Sickness Benefit Medical Care

Definition

Sickness Benefit Medical Care involves the limited reimbursement of Medical Expenses incurred by an Insured Person, who is rendered temporarily incapable of work. This Benefit is available for Medical Care Expenses incurred both Locally and Overseas.

Qualifying Conditions

The Qualifying Conditions for the receipt of Sickness Benefit Medical Care are the same as those for the receipt of Sickness Benefit.

However, if the Claim is for the reimbursement of the cost of providing Orthopedic or Prosthetic Appliances, it is not necessary for the Insured Person to show that he was incapable of work (i.e. it is not compulsory that the Medical Certificate show incapacity days).

The Benefit is available to Insured Persons who are sixteen (16) years and over, but below sixty- (60) years of age. There is however an exception for persons who are in receipt of Invalidity and Old Age Benefit, providing such persons can show that they have a history of the particular Medical Condition, before receiving Invalidity or Old Age Benefit.

Rate of Benefit

Reimbursement of Medical Expenses is subjected to specific rates for the various aspects of Medical Care.

Recipients of Invalidity and Old Age Benefit are provided with Drugs free of cost (once a valid Prescription is provided) and free Dental and Spectacle Care (subject to specific limits).

Duration of Benefit

An Insured Person is entitled to the reimbursement of Medical Expenses from the date on which he is rendered incapable of work, for as long as the need for such care continues.

Method of Payment

Benefit Payment Vouchers are issued to Recipients of this Benefit, and these can be encashed at the National Insurance Offices, Post Offices or some Commercial Banks.

Recipients of Old Age and Invalidity Benefit are issued with Coupons to access free Dental and Spectacle care. These Coupons are taken to the Optometrist / Dentist who would be reimbursed by the National Insurance Scheme.

The ‘Coupon System’ is also available to Contributors who are desirous of obtaining Spectacle Care without having to pay cash (the Benefit is limited to a specific amount).

Manner of Claiming

To claim Sickness Benefit Medical Care, the Insured Person must complete the Form SB6A - Claim for Sickness Benefit , and have his Employer complete the Form SB1 - Employer's Statement in Support of Sickness Benefit Medical Care. These, together with all Receipts and a Medical Certificate, must be taken to the nearest National Insurance Office.

Where the Contributor is accessing the Coupon System for Spectacle Care, he/she is required to visit the National Insurance Office with his/her Social Security Card, and (if Spectacles are to be worn for the first time) a Medical Certificate would also be required.

Downloads:

Form SB6A - Claim for Sickness Benefit
Form SB1 - Employer's Statement in Support of Sickness Benefit Medical Care