2019 - home | samwumed
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MEMBER GUIDE2019
• Increases in Overall Annual Limit for hospitilisation to R750,000 on Option A and R1,500,000 on Option B.
• Removal of State hospitals from network of DSP for all in-hospital procedures.
• Yet still one of the lowest contribution you will pay in the entire sector.• No contribution increase for salary bands R0 - R5,900 on Option A
and salary bands R0 - R5,400 on Option B.• Non-PMB Chronic covered on both Options.• Improved oncology benefits – members on both Options get to
enjoy the non-PMB oncology benefit.• General radiology on Option A for also covers non-PMB
conditions.• Improved Preventative Care Benefits for 2019.
MISSION STATEMENT
We commit ourselves to service excellence by providing the most affordable, member friendly, accessible and accountable scheme and administration.
VISION
BENEFITS AND CONTRIBUTION IMPROVEMENTS
• To be the leading medical scheme in the local government sector.• To provide a holistic and progressive primary health service
nationally.• To provide guaranteed affordability by offering appropriate benefits
and access to the best medical services.• To create healthy and satisfied members through education
and efficient administration in a member friendly environment.• Commitment to the principle of non-profit and to remain sustainable.• To be one of the most desired organisations to work for
in South Africa.• To promote clean, healthy and sustainable environment.
SAMWUMED | MEMBER GUIDE 2019
DISCLAIMER:This Member Guide is prepared and distributed for purposes of providing you with essential information to help you select the best benefit option for you and your family. It is not a full guide to the Scheme Rules and Benefits and does not supersede the Scheme Rules. All contributions and benefit options presented in the Member Guide are subject to the approval by the Council for Medical Schemes. Kindly familiarise yourself with your chosen benefit option and note where pre-authorisations, motivations and or letters of referral are required to access benefits.
SAMWUMED | MEMBER GUIDE 2019
The Scheme’s foremost priority, which is quality service to its members and all related parties, remains unchanged.
People are at the heart of all we do. For this reason, we strive to provide our members with positive experiences that go beyond simply facilitating healthcare transactions.
Our success is based on high reserve levels way above the requirements of the Regulator, a strong focus on service excellence which together, ensure that our members and their families have access tothe right medical cover when they need it.
In this way, we see ourselves not just as a medical aid scheme, but as an advocate of our members’ interests and their right to a healthy life.
CONTENTS
GLOSSARY OF TERMS USED IN THIS GUIDE 1REASONS WHY WE ARE THE BEST MEDICAL AID FOR YOU 3BENEFITS CAN BE GROUPED INTO TWO CATEGORIES 4PREVENTATIVE CARE BENEFITS AND EARLY DETECTION 5ENTITLEMENT TO BENEFITS 6CHANGING OF BENEFITS, LIMITS (INCLUDING OVERALL ANNUAL LIMITS), AND MEMBERSHIP CATEGORIES
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PRESCRIBED MINIMUM BENEFITS (“PMB”) 8GENERAL BENEFITS AND LIMITS 8Prescribed Minimum Benefits 8Limitation and Restriction of Benefits 82019 BENEFITS AND CONTRIBUTIONS 11Option A 12Option B 17MATERNITY BENEFITS 22ADDITIONAL VALUE 23SAMWUMED Primary Healthcare Benefit Programme 23Chronic Medicine Benefits 23Hospital Care 23MONTHLY CONTRIBUTIONS 24Definitions 26WHAT DOCUMENTS DO I NEED TO BECOME A MEMBER? 27MEMBERSHIP MANAGEMENT 28SAMWUMED’s Premiums and Membership Department is responsible for all aspects of membership and the collection of contributions
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Movement between Schemes during the year is not allowed 28Registering dependants 29Child dependants 29Birth of a child 29Adult Dependants 29EXCLUSIONS 30
SAMWUMED | MEMBER GUIDE 2019
CONTENTS
SAMWUMED | MEMBER GUIDE 2019
QUICK GUIDE: INFORMATION ON ACCESSING YOUR BENEFITS EFFICIENTLY 30Getting authorisation for your hospital stay 30Why is pre-authorisation necessary? 30When do you need to contact us for pre-authorisation? 31How do I pre-authorise? 31What if I'm diagnosed with Cancer? 31What happens in an emergency? 31What is a PMB? 32Access and care 32Checking available benefits 33Obtaining pre-authorisation from the call centre 33Benefits that require motivation and/or referral letters 33What is covered under the medication benefit? 33How to register and obtain medication for a chronic condition 33HIV MANAGEMENT PROGRAMME 34How and when to use the SAMWUMED Primary Healthcare Programme Benefit 34How to replace lost membership cards 35Submission and payment of accounts 35How our claims processing works 36HOW TO CHOOSE YOUR MEDICAL SCHEME FOR 2019 37Advice on choosing a medical scheme or benefit option 37Advice for current medical scheme members 37WHAT IS A MEDICAL SCHEME? 38But what does this mean? 38How the Act protects members of medical schemes 38WHAT IS AN ADMINISTRATOR? 38What are administrators? 38What do administrators do exactly? 38Self-administered medical schemes 39MEDICAL SCHEMES VS MEDICAL INSURANCE? 39
CONTENTS
SAMWUMED | MEMBER GUIDE 2019
WHAT SHOULD YOU ASK YOUR DOCTOR OR SERVICE PROVIDER BEFORE TREATMENT?
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What is involuntary use of a non-DSP? 41How does treatment at DSPs work? 41THE COMPLAINTS PROCESS 42Who can complain to the Registrar’s Office? 42Who can you complain about? 42Time limits for dealing with complaints 42The Registrar’s Ruling and appeal to Council 43The Section 50 Appeal’s process 43How to avoid complaints 43HOSPITAL NETWORKS 44Eastern Cape 44Free State 44Gauteng 44Kwa-Zulu Natal (*Note: Melomed Richards Bay is an exclusive Scheme DSP) 45Limpopo 46Mpumalanga 46North West 46Northern Cape 46Western Cape (*Note: The Scheme has an exclusive contract with the Melomed group of hospitals in Cape Town and surroundings, up to a 40 km radius).
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PHARMACY NETWORKS 46Eastern Cape 46Free State 48Gauteng 49Kwa-Zulu Natal 55Limpopo 58Mpumalanga 59North West 59Western Cape 61FAQ'S: FREQUENTLY ASKED QUESTIONS 65TALK TO SAMWUMED TODAY 66
GLOSSARY OF TERMS USED IN THIS GUIDE:• BENEFIT LIMIT:
The maximum amount that the member or dependant is entitled to for a specific benefit category, taking into account the Scheme Rules and Scheme Tariff paid for goods, services or appliances.
• CO-PAYMENT:The part of the account that a member pays in situations where the benefit does not cover the relevant health service, or when the provider charges fees that are higher than the Scheme Tariff.
• DEPENDANT:A spouse or partner, child or parent who is dependent on the member for care and support.
• PBPA: Per Beneficiary Per Annum
• DESIGNATED SERVICE PROVIDER (DSP):The service provider that the Scheme has chosen to provide certain medical care for PMBs.
• EXCLUSIONS:Any treatment, medications, appliances or similar that are not covered in terms of the Rules of the Scheme.
• FORMULARY: A list of medicines.
• ICD-10 CODE:The International Classification of Diseases (ICD) – 10. A system that organises diseases and the complications connected to these diseases according to specific categories.
• MEDICAL SCHEMES ACT: The law that governs all medical schemes in South Africa.
• OVERALL ANNUAL LIMIT (OAL): The limit that every member and their dependants cannot exceed during each benefit year.
• PRE-AUTHORISATION:The prior approval of scheduled surgeries and procedures. Whenever hospitalisation is required (ER, triage, that already exists at the time a member or their dependant joins the Scheme (scans and casualty ward) this must be confirmed with the Scheme and Managed Care. Please also not that there are certain day-to-day benefits that require pre-authorisation.
• PRE-EXISTING MEDICAL CONDITION: A medical condition or illness.
• PRESCRIBED MINIMUM BENEFITS (PMBs): A list of conditions, specified in the Medical Schemes Act 131 of 1998, for which all members are entitled to treatment.
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• PRESCRIBED CYCLES:The number of times a member is allowed to access certain benefits during a specific benefit year(s).
• PREFERRED PROVIDER:A provider that the Scheme has negotiated favourable rates with and that can be used as an alternative to a DSP in the event of an emergency. A Preferred Provider may also be used if a DSP is not within reasonable travelling distance or does not offer the treatment or services required.
• PRO-RATED BENEFITS:Benefits allocated to a member based on the number of contributions they have paid. This applies to members who join after March of the benefit year.
• SCHEME TARIFF:The rate according to which the Scheme pays for claims.
• SUB-LIMIT:Forms part of a broader benefit category.
• WAITING PERIOD:A period during which members will not be covered even though they are paying contributions.
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• 1 MONTH WAITING PERIODWe have reduced the general waiting period from 3 months to 1 for new members.Dependants who join after the main member will be subject to a 3 month waitingperiod.
• LOWEST CONTRIBUTION INCREASES IN THE INDUSTRY Our contribution increases are about the lowest in the industry. Whilst we have reviewed the Overall Annual and Hospital Limits – our analysis indicates that this may only adversely affect approximately 3% of members. The average claim spend of an average family remains at approximately R30 000.00 – so in simple terms a million rands worth of benefit is not generally going to be consumed by the average family – except being used to woo and impress members. The only incentive this creates is for opportunistic service providers. In the event that a member does require high level care for PMB conditions – THERE ARE NO LIMITS.
• ACCESS TO PRIVATE HOSPITALS* Our hospital contracts and networks have been reviewed to include more choice for our members and PMB level of care in private hospitals, subject to terms and conditions.
• WE ARE ABLE TO PROVIDE PERSONALISED SERVICES We have our own marketing infrastructure – this means that we are able to provide personalised services on an exclusive and consistent basis. We have our own offices and are rolling out more offices around the country.
• NO LATE JOINER FEES You do not pay late joiner fees when you join us.
REASONS WHY WE ARE THE BEST MEDICAL AID FOR YOU
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BENEFITS CAN BE GROUPED INTO
• DAY-TO-DAY 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 and/or transfers to rehabilitation and step-down facilities.
