outpatient claim?

If you need to submit a claim, please provide the following original documents:

• Claim form correctly completed and signed
• Doctor’s receipt(s)/reports clearly stating the diagnosis o Doctor’s prescription
• Pharmacy receipts, which must be typed or written in clear handwriting o Hospital discharge summary
• Doctor’s requests for ALL tests done
• Doctor’s referral letter for physiotherapy or other therapies
• Breakdown of costs of all blood tests and other investigations
• Optical: optician’s prescriptions for new or replacement lenses
• Dental: detail of procedure(s) done, including notation of tooth or teeth treated or repaired

Submit the claim form, along with the claim reimbursement supporting documents to our nearest branch or to head office:

Health & Travel Department - Claims Section
11th Floor Swan Centre
10, Intendance Street
PORT LOUIS