Prostheses & Devices 2026

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SAMWUMED provides cover for both internal and external prostheses. These are artificial body parts such as legs, arms and eyes.

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OPTION A

Paid from Risk

Internal

  • There is an annual family limit of R36,010 for internal prostheses.
  • This includes temporary prostheses and any related apparatus, such as bone cement, bone graft substitutes, and bone anchors.

External

  • There is an annual family benefit of R26,780 for external prosthetics, including artificial eyes, limbs, breast prosthetics and bras.
  • There is an annual limit of R18,020 per beneficiary for artificial iris implants.
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OPTION B

Paid from Risk

Internal

  • There is an annual family limit of R36,730 for internal prostheses.
  • This includes temporary prostheses and any related apparatus, such as bone cement, bone graft substitutes, and bone anchors.

External

  • There is an annual family benefit of R31,260 for external prosthetics, including artificial eyes, limbs, breast prosthetics and bras.
  • There is an annual limit of R18,780 per beneficiary for artificial iris implants.

Conditions:

  • Members are encouraged to use the Scheme’s Network Providers for hip and knee replacement prostheses to avoid a R10,000 co-payment.
  • A clinical motivation, quotations from at least three providers and pre-authorisation are required to access these benefits.
  • The Scheme maintains the right to procure prostheses on behalf of members and to deduct the members’ allocated benefits.

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MEMBERSHIP OPTIONS
OPTION A
Option A for younger members and younger families offers more flexibility and peace of mind.
OPTION B
With Option B we make it possible for the main member to cover up to eight child dependents.