Managed Care

 

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Medscheme

SAMWUMED recognises the importance of managed care systems in the provision of quality healthcare for our members. As such, we have contracted Medscheme as our Hospital and Oncology Benefit Management Service Provider, Pharmacy Benefit Management and HIV/AIDS Programme Service Provider.

Medscheme is responsible for the following Hospital Benefit Management services:

  • hospital pre-authorisation
  • hospital claims processing and
  • hospital adjudication cases

 

For Hospital Pre-authorisation contact 0860 33 33 87

Under normal circumstances, Medscheme requires pre-authorisation to be completed before admission to hospital, preferably 72 hours before the procedure is performed.

Medscheme has also been appointed to assist our members with the following processes:

  • Pharmacy Benefit  Management and Chronic Medication Registration & Enquiries
  • HIV/AIDS

 

Pharmacy Benefit Management & Enquiries – Medscheme

Tel: 0860 33 33 87 / 0861 100 220
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Chronic Medication Registration & Enquiries – Medscheme

Tel: 0860 33 33 87 / 0861 100 220
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

HIV Management Programme Registrations & Enquiries – Aid for AIDS

Tel: 0860 100 646 / 021 466 1700
Fax: 0800 600773 / 021 466 1701
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Download Aid for AIDS Application Form


Exclusions

With effect from 1 April 2013, all medication on the Acute Exclusion List will no longer be funded from the acute medicine benefit, except where we indicate otherwise. Members should request their prescriber to contact the Scheme's Medicine Risk Management Department with the relevant clinical information in order for their pre-authorisation requests to be considered.

Please click here to view the Exclusion List for all options

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