BENEFITS CAN BE GROUPED INTO TWO CATEGORIES:
SAMWUMED | MEMBER GUIDE 20194
• Addison's disease• Asthma• Bipolar Mood Disorder• Bronchiectasis• Cardiac failure• Cardiomyopathy• Chronic obstructive pulmonary disease• Chronic renal disease • Coronary artery disease
• Crohn's disease • Diabetes insipidus• Diabetes mellitus types 1 & 2• Dysrhythmias • Epilepsy• Glaucoma • Haemophilia• HIV/Aids• Hyperlipidaemia
• Hypertension• Hypothyroidism• Multiple sclerosis• Parkinson's disease• Rheumatoid arthritis• Schizophrenia• Systemic lupus erythematosus• Ulcerative colitis
SPECIFIES MEDICATION AND TREATMENT FOR THE 26 CHRONIC CONDITIONS THAT ARE COVERED UNDER THE PMBs:
IF YOU HAVE ANY QUESTIONS PLEASE CONTACT OUR CONTACT CENTRE ON 0860 104 117
THE CHRONIC DISEASE LIST (CDL)
WE BELIEVE EVERYONE
IS ENTITLED TO QUALITY
HEALTHCARE
AGE SCREENING TEST CONDITIONS 2019Adults Blood Pressure Up to one screening Pbpa
Adults Type II diabetesAdults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg or BMI in the overweight or obese ranges
Up to one screening Pbpa
25 to 64 years Total Blood Cholesterol
• Males between 25-64 years of age• Females between 45-64 years of age• Persons with a family history of familial hypercholesterolemia, heart attacks and cholesterol problems
Up to one screening Pbpa
11 To 24 years
25 To 64 years
over 65 years old
Papanicolaou (Pap) test
• Sexually active female beneficiaries from age 18• Chlamydia screen is recommended as part of this process• Teach clinical breast examination to >18 Up to one screening
Pbpa within a 2 year cycleChlamydia screening This should be done concomitantly with Pap Smear.
Child bearing age Folic acid Up to 1 per month for the first 3 months of pregnancyUp to 1 per month for the first 3 months of pregnancy
50 Years and older
Faecal occult blood test Up to one screening Pbpa Up to one screening Pbpa
Over the age of45 until the age of 70 Mammogram
• Breast Cancer • Every 3 years - females over the age of 45 until the age 70• If sister or mother had/ has breast cancer start annually at 40 years of age• Every 1-2 years - Females between 65-69 years of age• If normal previously: do every 2 years, if clinical examination normal and self-examination is done
Up to one screening Pb every three years until the age of 70
Women older than 60 years and men older than 70 years
Bone density Test Screening from 60 years for patients who are at risk of developing osteoporosis Up to one Pbpa
45 years to 70 years
Screening for prostate cancer Up to one Pbpa
All Ages HIV One test per member per annum
25 years to 65 years Cervical cancer
• Initiate screening at age 25 or at diagnosis of HIV positivity• End screening at age 65 or after hysterectomy• End screening only after previous negative tests, never end if HIV positive• HPV tests to be repeated every 5 years if HIV negative or unknown and annually if HIV positive• Cytology tests to be repeated every 3 years if HIV negative or unknown or annually if HIV positive
Repeat every 5 years if HIV negative, every 3 years if HIV positive
Less than 1 month old TSH screening Congenital hyperthyroidism
Once-off for hyperthyroidism in new-borns
2 to 64 years,over 65 years old
Pneumococcal vaccine
Up to one vaccination per beneficiary over 65 and beneficiaries aged 2-64 who are at risk of serious pneumococcal disease per lifetime.
One vaccination per beneficiary per lifetime
* Pbpa = Per beneficiary per annum
PREVENTATIVE CARE BENEFITS AND EARLY DETECTION
Apart from ensuring our members do not find themselves in hospital, the SAMWUMED Preventative Healthcare and early detection benefit provides members with an opportunity to take ownership of their own health. This programme will ensure together we could better manage quality health outcomes which would ultimately result in lower medical aid premiums. Our amazing Preventative Healthcare Programmes includes the following screenings:
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• The Scheme Tariff for will be the SAMWUMED monetary tariffs applicable in 2019 increased by CPI as published by the SARB, unless an alternative tariff has been negotiated with specific providers, which will not be less than the fee charged by the State.
• Beneficiaries are entitled to benefits as shown in this Annexure B, subject to the monetary limits and implementation restrictions set out herein, to the exclusions referred to in Annexure C of the Rules, to the general limitation and restriction of benefits set out in Annexure D of the Rules and to the procedural and other requirements set out in the Main Rules.
ENTITLEMENT TO BENEFITS
• The column headed “SAMWUMED Option benefits available” shows the extent to which the relevant benefit is limited annually or sub-limited in monetary value or other terms. When that limit is reached no further benefits are available in the category.
• The column headed “Benefits” shows how the cost of a valid claim shall be determined for the purpose of reimbursing the member or the supplier and the share of such cost that the Scheme will bear. The balance of the share of costs to make up 100% thereof shall be the member’s responsibility, except for Prescribed Minimum Benefits.
• The overall annual benefit limits are as follows:
OPTION LIMIT AMOUNTS Option A R 750,000 per family per annum Option B R 1 500,000 per family per annum
• Membership categories:
Member only = M0 Member plus 1 dependant = M1 Member plus 2 dependants = M2 Member plus 3 or more dependants = M3+
CHANGING OF BENEFITS, LIMITS (INCLUDING OVERALL ANNUAL LIMITS), AND MEMBERSHIP CATEGORIES
SAMWUMED | MEMBER GUIDE 20196
• General conditions for the selection/change of a Preferred Family Practitioner (PFP)
• The Scheme shall pay for benefits in respect of out-of-hospital consultations by Family Practitioners subject to the conditions set out in the Scheme Rules.
• Each member, on behalf of himself or herself and his or her registered dependants, shall select a PFP by completing the Selection Form as required by the Scheme.
• It is permissible for dependants to select different PFP’s, subject to the following provi-sions:
• Adult dependants (e.g. spouses) may select a PFP of their choice;• For child dependants under the age of 16 years, a PFP will be selected by the parent
registered as the principal member of the Scheme;• Child dependants over the age of 16 years may select their own PFP, with the con-
sent of the parent registered as the principal member of the Scheme;• A PFP may be changed at the principal member’s discretion once every six (6)
months by completing a “Selection/Change of Preferred Family Practitioner” form. These forms are available from the Employer’s Human Resources Department;
• Where a PFP is part of a group practice of Family Practitioners, members may visit any doctor in the group practice provided that the claim is submitted on a group practice number;
• When a member/beneficiary is referred by a Family Practitioner to a specialist, the consultation for the specialist will be covered in accordance with the Scheme Rules;
• In the event of emergencies, the rule relating to PFP’s will apply.
• A member/beneficiary will be required to obtain a referral number from his PFP for a specialist consultation. The following exceptions are applicable:
• 1 (one) Urologist consultation/ visit for male beneficiaries• 1 (one) gynaecological consultation/ visit for female beneficiaries• Children under the age of 2 (two) years, for paediatric visits / consultations• Alternative healthcare practitioners • Dental practitioners, technologists and therapists• Maternity benefits - Ante natal visits and consultations• Oncologists, haematologists and credentialed medical practitioners during pre,
active and/ or post active treatment periods• Ophthalmologist• Optometrists• Pathologists• Psychiatrists, psychometrists, psychologists and registered counsellors• Radiologists
The preferred family practitioner (PFP) negotiations are still in progress
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Prescribed Minimum Benefits as shown in Annexure A of the General Regulations, made in terms of the Medical Schemes Act 131 of 1998, override all benefits and limits indicated in this Annexure.
The Prescribed Minimum Benefits are available in conjunction with the Scheme’s contracted managed health care programmes, which include the application of treatment protocols, medicine formularies, pre-authorisation and case management. These measures have been implemented to ensure appropriate and effective delivery of Prescribed Minimum Benefits. See Annexure D - paragraph 7 for a full explanation.
PRESCRIBED MINIMUM BENEFIT (“PMB”) RULES EXTRACT
PRESCRIBED MINIMUM BENEFITS
• The Scheme will pay in full, without co-payment or use of deductibles, the diagnosis, treatment and care costs of the prescribed minimum benefits as per Regulation 8 of the Act, in compliance to agreed tariffs. The Scheme will employ appropriate interventions aimed at improving the efficiency and effectiveness of healthcare provision, including such techniques as requirements for pre-authorisation, the application of treatment protocols, and the use of formularies. (Regulation 8(3)).
• Where a managed health care protocol or a formulary drug preferred by the Scheme, but excluding the PMB algorithm as defined in the Regulation has been ineffective or would cause harm to a beneficiary, the Scheme will fund the cost of the appropriate substitution treatment without a penalty to the beneficiary as required by Regulation 15H and 15I of the Act.
LIMITATION AND RESTRICTION OF BENEFITS
• In cases of an illness of a protracted nature, the Scheme shall have the right to insist upon a member or dependant of a member consulting any particular specialist, the Scheme may nom-inate in consultation with the attending provider.
• The Scheme may require a second opinion in respect of proposed health care service(s) which may result in a claim for benefits and for that purpose the relevant beneficiary shall consult a dental or medical provider nominated by the Scheme and at the cost of the Scheme. In the event that the second opinion proposes different health care service(s) to the first, the Scheme may in its discretion require that the second opinion proposals be followed, unless in terms of the managed health care programme.
• In cases where a specialist is consulted without the recommendation of a Family Practitioner, the benefit allowed by the Scheme may, at its discretion, be limited to the amount that would have been paid to the Family Practitioner for the same service.
• Unless otherwise decided by the Scheme, benefits in respect of medicines obtained on a prescription are limited to one month’s supply (or to the nearest unbroken pack) for every such prescription or repeat thereof.
• If the Scheme or its managed health care programme contracted service supplier has funding guidelines or protocols in respect of covered services and supplies, beneficiaries will only qualify for benefits in respect of those services and supplies with reference to the available funding guidelines and protocols with due regard to the provision of Regulation 15(H) and 15(I).
