Prime Cure Forms
Please see below links to our forms available online or downloadable.
Policyholder / Member Forms
Please complete the entire form for your refund to be processed.
Please fill in the entire form online or e-mail the completed form as well as your supporting documentation to refunds@kaelo.co.za. Your refund will be processed within 14 days of receipt of all the information.
Patient Consent Form
Please download and complete the form in full.
Death / Disability Claim Form
Please complete the form online or email the completed form together with all supporting documentation to claims@kaelo.co.za. The death/disability claim will be processed within 14 days of receipt of all the requirements. Where no proof of bank details have been supplied, Prime Cure will not be held responsible for any payment made into an incorrect account.
Healthcare Provider Forms
Dental Pre-Authorisation Request Form
Application forms must be completed in full and submitted either online or via email to authorisation@kaelo.co.za.
For any enquiries, call the Prime Cure Contact Centre on 0861 665 665. If the benefits are approved, a letter of authorisation will be faxed to the attending dental practitioner within three (3) working days of receiving this form. The following benefits require pre-authorisation: dentures (full / partial / reline / rebase).
Optometry Authorisation Form
Application form is to be completed in full and submitted via email: authorisation@kaelo.co.za or online. For any enquiries call
the Prime Cure Call Centre on 0861 665 665. Should benefits be approved, a letter of authorisation will be emailed to the attending provider within
two (2) working days of receipt of this form. Pre-authorisation is required for glasses.
HIV Disease Management Programme Registration
This form must be completed by the treating doctor. Attach the prescription and supporting documentation to the application and submit online or send via email to hivdmp@primecure.co.za.
CDL Chronic Application Form
To be completed by the treating doctor. For a list of approved conditions, please see Section E. Attach the prescription and supporting documentation (laboratory results or motivation), if necessary, to the application. Alternatively download the form to complete and email to pcauth@mediscor.co.za.
Members must be referred by a network GP for out-of-hospital radiology tests. Casualty and in-hospital radiology services require prior authorisation. Contact Prime Cure on 0861 665 665 or send an email to support@kaelo.co.za with your queries. All claims must be submitted electronically to Prime Cure via EDI.
Specialist Referral Form
To be completed by the referring Prime Cure Network doctor. Any procedure not listed requires pre-authorisation. Contact Prime Cure on 0861 665 665 or email – authorisation@kaelo.co.za. The pre-authorisation number must be recorded on the account for it to be considered for payment. Please submit your account electronically via EDI.
Pathology Referral Form
Prime Cure Network GP to refer to a Prime Cure pathology laboratory only. Prime Cure pathology laboratory to submit the claims electronically via their preferred switching house for payment.
Maternity Application Form
Any consultation or procedure not listed requires pre-authorisation by calling Prime Cure – 0861 665 665 or emailing maternity@primecure.co.za. Pre-authorisation number should be recorded on the account to be considered for payment. Please submit your account electronically using the following destination code – 642P.
Patient Consent Form
Please download and complete the form in full.
Banking Details Verification Form
Service providers are requested to complete this form and submit to bankingdetails@primecure.co.za. Kindly accompany the form with a certified ID copy of the account holder and a stamped bank confirmation letter not older than three (3) months.