1UMVUZO HEALTH EXTREME

EXTREME

2018HEALTH GUIDE

2 UMVUZO HEALTH EXTREME

MEDICATION> Scripted: acute medication as prescribed > Unscripted: over the counter medication

ADDITIONAL CHRONIC MEDICATION (FORMULARY)> Scripted: 9 additional chronic conditions subject

to available funds in the family bene�t and Disease Management Programme registration

OVER THE COUNTER MEDICATION> Limited to R750 per bene�ciary per year

ORAL CONTRACEPTIVES> Limited to R140 per registered female per month

HOMEOPATHY> Cover limited to homeopathic consultations and

medication, subject to available funds in the family bene�ts

WELCOME TO

Umvuzo’s EXTREME OPTION.Your comprehensive healthcare solution.

YOUR PRIMARY BENEFITS

GENERAL PRACTITIONER & SPECIALIST VISITS> Consultations> Minor procedures in the doctors’ rooms

DENTAL CARE> Consultations> Cleaning, �uoride treatment, scaling, polishing> Fillings> Wisdom teeth extraction (in the dentists’ rooms)> Dentures

OPTOMETRY> Eye test> Frames/lenses/contact lenses: limited to R3 300 per

bene�ciary every 2 years

NO PRE-AUTHORISATION REQUIRED • SUBJECT TO FAMILY BENEFIT

IMPORTANT NOTES

• Penalties will apply if authorisation is obtained after treatment.• The claim may not be paid if pre-authorisation is not obtained.• The Scheme rules supersede the information on this brochure.

UMVUZO ABBREVIATION DICTIONARYGP - General Practitioner • DSP - Designated Service Provider • CDL - Chronic Disease List • PMB - Prescribed Minimum Bene�ts

ANNUAL FAMILY BENEFIT ALLOCATIONMAIN MEMBER ADULT DEPENDANT CHILD DEPENDANT FAMILY BENEFIT

R10 740.00 R10 740.00

R10 740.00 R8 640.00 R19 380.00

R10 740.00 R8 640.00 R4 260.00 R23 640.00

R10 740.00 R8 640.00 R8 520.00 R27 900.00

R10 740.00 R8 640.00 R12 780.00 R32 160.00

IN A RECENT INDEPENDENT BRAND AUDIT OUR MEMBERS HAD THE FOLLOWING TO SAY ABOUT US:

• We go the extra mile• We are co-operative• We listen• We are �exible• We give access

• We are member focussed• Value in bene�ts• We are affordable• We are very inclusive• We are quick to process claims

THE REASONS TO CHOOSE UMVUZOWe have been providing solutions for our members and their families for the past 13 years. We are passionate about people, and show this in everything that we do.

Limited to R2 220 per bene�ciary per year, with a maximum of R185 per event.

3UMVUZO HEALTH EXTREME

YOUR SECONDARY BENEFITS

APPLIANCES (crutches/support/slings)> R10 350 per family per year

TERMINAL AND WOUND CARE> R10 000 per family per year

EMERGENCY MEDICAL SERVICES> Netcare 911

SUPPLEMENTARY BENEFITS> R5 600 per family per year

• Occupational Therapy • Podiatry • Dieticians • Psychology • Speech Therapy and Audiology • Physiotherapy

SPECIALISED DENTISTRY> R7 600 per family per year

• Orthodontic and prosthodontic treatment • Metal base dentures • Ceramic/laminated inlays • Gold inlays • Crowns and bridges

EYE SURGERY> Radial keratotomy/excimer laser once every 2 years

(set protocols apply)

INVESTIGATIONS (OUT OF HOSPITAL)> Limited to R6 500 per family per year

• X-rays and blood tests

PRE-AUTHORISATION REQUIRED • SCHEME RATES APPLY

DISEASE MANAGEMENTACTIVE DISEASE MANAGEMENT PROGRAMMES> Our Active Disease Management Programmes enable us

to plan and coordinate the healthcare of members living with chronic medical conditions, in order to give them the best possible outcomes.