GENERAL BENEFITS AND LIMITS
SAMWUMED | MEMBER GUIDE 20198
• If the Scheme does not have funding guidelines or protocols in respect of benefits for services and supplies referred to in Annexure B, beneficiaries will only qualify for benefits in respect of those services and supplies if the Scheme or its managed health care programme contracted service supplier acknowledges them as medically necessary, and then subject to such conditions as the Scheme or its managed health care programme contracted service supplier may impose.
“Medically necessary” refers to health services or supplies that meet all the following requirements:
• they are required to restore normal function of an affected limb, organ, or system; • no alternative exists that has a better outcome, is more cost-effective, or has a lower risk; • they are accepted by the relevant service provider as optimal and necessary for the specific
condition, and at an appropriate level to render safe and adequate care; • they are not rendered or provided for the convenience of the relevant beneficiary or service
provider;• outcome studies are available and acceptable to the Scheme in respect of such services
or supplies.• they are not rendered or provided because of personal choice or preference of the relevant
beneficiary or service provider, while other medically appropriate, more cost-effective alternatives exist.
• The Scheme reserves the right not to pay for any new medical technology or, investigational procedures, interventions, new drugs or medicine as applied in clinical medicine, including new indications for existing medicines or technologies, unless the following clinical data relating to the above have been presented to and accepted by the Medical Advisory Committee and such data demonstrating their:
• therapeutic role in clinical medicine;• cost-efficiency and affordability;• value relative to existing services or supplies;• role in drug therapy as established by the Schemes’ managed health care programme
contracted service supplier.
• In the event that:
• the treatment of an extended chronic sickness condition becomes necessary; • a disease or a condition (including pregnancy) requires specialised or intensive treatment; • the treatment of any disease or condition becomes of a protracted nature or requires
extended medicine and such treatment is given in or by a non-designated service provider or a preferred provider, the case may be evaluated in terms of the relevant managed health care programme and, having regard to the aforementioned diseases or conditions in question, the Scheme may require or advise:
• the transfer as arranged by the Scheme of that beneficiary to a public hospital or other designated service provider where appropriate care is available, with due regard to Regulation 8(3)(c);
• the application of a limited drug formulary; • both such transfer and restricted drug formulary;• in order to conserve or maximise efficient utilisation of available benefits.
SAMWUMED | MEMBER GUIDE 2019 9
• In the event that a decision has been, the following conditions shall apply:
• in respect of Prescribed Minimum Benefits, no benefit limit shall apply provided treatment is given in or by a public hospital or designated service provider. If for any reason the beneficiary involuntarily receives treatment in or by a non-designated service provider, no co-payment applies;
• in respect of non-Prescribed Minimum Benefit conditions, if the Scheme or its managed health care programme contracted service supplier should determine that any annual benefit limits, as set out in Annexure B, and available to the beneficiary receiving such treatment, are likely to be exceeded in the course of the year, the beneficiary may be advised to move to a public hospital or designated service provider or to accept a limited drug formulary, or both, in order to conserve available benefits.
In such designated service provider or public facility any costs incurred over and above the limit stipulated in Annexure B (excluding Prescribed Minimum Benefit conditions), shall be the member’s responsibility. The member may elect on behalf of himself or his beneficiary, to remain in the private hospital, or remain on the full drug formulary available, or both, in which event the Scheme shall pay up to the benefit limit stipulated in Annexure B, whereafter the member shall be responsible for payment, direct to the private hospital, for any further treatment in such hospital, or for payment direct to the supplier for further medicine.
• The Scheme (or its managed health care programme contracted service supplier on behalf of the Scheme) may from time to time contract with or credential specific provider groups (networks) or centres of excellence as determined by the Scheme in order to ensure cost effective and appropriate care. The Scheme reserves the right not to fund or partially fund services acquired outside of these networks, provided reasonable steps are taken by the Scheme to ensure access to the network, subject to Prescribed Minimum Benefits.
• The Scheme reserves the right not to pay for procedures performed by non-recognised provid-ers (where applicable).
• Certain procedures may be associated with a significant learning curve and/or are not taught routinely at local universities and/or require special training and experience, including that aimed at maintenance of expertise, and/or need access to certain infrastructure for quality outcomes, where such procedures have been identified by the Scheme’s managed health care programme contracted service supplier. Recognised providers are those who have been acknowledged by meeting minimum training and practice criteria for the safe and effective performance of such procedures. Recognition occurs as a result of a formal application process by interested providers and adjudication of relevant information against competency guidelines by the managed health care programme contracted service supplier and/or appointed credentialing body. Criteria for formal recognition are informed by clinical evidence, clinical guidelines and/or expert opinion.
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BENEFITS & CONTRIBUTIONS
WE HAVE TWO BENEFIT PLANS, OPTION A AND OPTION B,HAVE BEEN CAREFULLY DESIGNED TO PROVIDE FOR YOUR HEALTHCARE NEEDS.
AOPTION BENEFITS
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ALTERNATIVE HEALTH CARE
PODIATRISTHOMEOPATH NATUROPATH CHIROPRACTOR
INCLUDED with GP consultations and visits.
Practitioners to be registered with the Health Professions Council of SA or Allied Health Professionals Council of South Africa.
R 2,650
R 3,750
R 4,750
AMBULANCE SERVICES
ROAD AND AIR Designated Service Provider only.
UNLIMITED FOR EMERGENCY ASSISTANCE ONLY - case managed, and protocols apply.
25% Co-Payment rule for voluntary use of a Non-DSP.
Scheme Members to be held liable for the full cost oftransportation for non-medically justifiable cases.
APPLIANCES MEDICAL ANDSURGICAL
Subject to the submission of a clinical motivation with correct Tariff codes and costing for pre-authorisation by the Scheme.
The Scheme (or contracted managed care company on behalf of the Scheme) may from time to time contract with or pilot with or credential specific provider groups (networks) or centres of excellence or supplier groups as determined by the Scheme in order to ensure cost effective and appropriate care.
Beneficiaries are entitled to benefits from contracted networks appointed as the Scheme’s DSP for PMB benefits and other benefits.
DENTISTRY BASIC BASIC DENTISTRY INCLUDES fillings, root canal treatments, scaling & polishing, extractions, fissure sealants, dentures and repairs Subject to prescribed cycles
R 3,300
R 3,940
R 5,470
R 6,600 FULL DENTURES A 3 YEAR benefit cycle applies.
A 2 YEAR benefit cycle applies.
PFPA = R2,100
The Scheme reserves the right not to fund or partially fund services acquired outside of these networks, provided reasonable steps are taken by the Scheme to ensure access to the network, subject to Prescribed Minimum Benefits.
The Scheme reserves the right not to fund or partially fund services acquired outside of these networks, provided reasonable steps are taken by the Scheme to ensure access to the network, subject to Prescribed Minimum Benefits.
Limits and cycles as per the Scheme’s list of approved appliances apply
PARTIAL DENTURES
GP CONSULTATIONS,
VISITS AND PROCEDURES
DOCTOR’S ROOMS OR HOME
R 3,150
R 4,200
R 5,250
R 6,300
BENEFICIARY LIMITR 3,150 PER ANNUM
EMERGENCY TREATMENT AND PROCEDURES
THIS SUB-LIMIT IS INCLUDED WITH THE GP Consultations, Visits and Procedures limit.
INFERTILITY ONLY PMB CONDITIONS
SUB-LIMITR 1,180 PER FAMILYPER YEAR
EXCLUDED:Cosmetic Dentistry, Veneers and Implants.
Use of DSP
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MEDICATION PRESCRIBED, DISPENSED OR ACUTE
R 1,700
R 2,900
R 4,000
R 5,300
SUB-LIMITR 2,900 PER BENEFICIARY, PER YEAR
PRIMARY HEALTHCARE BENEFIT PROGRAMME
Condition specific benefits, sub limits and treatment plans apply.
CHRONIC MEDICATION Subject to Chronic Disease List (CDL) and Chronic Formulary and protocols apply.
PAT: OVER-THE-COUNTER MEDICINE
INCLUDED with prescribed, dispensed or acute medication limit.
25% CO-PAYMENTvoluntarily utilisation of an out-of-network pharmacy
25% CO-PAYMENTusing out-of-formulary medication
Limited to listed conditions and number of incidents per beneficiary per year as outlined below: Stomach pain, heartburn, indigestion (including reflux), 2 | Acute gastroenteritis: - vomiting and diarrhoea, 2 | Upper and lower respiratory tract infections, 3 | Oral and topical candidiasis: - thrush/fungal or yeast infections, 2 | Helminthic infestation: - worms, 2 | Headache, 4 | Bacterial conjunctivitis: - eye infection, 2 | Urinary tract infection (acute uncomplicated cystitis), 1 | Urticarial: skin rashes, insect bites and stings, 2 | Treatment of wounds and/or infections of the skin/subcutaneous tissues (excl. post- operative wound care), 1
Remind your pharmacist to include the appropriate ICD-10 diagnostic codes with all claims for this Programme.
25% CO-PAYMENTfor Chronic medication not on the Chronic Formulary
25% CO-PAYMENTfor voluntarily utilisation of an out-of-network pharmacy
25% CO-PAYMENTfor using out-of-formulary medication.
25% CO-PAYMENTfor voluntarily utilisation of an out-of-network pharmacy
MENTAL HEALTH
SUBSTANCE DEPENDENCY
CONSULTATIONS/VISITS AND PROCEDURES
Clinical motivation required for authorisation of continued consultations AFTER FIRST 10 INITIAL ASSESSMENTS.
HOSPITALISATION SUBSTANCE DEPENDENCYReferral from an Employee Assistance Programme (EAP) or GP required
MENTAL HEALTH CONDITIONSReferral from specialist required
UP TOR 660PER FAMILY, PER YEAR
SUB-LIMITR 140 PER DAY
Subject to Medicine Formularies and Exclusion Lists.
PMB conditions and protocols apply.
