Medical aid claims assessment for South African schemes
Every claim assessed before a single rand is paid.
Aion checks each hospital, practice, pharmacy and dental claim against the member's option, savings pot and annual limits, puts investigation flags in front of the assessor, and sends every member a monthly statement.
How a claim moves
Captured, assessed, decided — with the reason kept on the claim
Capture
A practice submits online, or the counter photographs the handwritten form. The AI layer reads it and a clerk confirms every field.
Assess
The claim is checked against the option: what the savings pot still holds, and how much of each annual limit and sub-limit is left.
Decide
The assessor approves, short-pays, queries or rejects, with flags on the claim, the member or the provider shown first.
Pay and state
Providers are paid by EFT, contributions are collected, and each member gets a monthly statement in their portal.
Built for all four levels of care
One system for hospitals, practices, pharmacies and dental
Hospitals
Admissions drawn against the hospital benefit and annual limit, with ward-rate short-payments recorded.
Practices and GPs
Consultations paid from savings or the day-to-day sub-limit, tracked per family.
Pharmacies
Scripts claimed at the counter and checked against the medicine benefit.
Dental
Procedures checked against the dental sub-limit before payment.
Scheme options on Aion
Options, contributions and savings pots
Monthly contribution for the principal member. Dependant rates are set per option by each scheme.