Claim Date: Enter the date that the claim was submitted by the employee.

Dependant: If the claim is for the employee's dependant, select the dependant from the list of the employee's registered dependants. All other dependant details (Date of birth, age, relationship and any medical condition ) will be auto-filled from the dependant's record that is linked to the employee's profile.

Claim Code: Once the employee is selected, the health plan options available for selection are shown based on where the person is enrolled. The Single YTD and Dependant YTD will be auto-filled based on the claim type selected.

Doctor/Institution: Select the provider name from the list of available options.

$ Claimed: Enter the full amount being claimed as entered on the claim form submitted by the employee.

Status: The status of the claim will default to NOT SETTLED.

Credit Payment: Select if the refund will be credited to the employee.

YTD Refund: The year-to-date refund amount for the respective claim type and employee will be calculated and displayed. This amount represents the total amount refunded to date for the respective employee and claim type e.g. the total refund for all ‘Medical’ claim types for the employee. You are not allowed to edit this amount.