All 26 Chronic Disease List (CDL) are covered as part of Prescribed Minimum Bene�ts (PMB).

Registration on these Disease Management Programmes is necessary to access full bene�ts:

> HIV/Aids> Oncology> Diabetes> Musculoskeletal> Renal> Hypertension> Hyperlipidaemia (high cholesterol)> Asthma/COPD/Bronchiectasis

A total treatment plan for each member includes:• Con�dentiality• Ongoing member support and education• Individualised treatment plan• Ongoing counselling and health monitoring

All Prescribed Minimum Bene�ts are covered according to Scheme rules, protocols and formularies.

How to registerSTEP 1Consult your GP to con�rm diagnosis, registration and fax/email script to Mediscor. ChroniLineTM: Tel: 0860 119 553 | Fax: 0866 151 509 Email: preauth@mediscor.co.za*A look-up facility is available on our website (www.mediscor.net) for the formularies.

STEP 2The member, doctor/pharmacist can contact ChroniLineTM and speak to one of the pharmacists to verify whether the medicine will be authorised from the chronic bene�t.

STEP 3The member can fax/email their chronic prescription. Please ensure that the medical aid details and diagnosis code (ICD10 code) are stated on the script.

For further information on all our Active Disease Management Programmes please email. Email: chronicdisease.management@rxhealth.co.za

YOUR HOSPITAL BENEFITSPRE-AUTHORISATION REQUIRED • SCHEME RATES APPLY • SCHEME USES ALL HOSPITAL GROUPS

GENERAL> Consultations (GP and specialists)> Treatment> Surgical procedures> Non-surgical procedures> Anaesthesia

ACCOMMODATION> General ward> ICU and/or high care (limited to 12 days per bene�ciary

per year)

OVERALL PROSTHESES> R70 850 overall per family per year

The following sub-limits are applicable: • Vascular R46 440 • Joint replacement R46 440 • Functional R16 400 • Major musculoskeletal R27 920

BLOOD TRANSFUSION> 100% covered

SCANS (IN & OUT OF HOSPITAL)> 2 scans per family per year

• RT scan • MRI scan • CAT scan

DISCHARGE MEDICATION> 7 days’ supply

IMPORTANT CONTACT INFORMATION

Alenti Of�ce Park, Building D, 457 Witherite Road, The Willows, Pretoria, 0040PO Box 1463, Faerie Glen, 0043

Call Centre and Authorisations: 0861 083 084

Please Call Me: 082 416 9898

T: +27 (0) 12 845 0000F: +27 (0) 86 670 0242E: info@umvuzohealth.co.za

www.umvuzohealth.co.za

HOW DO I GET A PRE–AUTHORISATION NUMBER?• Call us on 0861 083 084• E-mail: authorisations@rxhealth.co.za• We will access your medical history immediately and assist you with

obtaining any information you may need

PLEASE HAVE ONE OF THE FOLLOWING HANDY WHEN YOU CALL UMVUZO HEALTH• Umvuzo Health membership number• Surname• South African ID number• Passport number (if you are from a neighbouring country)

Administrative and non-emergency medical services are attended to during business hours from:MONDAYS TO THURSDAYS08:00 – 16:30FRIDAYS08:00 – 16:00

COUNCIL FOR MEDICAL SCHEMESCall: 0861 123 267E-mail: support@medicalschemes.com

complaints@medicalschemes.comWebsite: www.medicalschemes.com

SINGLE PARENT FAMILY

R3 576.00

R4 473.00

R5 370.00

R6 267.00

PER MAIN MEMBER: R2 679.00

PER ADULT DEPENDANT: R2 518.00

PER CHILD DEPENDANT: R897.00

CONTRIBUTIONS: FULL DEAL

DUAL PARENT FAMILY

R5 197.00

R6 094.00

R6 991.00

R7 888.00

SINGLE MEMBER

R2 679.00

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