Subject to Scheme Network
Limited to PMB Conditions only
Subject to Scheme Network
Chronic Medication for Depression, Gout, and GORD added to the chronic formulary
Scheme Rules and Protocols apply
INCLUDED with In-Patient benefit.
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AOPTION BENEFITS
OPTICAL FRAMES/LENSES R 6,300 PER FAMILYSubject to prescribed cycles.
Exclusions apply, including but not limited to repairs.
OPHTHALMOLOGIST VISITsubject to referral from Optometrist or GP
FRAMES LENSES A 2 YEAR benefit cycle applies.
SUB-LIMITR 2,100 PER BENEFICIARY, PER YEAR
FRAMES FRAMESR 810 LIMIT PER BENEFICIARY
FRAMES LENSES A 2 YEAR benefit cycle applies.
PATHOLOGY OUT-OF-HOSPITAL INCLUDED with Specialist Benefit.
IN-HOSPITAL R 4,300 PER FAMILYPER YEAR
INCLUDED with In-Patient benefit
PHYSIOTHERAPY OUT-OF-HOSPITAL
IN-HOSPITAL Clinical motivation required for authorisation of continued consultations after first two visits.
INCLUDED with Specialist Benefit.
Limited to PMB Conditions only
R 1,950 PER FAMILYPER YEAR
INCLUDED with Specialist Benefit.
LENSESWHITE LENSES: 100% of the lower cost or Optical Assistant Tariff.
PHOTOCHROMIC LENSES: 100% of the lower cost or Optical Assistant Tariff up to a maximum of R 370 per pair Subject to a prescription of +0.50/-0.50 and above.
FIXED OR GRADIENT TINTS UP TO 35%100% of the lower cost or Optical Association Tariff.
EYE TESTS Subject to family limitLIMITEDONE CONSULTATION PER BENEFICIARYPER ANNUM
Clinical motivation required for authorisation of continued consultations after first two visits.
SAMWUMED | MEMBER GUIDE 2019 15
PROSTHESES INTERNAL
The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member’s benefit.
EXTERNAL (INCLUDING ARTIFICIAL EYES AND LIMBS)
R 25,600PER FAMILY, PER YEARIncluded with In-Patient benefit.
25% co-paymentsAPPLY FOR VOLUNTARY USE OF NON-DSP NETWORKS.
Subject to the submission of a clinical motivation and costings for pre-authorisation by the Scheme.
R 13,150 PER FAMILY, PER YEAR
Subject to the submission of a clinical motivation and costings for pre-authorisation by the Scheme.
The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member’s benefit.
RADIOLOGYRADIOGRAPHY
GENERAL(IN AND OUT-OF-HOSPITAL)
R 8,500 INCLUDED WITH IN-PATIENT BENEFIT
SPECIALISED (IN AND OUT-OF-HOSPITAL)
R 2,300 PER FAMILY, PER YEAR
REMEDIAL THERAPY
OCCUPATIONAL, SPEECHTHERAPY, AUDIOLOGY & DIETICIANS
Subject to GP Referral. Applicable for Out-of-hospital treatment.
SUBJECT TOR 2,110PER FAMILY, PER YEAR
INCLUDED with Specialist benefit for In- or Out-of-hospital treatment.
SPECIALIST CONSULTATIONS,
VISITS AND PROCEDURES
OUT-OF-HOSPITAL R 3,800
R 5,700
R 7,600
R 9,500
IN-HOSPITAL
BENEFICIARY LIMITR 4,600 PER YEAR
Subject to GP Referral
INCLUDED with In-Patient benefit
PER FAMILY,PER YEAR
SAMWUMED | MEMBER GUIDE 201916
AOPTION BENEFITS
HOSPITALISATION IN-PATIENT
“Take Home” medication limited to 7 days’ supply
MATERNITY CAESAREAN SECTIONR 24,400 PER BENEFICIARY, PER YEAR
NORMAL DELIVERY
ABORTIONTHREATENEDR 5,900 PER BENEFICIARY, PER YEAR
OVERALL ANNUAL LIMIT - R 750,000 PER FAMILY, PER YEAR.
R 750,000PER FAMILY,PER YEAR
ABORTIONINCOMPLETER 16,550 PER BENEFICIARY, PER YEAR
ABORTIONINEVITABLER 16,600PER BENEFICIARY, PER YEAR
ABORTIONVOLUNTARYR 4,650 PER BENEFICIARY, PER YEAR
BLOOD TRANSFUSIONSERVICES
INCLUDED with In-Patient benefit
ALTERNATIVES TOHOSPITALISATION
Private nursing, Frail care, Hospice, Step-down facility
INCLUDED with In-Patient benefit
ORGAN TRANSPLANT Scheme Rules and treatment plans apply
OUT-OF-HOSPITALMedication to be obtained from Scheme Networks.
IN-HOSPITALIncluded with In-Patient Benefit. Subject to Scheme Networks.
Pre-Authorisation required
ONCOLOGY
OUT-OF-HOSPITALNon-PMB subject to R 200,000 Subject to Overall Annual Limit and Scheme Networks.
IN-HOSPITALSubject to Overall Annual Limit and Scheme Networks. Included with In-Patient benefit and subject to Scheme Networks.
Subject to Pre-Authorisation
RENAL DIALYSIS PMB ONLYINCLUDED with In-Patient benefit
Subject to Scheme Networks.
Subject to Scheme Network
Scheme Rules and Protocols apply
Subject to pre-authorisation at a DSP (Scheme Network hospitals).
Scheme Rules and Protocols apply
25% co-paymentsAPPLY FOR VOLUNTARY USE OF NON-DSP NETWORKS.
SAMWUMED | MEMBER GUIDE 2019 17
BOPTION BENEFITS
ALTERNATIVE HEALTH CARE
PODIATRIST HOMEOPATH NATUROPATH CHIROPRACTOR
INCLUDED with GP andSpecialist consultations and visits limit.
Practitioners to be registered with the Health Professions Council of SA or Allied Health Professionals Council of South Africa.
AMBULANCE SERVICES
ROAD AND AIR Preferred Service Provider only: Netcare 911
UNLIMITED FOR EMERGENCY ASSISTANCE ONLY - case managed, and protocols apply.
25% Co-Payment rule for voluntary use of a Non-DSP.
Scheme Members to be held liable for the full cost oftransportation for non-medically justifiable cases.
APPLIANCES MEDICAL AND SURGICAL
Subject to the submission of a clinical motivation with correct Tariff codes and costing for pre-authorisation by the Scheme.
The Scheme (or contracted managed care company on behalf of the Scheme) may from time to time contract with or pilot with or credential specific provider groups (networks) or centres of excellence or supplier groups as determined by the Scheme in order to ensure cost effective and appropriate care.
Beneficiaries are entitled to benefits from contracted networks appointed as the Scheme’s DSP for PMB benefits and other benefits.
DENTISTRY BASIC R 7,050
R 8,100
R 9,400
R 10,600 FULL DENTURES
GP AND SPECIALIST
CONSULTATIONS AND VISITS
ROOMS OR HOME R 3,700
R 6,000
R 8,150
R 10,150
BENEFICIARY LIMITR 6,000 PER YEAR
ROOMS OR HOME
A 3 YEAR benefit cycle applies.
A 2 YEAR benefit cycle applies.
PFPA = R3,200
The Scheme reserves the right not to fund or partially fund services acquired outside of these networks, provided reasonable steps are taken by the Scheme to ensure access to the network, subject to Prescribed Minimum Benefits.
Limits and cycles as per the Scheme’s list of approved appliances apply
PARTIAL DENTURES
R 7,710 PER FAMILY, PER YEAR
R 5,850 PER FAMILYPER YEAR
Subject to Scheme networks.
Subject to Scheme networks.
ADVANCED DENTISTRY
Clinical motivation required for pre- authorisation from Scheme.
Orthodontics, crown and bridge work or any procedure that requires anaesthetics. Hospitalisation costs for removal of wisdom teeth or treatment for children under the age of 7 paid from the hospitalisation benefit. Dental procedure costs paid from dentistry benefit
EXCLUSIONS Cosmetic dentistry such as veneers and implants is excluded
GP AND SPECIALIST
PROCEDURES AND TESTS
BASIC DENTISTRY INCLUDES Fillings, root canal treatments, scaling & polishing, extractions, fissure sealants, dentures and repairs Subject to prescribed cycles
SAMWUMED | MEMBER GUIDE 201918
INFERTILITY ONLY PMB CONDITIONS PMB Protocols Apply
MEDICATION PRESCRIBED, DISPENSED OR ACUTE
R 3,300
R 4,350
R 6,650
R 8,750
SUB-LIMITR 4,350 PER BENEFICIARY, PER YEAR
PRIMARY HEALTHCARE BENEFIT PROGRAMME
Condition specific benefits, sub limits and treatment plans apply.
CHRONIC MEDICATION Subject to Chronic Disease List (CDL) and Chronic Formulary and protocols apply.
PAT: OVER-THE-COUNTER MEDICINE
25% CO-PAYMENTfor voluntarily utilisation of an out-of-network pharmacy
25% CO-PAYMENTfor using out-of-formulary medication
Limited to listed conditions and number of incidents per beneficiary per year as outlined below: Stomach pain, heartburn, indigestion (including reflux), 3 | Acute gastroenteritis: - vomiting and diarrhoea, 3 | Upper and lower respiratory tract infections, 4 | Oral and topical candidiasis: - thrush/fungal or yeast infections, 3 | Helminthic infestation: - worms, 2 | Headache, 6 | Bacterial conjunctivitis: - eye infection, 2 | Urinary tract infection (acute uncomplicated cystitis), 1 | Urticarial: skin rashes, insect bites and stings, 2 | Treatment of wounds and/or infections of the skin/subcutaneous tissues (excl. post- operative wound care), 2
Remind your pharmacist to include the appropriate ICD-10 diagnostic codes with all claims for this Programme.
25% CO-PAYMENTfor Chronic medication not on the Chronic Formulary
25% CO-PAYMENTfor voluntarily utilisation of an out-of-network pharmacy
25% CO-PAYMENTfor using out-of-formulary medication
25% CO-PAYMENTfor voluntarily utilisation of an out-of-network pharmacy
MENTAL HEALTH
SUBSTANCE DEPENDENCY
CONSULTATIONS/VISITS AND PROCEDURES.
