What percentage of my contributions does SAMWUMED allocate to my savings?
The PMSA amount is a fixed amount. It is equal to 15% of your total contributions.
Question - How is my monthly Contribution income allocated?
The money paid into your PMSA forms part of your monthly contribution to the Scheme. If you leave the Scheme during the year, or move to an Option without a PMSA, the Scheme will calculate how much has been paid into your PMSA and how much you have used. If you have used more than you have paid in, you will need to pay back the difference to the Scheme.
Payment of claims
Claims are paid from your PMSA according to the Scheme Rules and approved benefits. Your PMSA works like a savings account. If you do not use all the money in the account, the balance is carried over to the next year. If you leave the Scheme and join another medical scheme, the Scheme must pay any remaining balance to your new medical scheme. If you do not give us the details of your new medical scheme, or if your new plan does not have a savings account, the remaining balance will be paid to you after five (5) months. This payment will only be made if you have paid in more than you have claimed.
If you have claimed more than you have paid into your PMSA, you will need to pay the extra amount back to the Scheme.
Please note: The Scheme will pay healthcare providers according to the payment agreement in place with them.
How is interest calculated on my Personal Medical Savings Account (PMSA)?
The Scheme pays interest when there is money available in your Personal Medical Savings Account.
The interest rate depends on how much money is in your account. The total interest earned is shared fairly between members who have a positive savings balance at the end of the month. If you have used more from your savings account than you have paid, that amount will first be deducted from your available balance before interest is calculated.
If you leave the Scheme or change options, interest will still be added to any positive PMSA balance until the final refund is paid.
What happens to your savings account if you leave the Scheme (Termination)
Resignation
If you resign from the Scheme and join another medical scheme, any money left in your PMSA will be paid to your new medical scheme. This payment will be made five (5) months after your resignation. This gives healthcare providers four (4) months to submit any outstanding claims and allowance for the Scheme to review your account. If your new medical scheme does not have a savings account, or if you do not join another medical scheme, the money will be paid into your personal bank account.
Death
If a member dies, any money left in their PMSA will be paid to their estate within five (5) months of the date of death.
If the money is not claimed within three (3) years, the Scheme may keep the money as income, in line with the Prescription Act, including when a member cannot be traced and the Scheme has made all reasonable efforts to find the member.
*Before any payment is made, the Scheme will first deduct any money that the member owed to the Scheme.
What happens to your savings account if you change options?
If you move from a plan with a savings account to a plan without a savings account, the Scheme will pay any money owed to you within five (5) months after the change.
How do you track your savings balance?
Each month, the Scheme will send you a statement showing all activity on your PMSA. This will show money paid in, claims paid out, and your remaining savings balance.
What information must be submitted to the Scheme upon termination, transfer or death?
You must send the Scheme the following information within 30 days after your membership ends, you transfer to another scheme, or the member passes away:
- proof that you have joined another medical scheme;
- certified bank details for the new medical scheme, if your PMSA balance must be transferred;
- estate bank account details if the member has passed away; or
- your certified recent bank account details or bank confirmation letter, if the money must be paid to you directly.
If you do not send the required documents, the Scheme will use the banking details recorded on your membership profile.
Can I use my full annual PMSA at the beginning of the year?
Yes. You can use your full annual PMSA amount at the start of the year. This means the Scheme makes the money available to you upfront. However, if you leave the Scheme, transfer to another scheme, or change options before you have paid enough contributions to cover the claims already paid from your PMSA, you must pay back the difference.
What types of claims are paid from the Personal Medical Savings Account?
Your PMSA is usually used to pay for everyday healthcare costs, such as visits to a GP, medicine from a pharmacy, and other day-to-day medical expenses. These claims will only be paid from your PMSA if they are not covered by the Scheme’s insured benefits.
What happens when my PMSA is depleted (runs out)?
If the money in your PMSA runs out, you will be liable to pay for your day-to-day medical expenses. This will apply unless your plan includes extra insured benefits that cover those costs.
What is the claims run-off period?
This is the four-month period after the date you received medical treatment or a service. During this time, healthcare providers can still send claims to the Scheme to be paid from your PMSA, even after your membership ends or after you change options.
Disclaimer:
This FAQ is a summary for informational purposes only. In the event of any discrepancies, the registered Scheme Rules and Benefits will prevail.
