Benefits


Effective 1 April, 2014 changes will be implemented to the following benefits:

Specialised radiology - On option A changes to a limit of R6330 subject to the following conditions:

  • Clinical authorisation protocols apply
  • Subject to pre-authorisation protocols within PMB guidelines, limited to two scans per family per year

EndoscopicProcedures - Co-payments on Option A and B will be reduced from R2000 to R1000 per event. Any endoscopic procedure under R1000 will be for the member's cost

SAMWUMED's two benefit plans, Option A and Option B, have been carefully designed to provide for your healthcare needs.

It is important that you use your benefits wisely. Ask your healthcare providers questions to make sure that the care prescribed is necessary and appropriate. This will ensure that your benefits are available for the entire year.

Benefits are available from 1 January to 31 December each year, except for members who join the Scheme later in the year in which case pro-rated befits will apply.

Benefits cannot be transferred between categories and cannot be carried over from one year to another. Members cannot claim more than the annual maximum benefit to which they are entitled in terms of the Rules of the Scheme.

SAMWUMED pays for all healthcare services according to the Scheme Tariff, except for PMBs where payment is subject to the relevant sections of the Medical Schemes Act. You are advised to request and check that service providers charge within this Tariff to avoid out-of-pocket costs.

Benefits explained

Benefits can be grouped into two categories:

  • Day-to-day benefits
    Day-to-day benefits are those benefits that you can access outside of hospital such as doctor and specialist consultations and visits, dental procedures, medication and optical care. Each benefit category is subject to limits as specified in the Scheme Rules. These benefits allow you and your family to access a wide range of healthcare services.

  • Secondary or Tertiary Care, includes hospitalisation and the treatment of Prescribed Minimum Benefit (PMB) conditions. The hospitalisation benefit makes provision for in-hospital admission or transfers to rehabilitation and step-down facilities.

Click here to view the benefit brochure.