HOSPITALISATION SUBSTANCE DEPENDENCYReferral from an Employee Assistance Programme (EAP) or GP required
MENTAL HEALTH CONDITIONSReferral from specialist required
LIMITEDR 1,400 PER FAMILY, PER YEAR
SUB-LIMITR 180 PER DAY
Clinical motivation required for authorisation of continued consultations AFTER FIRST 10 INITIAL ASSESSMENTS.
Subject to Medicine Formularies and Exclusion Lists. Included with prescribed, dispensed or acute medication limit.
INCLUDED with In-Patient benefit
Chronic Medication for Depression, Eczema, Gout, GORD, and Menopause added to the chronic formulary
Subject to Scheme Network
Scheme Rules andPMB Protocols apply
Scheme Rules andPMB Protocols apply
Subject to Scheme Network
BOPTION BENEFITS
SAMWUMED | MEMBER GUIDE 2019 19
OPTICAL FRAMES/LENSES/CONTACT LENSES
R 8,450 PER FAMILYSubject to prescribed cycles.
Exclusions apply, including but not limited to repairs.
OPHTHALMOLOGIST CONSULTATIONsubject to referral from Optometrist or GP
SUB-LIMITR 3,150 PER BENEFICIARY, PER YEAR
FRAMES LENSES A 2 YEAR benefit cycle applies.
SPECTACLE LENSES AND CONTACT LENSES CANNOT BE OBTAINED SIMULTANEOUSLY
LENSES WHITE LENSES: 100% of the lower cost or Optical Assistant Tariff.
PHOTOCHROMIC LENSES: 100% of the lower cost or Scheme Tariff up to a maximum of R 370 per pair Subject to a prescription of +0.50/-0.50 and above.
FIXED OR GRADIENT TINTS: 100% of the lower cost or Optical Association Tariff.
PATHOLOGY IN-AND-OUT-OF-HOSPITAL
PHYSIOTHERAPY IN-AND-OUT-OF-HOSPITAL
FRAMES FRAMESR 1,050 LIMIT PER BENEFICIARY
EYE TESTS Subject to family limitONE EYE TEST PER BENEFICIARY, PER ANNUMAT OPTICAL ASSISTANT’S TARIFF
R 8,700 PER FAMILYPER YEAR
Subject to Scheme Network
R 4,350 PER FAMILYPER YEAR
Clinical motivation required for authorisation of continued consultations after first two visits.
SUB-LIMITR 1,780 PER BENEFICIARY, PER YEAR
CONTACT LENSES Contact lenses with a prescription reading of -0.75 or +1.00 and above: 100% of the lower of costs or Optical Assistant Tariff up to a maximum of R 2,350 per beneficiary
FRAMES LENSES A 2 YEAR benefit cycle applies
CONTACT LENSES A 2 YEAR benefit cycle applies
SAMWUMED | MEMBER GUIDE 201920
BOPTION BENEFITS
PROSTHESES INTERNAL
The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member’s benefit.
EXTERNAL (INCLUDING ARTIFICIAL EYES AND LIMBS)
RADIOLOGYRADIOGRAPHY
GENERAL (IN AND OUT-OF-HOSPITAL)
R 13,100PER BENEFICIARY, PER YEAR MRI/CAT or similar Scans limited
SPECIALISED (IN AND OUT-OF-HOSPITAL)
REMEDIAL THERAPY OCCUPATIONAL, SPEECH
THERAPY, AUDIOLOGY & DIETICIANS
Subject to GP Referral.Only applicable for Out-of-hospital treatment.
R 26,100 PER FAMILY, PER YEARIncluded with In-Patient benefit.
Subject to the submission of a clinical motivation and costings for pre-authorisation by the Scheme.
R 15,350 PER FAMILY, PER YEARIncluded with In-Patient benefit.
The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member’s benefit.
R 8,700PER FAMILY, PER YEAR
SUB-LIMITR 4,350PER FAMILY, PER YEAR
In-and-Out of Hospital
Subject to the submission of a clinical motivation and costings for pre-authorisation by the Scheme.
Subject to pre-authorisation from the Scheme
HOSPITALISATION IN-PATIENT Subject to pre-authorisation and registration with Clinical Disease Management Programme for asthma, cardiovascular disease, diabetes, and cancer, where applicable.Scheme Networks for joint replacements, cardiac and abdominal surgery.
“Take Home” medication up to 7 days’ supply
R 1,500,000PER FAMILY,PER YEAR
Subject to Scheme Network
Scheme Rules and PMB Protocols apply
25% co-paymentsAPPLY FOR VOLUNTARY USE OF NON-DSP NETWORKS.
25% co-paymentsAPPLY FOR VOLUNTARY USE OF NON-DSP NETWORKS.
SAMWUMED | MEMBER GUIDE 2019 21
MATERNITYCAESAREAN SECTIONR 26,100PER BENEFICIARY, PER YEAR
NORMAL DELIVERY
ABORTIONTHREATENEDR 6,400 PER BENEFICIARY, PER YEAR
ALTERNATIVES TOHOSPITALISATION
Private nursing, Frail Care,Hospice, Step down Facilities
BLOOD TRANSFUSIONSERVICES
RENAL DIALYSIS
ORGAN TRANSPLANT Scheme Rules and treatment plans apply
OUT-OF-HOSPITALSubject to Overall Annual Limit and Scheme Networks.
IN-HOSPITALIncluded with In-Patient benefit.Subject to Scheme Networks.
ONCOLOGY
OVERALL ANNUAL LIMIT - R 1,500,000 PER FAMILY, PER YEAR.
ABORTIONINCOMPLETER 17,750PER BENEFICIARY, PER YEAR
ABORTIONINEVITABLER 17,750PER BENEFICIARY,PER YEAR
ABORTIONVOLUNTARYR 4,950PER BENEFICIARY, PER YEAR
INCLUDED with In-Patient benefit
INCLUDED with In-Patient benefit
Subject to Scheme Networks.
INCLUDED with In-Patient benefit
Pre-Authorisation required
OUT-OF-HOSPITALNON-PMB SUBJECT TO R300,000Subject to Overall Annual Limit and Scheme Networks.
IN-HOSPITALIncluded with In-Patient benefit and subject to Scheme Networks
Subject to pre-authorisation and registration with Disease Management Programme.
HOSPITALISATION
Scheme Rules and PMB Protocols apply
Expecting moms can access the SAMWUMED Maternity Programme to help take better care of themselves and their unborn baby by taking advantage of a wide range of maternity preventative care and early detection benefits.
Folic Acid At least first trimester of pregnancy Up to first 3 months of pregnancy.
Ultrasounds 100% of Scheme rate, limited to two ultrasounds Pbpa for maternity. Up to two screening Pbpa.
Ante NatalConsultations
8 Ante-natal consultations per maternity event Up to 8 Ante-natal consultations per maternity.
Vitamins Iron Supplements Up to first 3 months of pregnancy.
HIV Screening Screen of 1 test per maternity event within 1st trimester Up to one Pbpa.
Pap Smear(6 weeks Post-Partum)
Limited to one Pbpa within 6 weeks post-partum. Up to one Pbpa.
MATERNITYBENEFITS
SAMWUMED | MEMBER GUIDE 201922
SIMPLY DIAL 0860 33 33 87 TO REGISTER
SAMWUMED PRIMARY HEALTHCARE BENEFIT PROGRAMME
This unique benefit offers SAMWUMED members peace of mind should a member deplete his/her annual medicine benefit. In partnership with our pharmacy network, SAMWUMED has created a formulary (a specific list of most cost effective medicines) available over the counter for the 10 most common ailments:
Subject to Scheme tariffs, members can access these from an approved pharmacist without paying extra money.
• Stomach pain, heartburn, indigestion (including reflux), 2• Acute gastroenteritis: vomiting and diarrhoea, 2• Upper and lower respiratory tract infections, 3• Oral and topical candidiasis: thrush/fungal or yeast infections, 2• Helminthic infestation: worms, 2• Headache, 4• Bacterial conjunctivitis: eye infection, 2• Urinary tract infection (acute uncomplicated cystitis), 1• Urticarial: skin rashes, insect bites and stings, 2• Treatment of wounds and/or infections of the skin/subcutaneous tissues (excl. post- operative wound care), 1
ADDITIONAL VALUE
CHRONIC MEDICINE BENEFITS
A chronic condition is a persistent or otherwise long-lasting illness that may be longer than three months or lifelong. SAMWUMED will cover for the diagnosis, treatment and care of 26 chronic conditions.
SAMWUMED works with Medscheme to give members the best advice on the use of their chronic medication, as well as ensure that their chronic benefits are correctly allocated.
You treating doctor will need to call our Managed Care Provider, Medscheme on 0860 33 33 87 to register for your Chronic Medication.
HOSPITAL CARE
When you need hospital treatment or an operation, SAMWUMED will cover you for approved medical expenses when you are in hospital. The comprehensive hospital benefit cover ensures you are taken care of should you or your loved ones land up in a hospital.
We have partnered with Medscheme as our Hospital and Oncology Benefit Management Service Provider to manage your hospital care.
For all hospital pre-authorisations members can call 0860 33 33 87.
Unless an emergency, members will need to contact Medscheme no less than 72 hours before the procedure to get authorisation for their admission to
hospital on 0860 33 33 87
SAMWUMED | MEMBER GUIDE 2019 23
OUR CONTRIBUTION TABLE FOROPTION A
Table below represents 100% contribution. EMPLOYEES ONLY PAY UP TO 40%.
A] Contributions are paid monthly in arrears.
