Claiming correctly

Wellness and maternity

Got a wellness or maternity claim? Here’s all you need to know about correctly submitting your claims.

Wellness claims ICD-10 code: Z00.0

You are doing the right thing and going to have that all-important preventative care check-up with the doctor. Just remember, it is very important that you ask the general practitioner, urologist or gynaecologist to submit the wellness consultation claim using the correct primary ICD-10 code: Z00.0. If this code is not used, the benefit will be paid from your day-to-day benefit instead of from risk.

Maternity claims

If you are pregnant or trying to fall pregnant, OMSMAF is here for you in this exciting time of your life. Please familiarise yourself with the OMSMAF Mother and Baby Care Programme, as all pregnant beneficiaries have to register on the programme in order for maternity claims to be paid from the maternity benefits.

Please ask your treating GP or Gynaecologist to submit the maternity claims with the relevant ICD-10 code to ensure that your claims are paid from the correct benefit.

Remember to submit your claims within the stipulated timeframe, i.e. 4 months from the date of service/treatment.  You can find out more about this on the OMSMAF website. You can also check in on the status of your claims by registering on the Universal.one app.