CONTRIBUTION INCREASE0%100% Contribution 40% Contribution
INCOME BAND PRINCIPAL ADULT CHILD PRINCIPAL ADULT CHILD
R0 - R3 700 R995 R995 R350 R398 R398 R140
R3 701 - R4 800 R1 176 R1 176 R412 R470 R470 R165
R4 801 - R5 900 R1 265 R1 265 R444 R506 R506 R178
CONTRIBUTION INCREASEONLY 7%
SAMWUMED | MEMBER GUIDE 201924
100% Contribution 40% Contribution
INCOME BAND PRINCIPAL ADULT CHILD PRINCIPAL ADULT CHILD
R5 901 - R7 500 R1 530 R1 530 R537 R612 R612 R215
R7 501 - R9 100 R1 640 R1 640 R577 R656 R656 R231
R9 101+ R1 757 R1 757 R620 R703 R703 R248
100% Contribution 40% Contribution
INCOME BAND PRINCIPAL ADULT CHILD PRINCIPAL ADULT CHILD
R5 401 - R6 400 R2 054 R2 054 R720 R822 R822 R288
R6 401 - R7 501 R2 094 R2 094 R735 R838 R838 R294
R7 501 - R10 700 R2 137 R2 137 R751 R855 R855 R300
R10 701 - R13 900 R2 252 R2 252 R765 R901 R901 R306
R13 900+ R2 371 R2 371 R781 R948 R948 R312
Table below represents 100% contribution. EMPLOYEES ONLY PAY UP TO 40%.
B] Contributions are paid monthly in arrears.
OUR 2019CONTRIBUTION TABLE FOROPTION B
SAMWUMED | MEMBER GUIDE 2019 25
100% Contribution 40% Contribution
INCOME BAND PRINCIPAL ADULT CHILD PRINCIPAL ADULT CHILD
R0 - R5 400 R1 694 R1 694 R594 R678 R678 R238
CONTRIBUTION INCREASEONLY 8.3%
CONTRIBUTION INCREASE0%
HOW TO CALCULATE YOUR CONTRIBUTION AS PER YOUR EMPLOYMENT CONTRACT
Establish your income before deductions to establish your Income Band
1 Sum the values in the respective columns for the Principal member and beneficiaries
2 Multiply the total by your contribution percentage as per your Employment Contract
3
R2371 x (40% OR 0.4) = R948
MONTHLYCONTRIBUTIONS
DEFINITIONS OF THE COLUMNS OF THE CONTRIBUTION TABLES
• Salary column: This reflects the monthly salary before tax or other deductions.
• Principal column: This column shows how much the main member, who is a local government employee registered with SAMWUMED, has to pay.
• Adult column: This column shows how much you have to pay for your adult dependants.
• Child column: This column shows how much you have to pay for a child dependant. SAWUMED covers children up to the age of 21, unless the child is mentally or physically disabled or is below 25 years of age and is a student registered at a recognised educational institution and proof thereof is provided.
SAMWUMED | MEMBER GUIDE 201926
Your medical aid contribution is generally paid for from two sources: your employer’s subsidy and your monthly salary. Your employer deducts contributions from your salary each month and pays it over to the Scheme. Contributions are calculated according to income and family size and are paid monthly in arrears.
The Scheme does not have access to your salary.
The Scheme will advise you in cases where incorrect contributions are received or if your employer has not paid the correct amount to the Scheme. If you join after 31 March, you will be subject to pro-rated benefits.
January - March 100% of benefit April - June 75% of benefit July - September 50% of benefit October - December 25% of benefit
WHAT DOCUMENTS DO I NEED TO BECOME A MEMBER?
IT’S SIMPLE TO BECOME A MEMBER OF SAMWUMED
Request and complete an APPLICATION FORM from our Sales & Servicing and Broker Consultants or via your HR office.
Submit your application with photo copies of SOUTH AFRICAN IDENTITY.
You will receive an EMAIL AND SMS from SAMWUMED to confirm receipt of your application.
You will receive your SAMWUMED WELCOME PACK which includes your Membership Quick Guide and Membership Card.
STEP
1STEP
2STEP
3STEP
4
WHAT DOCUMENTS DO I NEED TO BECOME A MEMBER?
SOUTH AFRICAN ID Book/Card, Birth Certificates.
A SWORN AFFIDAVITproving financialdependency for children over the age of 21.
LEGAL DOCUMENTSof adopted/foster children, PREVIOUS MEMBERSHIP.CERTIFICATE
Confirmation of BANKING DETAILS and SALARY SLIP
No matter which benefit option you take, SAMWUMED Medical Aid offers cover in full and as stipulated by Scheme Rules, for the diagnosis, treatment and care of an extensive range of medical conditions.
GO AHEAD AND CHOOSE THE MOST SUITABLE OPTION FOR
YOUR FAMILY’S NEEDS
SAMWUMED | MEMBER GUIDE 2019 27
SAMWUMED’S PREMIUMS AND MEMBERSHIP DEPARTMENT IS RESPONSIBLE FOR ALL ASPECTS OF MEMBERSHIP AND THE COLLECTION OF CONTRIBUTIONS.
All local government employees have the opportunity to change their medical aid options during the Freedom of Association period (also known as the “window period”) from October until the end of November each year. Members who wish to make this change must notify the Scheme in writing by submitting an Option change form via their Human Resource Department by no later than 15 Decemberof the same year. All benefit option changes must be confirmed by January each year.
Section 7 of the South African Local Government Bargain Council’s Main Collective Agreement states that “medical scheme members may make an election regarding movement from one ac-credited medical scheme to another accredited medical scheme on an annual basis before 01 January”.
MOVEMENT BETWEEN SCHEMES DURING THE YEAR IS NOT ALLOWED.
Membership application and dependant registration forms make provision for the disclosure of pre-existing health conditions. Failure to provide the appropriate information to the Scheme could lead to the termination of your or your dependant’s membership. Single principal members are issued with one membership card and families receive two cards. The Scheme does not charge members for replacement of lost or stolen cards.
It is important that the Scheme has the correct identity numbers for members and dependants. Without it, you might not be able to use your benefits. Please contact the Scheme to ensure that we have your correct telephone numbers, address, and details of your dependants.
If your information changes during the year, it is important to let the Scheme know by contacting 0860 104 117.
MEMBERSHIP MANAGEMENT
ALL INFORMATION THAT YOU DISCLOSE TO THE SCHEME IS CONSIDERED CONFIDENTIAL.
You should be mindful not to disclose information such as your membership number or hand over tax or membership certificates/cards to any third party.
SAMWUMED | MEMBER GUIDE 201928
REGISTERING DEPENDANTS
• We have reduced the general waiting period from 3 months to 1 for new members. Dependants who join after the main member will be subject to a 3 month waiting period.
• To register a dependant, a Dependant Registration form must be completed and submitted to the Scheme via your Human Resource Department along with the required documentation such as copies of birth certificates when registering children; affidavits and marriage certificates for spouses and partners; proof of study and/or affidavits proving dependency for dependants over the age of 21.
• The Dependant Registration form makes provision for the disclosure of pre-existing conditions that prospective dependants might have. Depending on the severity of the condition(s), certain waiting periods may be considered by the Scheme before dependants can claim benefits.
• Failure to disclose these pre-existing conditions could limit or exclude a dependant from claiming benefits, according to provision 11.5 of the Scheme Rules, which states that “The Board may, in its absolute discretion, exclude from benefits or terminate the membership of a member or dependant whom the Board finds guilty of abusing the benefits and privileges of the Scheme by presenting false claims or making a material misrepresentation or non-disclosure of factual information or who, in the opinion of the Board, is guilty of misconduct that would either compromise the achievement of the aims and objects of the Scheme or bring the Scheme into disrepute. In such event, he or she may be required by the Board to refund to the Scheme any sum which, but for his or her abuse of the benefits or privileges of the Scheme, would not have been disbursed on his or her behalf.”
CHILD DEPENDANTS
A child dependant is someone up to the age of 21 but not older than 25 years. Student dependants must be attending a recognised educational institution and be without a regular income. To register a child dependant, a birth certificate, identity document, or affidavit (where the child’s surname is not the same as the main member’s) is required. Proof of study or medical report must be submitted for child dependants who are students or mentally/physically disabled.
Grandchildren can be registered, provided that the member is responsible for their care and financial support. An affidavit from parents and member confirming dependency is required and this is subject to an annual review.
BIRTH OF A CHILD
Members must notify the Scheme within 30 days of the birth of a child to qualify for immediate benefits. The birth certificate must be submitted along with the Dependant Registration form. A three-month waiting period will be imposed if the registration is not completed within this time.
ADULT DEPENDANTS
Adult dependants are 21 years and older and can be a spouse or partner. Spouses who are registered within 30 days of marriage will qualify for benefits immediately. A marriage certificate or affidavit must be submitted with the registration form.
A three-month waiting period will be imposed if the registration is not completed within this time.
Dependants over the age of 21, who are not spouses or partners, but are dependent on the main member for care and financial support, can be registered as adult dependants. An affidavit proving this dependency is required. Refer to scheme rules for definition.
SAMWUMED | MEMBER GUIDE 2019 29
If you have any questions regarding membership, please contact our Premiums Department by dialling 0860 104 117 and pressing 2 when prompted or email [email protected].
Exclusions: Any treatment, medications, appliances or similar that are not covered in terms of the Rules of the Scheme is regarded as an exclusion.
Refer to Annexure C of Scheme Rules.
EXCLUSIONSWHAT DOES THE SCHEME NOT PAY FOR?
GETTING AUTHORISATION FOR YOUR HOSPITAL STAY
A Managed Care partner has been contracted by the Scheme to ensure that you and your dependants get cost efficient, quality care in hospital. Managed Care offers you useful advice and their team of doctors and nurses will make sure that you are admitted at the appropriate facility at the correct fee. You must contact Managed Care for pre-authorisation on 0860 33 33 87, at least five (5) working days before a planned procedure or on the first working day after an emergency hospital admission to obtain an authorisation number for your treatment.
Authorisation requests for major surgery should be submitted at least thirty (30) days in advance to allow the Scheme to obtain a second opinion to ensure that you or your dependant receive appropriate treatment.
It is important to note that pre-authorisation is compulsory for hospitalisation and failure to comply could result in a commensurate penalty.
WHY IS PRE-AUTHORISATION NECESSARY?
Pre-authorisation for hospital admissions and certain out-of-hospital care is a key component in managing your access to affordable, appropriate, safe and quality health care. Medscheme’s pre-authorisation requests are adjudicated against clinical and funding guidelines as well as set criteria in recognising healthcare providers who are able to perform certain procedures. Once you are pre-approved, the healthcare provider and hospital account will then be paid according to your selected benefit option and available benefits.
QUICK GUIDE: INFORMATION ON ACCESSING YOUR BENEFITS EFFICIENTLY
SAMWUMED | MEMBER GUIDE 201930
SAMWUMED | MEMBER GUIDE 2019 31
WHEN DO YOU NEED TO CONTACT US FOR PRE-AUTHORISATION?
• Any procedure or treatment that clinically requires admission to hospital.• Specialised radiology in- and out-of-hospital (MRI and CT Scans).• Oncology Treatment.• Renal Dialysis.• Clinically appropriate home nursing, admission to a step-down facility and rehabilitation.• Maternity admissions and confinements.
HOW DO I PRE-AUTHORISE?
Call 0860 33 33 87 (preferably 72 hours before the procedure is performed) and provide the following information: • Membership number• Beneficiary details• Patient’s date of birth• Planned date of treatment or admission to hospital• Name and practice number of the hospital/facility• Name and practice number of the doctor who is treating the patient in hospital• Relevant diagnosis and/or procedure codes• If treatment will be in or out of hospital
WHAT IF I’M DIAGNOSED WITH CANCER?
• Register with the SAMWUMED Oncology Management Programme by calling 0860 33 33 87 or send an e-mail to [email protected].
• A SAMWUMED Oncology case manager will provide support and guidance that will continue throughout your treatment.
• As soon as you and your team of doctors agree on a treatment plan, ask your doctor to forward it to the SAMWUMED Oncology Management Programme. An Oncology case manager will review the plan, discuss it with your doctor and advise on the outcome of your application.
• You will then receive an authorisation letter for the authorised treatment. If there are certain items that are not covered, you will need to discuss this with your doctor.
• Please ensure that your doctor informs the SAMWUMED Oncology Management Programme of any change in your treatment, as your authorisation will have to be re-assessed and updated accordingly to ensure that your claim(s) are not rejected or paid from the incorrect benefit.
WHAT HAPPENS IN AN EMERGENCY?
Don’t worry. In the case of an emergency situation you or a family member may pre-authorise the admission on the first working day after being admitted.
WHAT IS A PMB?
Prescribed Minimum Benefits (PMB) is a set of defined benefits that ensure you have access to certain minimum health services, regardless of the benefit option you have selected. In accordance with the Medical Scheme’s Act, medical schemes have to cover the costs related to these conditions which include:
• Any emergency medical admission• A limited set of 270 pre-defined medical conditions• Twenty-six (26) chronic medical conditions
Your doctor will guide you in determining whether your condition falls into one of the PMB conditions. It is vital that you obtain a pre-authorisation for any PMB condition as your scheme may require you to be referred to a designated service provider so that all associated costs are in line with SAMWUMED’s Scheme Rules.
WHAT IS CASE MANAGEMENT AND CARE CO-ORDINATION?
While you are in hospital, our case managers will ensure that the appropriate length of stay and level of care is provided at all times and that appropriate discharge planning takes place.
Medscheme also focuses on care co-ordination to improve the quality of care that you receive while in hospital, and to improve your health status after you are discharged. The benefit of this is that, with your consent, we will share information about your condition, well-being and health within the different managed health care departments as well as with your nominated doctor.
Co-ordinating your care is done through various interventions from pre-admission to eight weeks after you are discharged so that you receive the best health care; reduce your chances of re-admission and encourage you to take responsibility for your own health.
Through care co-ordination you will receive a pre-admission hospital checklist (depending on your type of admission) that will assist you in preparing for hospitalisation and post discharge recovery. You will also be referred to various managed care services and appropriate healthcare providers as and when required.
ACCESS AND CARE
• SAMWUMED has removed State as a Designated Service Provider (DSP) for the treatment of Prescribed Minimum Benefit (PMB) conditions in hospital to ensure our member get value for their money.
• The Scheme still has negotiated favourable rates with various private hospital groups clas-sifying these as Preferred Providers (PPs). This excludes services rendered by attending specialists at these PPs. While the Scheme has secured agreements with certain providers, members might still be faced with possible out-of-pocket expenses based on tariffs above the Scheme’s rate. However negotiations with these networks will continue throughout the year for the benefit of our members.
• SAMWUMED pays for all healthcare services according to the Scheme Tariff, except in cases where involuntary utilisation of a non-DSP took place*.
• In cases of an emergency, you can access the hospital nearest to you if you are not within rea-sonable travelling distance from one of the Scheme’s Designated Service Providers (Melomed or Mediclinic) or a Preferred Provider (PP).
• Depending on where you are in the country, you can access hospital care kindly contact the Managed Care call centre for available facilities.
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CHECKING AVAILABLE BENEFITS
You can check your available benefits by logging onto the Scheme’s website at www.samwumed.org
OBTAINING PRE-AUTHORISATION FROM THE CALL CENTRE
The Call Centre can assist you with the pre-authorisation for procedures and tests done in doctors’ or any other equipped procedure rooms, advanced dentistry such as orthodontics, crown and bridgework and appliances, for example: wheelchairs, walking frames or neck braces related to hospital admissions.
BENEFITS THAT REQUIRE MOTIVATION AND/OR REFERRAL LETTERS
• Clinical motivation and cost estimates will be requested from your treating doctor or specialist before appliances are approved. Approved appliances would be subject to Scheme’s list.
• Clinical motivation is required for all advanced dentistry procedures.• To access the mental health or substance dependency benefit, clinical motivation will be
required after the first two visits for continued sessions.• Physiotherapy – clinical motivation required after two visits.• Prostheses – clinical motivation and costing.• Specialised radiology and radiography.
WHAT IS COVERED UNDER THE MEDICATION BENEFIT?
The medication benefit provides cover for acute/ prescribed; over-the-counter and chronic medication and the Primary Healthcare Programme. Chronic medication cover includes the diagnosis, medical management and medication of conditions on the Chronic Disease List (CDL) as provided under PMB legislation. The Scheme has contracted a medicine risk management department to provide a service to members and their registered dependants who need treatment for their chronic conditions which include the following:
• Making sure that your chronic benefits are allocated accordingly.• Access to expert advisors who will assess medication/ treatment.• Useful advice and information regarding various chronic conditions.
HOW TO REGISTER AND OBTAIN MEDICATION FOR A CHRONIC CONDITION:
A chronic condition is a persistent or otherwise long-lasting illness that may be longer than three months or lifelong. SAMWUMED will cover for the diagnosis, treatment and care of 26 chronic conditions (PMBs), and five (5) and three (3) additional chronic (Non-PMB) conditions on Option A and Option B respectively such as:
• Option A: Depression, Gout, Gastro-oesophageal reflux disease (GORD)• Option B: Depression, Eczema, Gout, Gastro-oesophageal reflux disease (GORD) and
Menopause
SAMWUMED works with Medscheme to give members the best advice on the use of their chronic medication, as well as to ensure that their chronic benefits are correctly allocated.
YOUR TREATING DOCTOR WILL NEED TO CALL OUR MANAGED CARE PROVIDER, MEDSCHEME ON 0860 33 33 87 TO REGISTER YOUR CHRONIC MEDICATION.
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YOUR TREATING DOCTOR WILL NEED TO FAX THE HIV APPLICATION FORM TO OUR HIV MANAGED CARE PROVIDER, AID FOR AIDS ON 0800 600 773 OR CALL 0800 227 700 TO REGISTER YOU ON THE HIV MANAGEMENT PROGRAMME.
MANAGEMENT PROGRAMME
HIVHIV is a chronic condition where treatment is available and must be taken for life. SAMWUMED will cover the treatment, pathology monitoring and doctor consultations in order to keep all HIV positive beneficiaries healthy.
SAMWUMED works with Aid for AIDS to give members the best advice on how to manage their HIV status and the use of their HIV medication, blood monitoring tests and other associated medication.
HOW AND WHEN TO USE THE SAMWUMED PRIMARY HEALTHCAREPROGRAMME BENEFIT
• You can only access the benefit after your acute, prescribed/ dispensed; and over-the-counter (PAT) medicine benefit has been depleted.
• The Scheme’s Pharmacy Benefit Partner with a wide range of pharmacy networks across the country.
• Ask your pharmacist for the specific list of medicines that have been allocated to the condition that you need care for and remind them to include the correct ICD-10 code on the account.
• If you are unsure about your medicine benefits, please contact the SAMWUMED Call Centre for advice 0860 104 117.
This benefit provides you with a safety net by granting access to essential medicine benefits to treat ten common ailments every family can experience including but not limited to:
1. Stomach pain, heartburn, indigestion (including reflux)2. Headache3. Acute gastroenteritis: vomiting and diarrhoea4. Bacterial conjunctivitis: eye infection5. Upper and lower respiratory tract infections6. Urinary tract infection (acute uncomplicated cystitis)7. Oral and topical candidiasis: thrush/fungal or yeast infections8. Urticarial: skin rashes, usually due to an allergic reaction; insect bites and
stings9. Helminthic infestation: tapeworm10. Wound care and infections of the skin/subcutaneous tissue (excluding
post-operative care.)
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It is important to note that there are sub-limits for each incident and that a specific list of suitable and cost efficient medicines has been prepared by the Scheme so that you can obtain these from your pharmacist without paying extra. The details and guidelines for this benefit category is outlined in the benefit tables on pages 9 - 13 (Option A) and 17 - 21 (Option B).
HOW TO REPLACE LOST MEMBERSHIP CARDS
Your SAMWUMED membership card is one of the most important items in your wallet because it ensures that you have access to the relevant healthcare services, therefore always take care to keep it in a safe place.
Please contact the Premiums Department on 021 697 9000 to request your newly branded membership card, should your card be lost or stolen.
SUBMISSION AND PAYMENT OF ACCOUNTS
• SAMWUMED will only accept original accounts and receipts for adjudication.
• The Scheme will not accept photocopied or faxed information, although we do advise that members keep copies for their own records. Providers may submit claims electronically via a process known as Electronic Data Interface (EDI) or via the post.
• It is your responsibility to confirm if your service provider is submitting claims on your behalf (via post or EDI) or if you should submit the account directly to the Scheme. It is common practice for many service providers to request that members settle their accounts in cash and then claim back from the Scheme.
• In instances where you have paid cash, submit the original account and receipt with your member number as reference to the Scheme for reimbursement. Members must be sure that every account they or their provider submits for payment includes the ICD-10 codes for the treatment or products provided. These codes are required by the Scheme to allocate and process payments according to the correct benefit categories.
HOW OUR CLAIMS PROCESSING WORKS
Members have four (4) months to submit claims for adjudication and processing Claims older than four months will be rejected as Stale Claims. Once a claim has been processed, you will receive a statement that details the payments that were made to service providers. It will also indicate your remaining benefits. Statements are sent via post or email. Receiving your statement electronically is safe and convenient. Please provide the Scheme with your updated email address. Please make sure that all claims indicated are accurate and that your bank details are correct.
STEP 1Service Provider submits account to Switchhouse
Should you have any queries regarding claims, please contact our Benefits Management Department by dialling 0860 104 117.
STEP 2Switchhouse submits to Scheme
STEP 3Account processed via system
STEP 4If approved, claim awaits payment during claims run
STEP 5Account paid
STEP 6Claims Statement sent to member
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It is important to choose the right medical scheme not only based on price but by doing research to ensure that the scheme meets your needs and those of your family.
It is also best to change your benefit option at the beginning of the year, if needed, in order to get full benefits.
ADVICE ON CHOOSING A MEDICAL SCHEME OR BENEFIT OPTION
Ensure that the scheme you are considering is duly registered in terms of the Medical Schemes Act 131 of 1998. The names, addresses and telephone numbers of all registered schemes are published on the website of the Council for Medical Schemes at www.medicalschemes.com.
Identify a few schemes and request information about their benefits, contributions, limitations and exclusions. Compare this information provided to see which one meets your needs.
Besides the healthcare benefits also find out what the schemes’ reserves (solvency ratio) are, and non-healthcare expenditure, such as administration costs, to ensure they are in good financial health.
Understand what prescribed minimum benefits (PMBs) are and under what circumstances the chosen scheme provides such cover for you. Here you can look at designated service providers and their proximity to you as well as other networks that provide benefits to members.
HOW TO CHOOSE YOUR MEDICAL SCHEME FOR 2019
ADVICE FOR CURRENT MEDICAL SCHEME MEMBERS
If you are already a member of a scheme, read all the material such as options to change plans. Ensure that you understand how the benefit options operate and select according to your healthcare needs and what you can afford. The registered rules of medical schemes fully disclose detailed information regarding the relevant benefits and contributions. It is essential that you obtain the rules of the scheme or a summary thereof to verify all relevant information to enable you to make an informed choice.
Some people choose to make use of an agent or broker (intermediary). Remember it is not compul-sory to use a broker, but if you do ensure that he/she has been accredited by the CMS and that your selection of a scheme is based on informed consent.
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WHAT IS A MEDICAL SCHEME?Medical Schemes are not for profit organisations.
“[The] ‘business of a medical scheme’ means the business of undertaking liability in return for a premium or contribution:
a) to make provision for the obtaining of any relevant health service;b) to grant assistance in defraying expenditure incurred in connection with the rendering of
any relevant health service; andc) where applicable, to render a relevant health service, either by the medical scheme itself,
or by any supplier or group of suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical scheme.”
BUT WHAT DOES THIS MEAN?
Point (a) in the definition means that medical schemes must provide healthcare benefits, including a prescribed package of minimum benefits for healthcare needs. The uncertainty attached to your health poses a number of risks for your medical scheme; the most obvious risk to you is the loss of health itself. This is why medical scheme members buy benefit packages based on their need for healthcare – and why medical schemes are structured in a way that makes them financially sustainable in the long run.
Point (b) in the definition means that monetary contributions are paid in exchange for healthcare benefits. Members of medical schemes have the obligation to pay a relevant contribution which entitles them to access a defined benefits package. Members are encouraged to read up on their rights and responsibilities when accessing benefits, specifically the prescribed minimum benefits or PMBs.
Point (c) in the definition means that medical schemes are allowed to contract with service providers for the provision of comprehensive benefits, including out-of-hospital benefits and PMBs.
HOW THE ACT PROTECTS MEMBERS OF MEDICAL SCHEMES
The definition of the business of a medical scheme, as in the Medical Schemes Act 131 of 1998, was always meant to guide medical schemes on the type of services required to be provided to members in order to operate as a registered medical scheme.
WHAT ARE ADMINISTRATORS?
Medical scheme administrators are privately owned companies with the skills, infrastructure, and capacity to render a full range of administration services to schemes in compliance with prevailing legislation. They are accredited by the Council for Medical Schemes (CMS) in terms of the Medical Schemes Act if they meet the certain criteria. Most medical schemes outsource many of their functions to administrators.
WHAT DO ADMINISTRATORS DO EXACTLY?
Administrators perform a variety of administration functions as per their written contracts and service level agreements with schemes. They utilise comprehensive and integrated information technology systems capable of performing all administration, financial, and management functions.
WHAT IS AN ADMINISTRATOR?
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MEDICAL SCHEMES VS MEDICAL INSURANCE?Medical schemes are not for profit organisations which operate like trust funds.
Short and long-term insurers providing health insurance products are commercially driven for-profit companies. Medical schemes belong to their members, while health insurance companies are owned by shareholders.
Medical schemes espouse unique principles which can only be found in the Medical Schemes Act. These principles are (i) open enrolment, (ii) community rating, and (iii) a set of prescribed minimum benefits, commonly called PMBs.
Open enrolment means that anyone can join a medical scheme and that if you apply for membership, the scheme of your choice cannot turn you away.
Community rating means that all members of a medical scheme pay the same monthly contribution for the same benefits. PMBs ensure that members are fully protected against unforeseen and potentially catastrophic health events.
These principles do not apply to health insurance products.
Anyone can buy a short- or long-term health insurance policy, but the premium you pay will usually depend on the insurer’s assessment of your state of health. Older individuals, or individuals with pre-existing health conditions, will pay more for health insurance cover. At the extreme, health insurance companies may refuse to cover you if they consider that there is too high a risk that you are likely to claim.
Medical scheme administrators maintain member records. Their systems can drill down to detailed information on an individual member. It is the administrator who processes your application for membership and also suspends and terminates it. Administrators collect the monthly member contributions and manage their allocation and reconciling. They ensure that outstanding amounts are collected.
SELF-ADMINISTERED MEDICAL SCHEMES
Some medical schemes do not use administrators. A self-administered scheme undertakes all administration functions with its own resources decisions. Self-administered schemes do not need to be accredited, but they must comply with the same administration standards and are subject to the same on-site evaluation of compliance as third-party administrators.
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WHAT SHOULD YOU ASK YOUR DOCTOR OR SERVICE PROVIDER BEFORE TREATMENT? • Is this a Prescribed Minimum Benefit?• Is this my medical scheme’s Designated Service Provider?• Do I need authorisation from my medical scheme?• Do you charge at my medical scheme’s tariff?• DURING: Is there a co-payment or levy?• AFTER: Is this medication on my medical scheme’s formulary list?
Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.
PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of:
• any emergency medical condition;• a limited set of 270 medical conditions; and• 26 chronic conditions defined in the Chronic Diseases List (CDL).
Medical schemes must pay in full, without a co-payment or the use of deductibles, for the diagnosis, treatment and care costs of the Prescribed Minimum Benefit conditions. The medical scheme cannot use your medical savings account to pay for Prescribed Minimum Benefits.
Each option offered by a medical scheme must make provision for the Prescribed Minimum Benefits, including hospital plan options.
State healthcare facilities can be DSPs too but before they can be listed as such in the rules of your medical scheme, your scheme must make sure that you and its other beneficiaries can reach these facilities with reasonable ease and that the required treatment, medication, and care are both available and accessible.
A designated service provider or DSP is a healthcare provider (doctor, pharmacist, hospital etc.) who is appointed by your medical scheme to treat or care for prescribed minimum benefit (PMB) conditions of their members.
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WHAT IS INVOLUNTARY USE OF A NON-DSP?
If circumstances force you to obtain a service from a non-DSP (i.e. involuntarily), and it’s a PMB condition, your scheme must pay for the costs of your treatment, diagnosis, and care in full. These are the reasons why you may need to obtain treatment from a non-DSP involuntarily:
• the required service or treatment is not readily available from your scheme’s DSP or it will be provided with unreasonable delay;
• an emergency occurs under circumstances or at a location that prevents you from obtaining PMB treatment from a DSP; or
• there is no DSP within reasonable proximity to your ordinary place of business or personal residence
HOW DOES TREATMENT AT DSPs WORK?
Your scheme can insist that you go to a DSP as soon as your PMB condition is diagnosed, in which case they cover the costs from the start. When your condition is identified as a PMB after diagnosis, your scheme must pay for the tests and treatment in full retrospectively. Treatment for a PMB condition at a DSP is covered in full by the medical scheme.
A co-payment is the amount of money or portion of the account that your scheme may request you to fund from your own pocket. This could be either a percentage of the fee or the difference between the tariff of your scheme’s chosen DSP and the amount charged by the provider (non-DSP) you went to. The co-payment amount must be specified in the scheme rules.
A medicine formulary is a list of medications that the scheme is willing to fund for the treatment of PMB conditions. Feel free to ask your scheme for the formulary list for your specific benefit option and discuss the available medicines with your doctor.
If you choose to use medicine not listed on the formulary, the scheme is allowed to charge you a co-payment. But there are specific circumstances where schemes cannot enforce a co-payment and must make provision for appropriate exceptions or substitutions, including where the formulary medicine has proven ineffective or would cause you harm or an adverse reaction.
The Regulations to the Medical Schemes Act provide for specific principles that medical schemes may use to manage the financial risk associated with PMBs.
These principles include designated service providers, managed care protocols and formularies.
THE COMPLAINTS PROCESSWHO CAN COMPLAIN TO THE REGISTRAR’S OFFICE?
• Any beneficiary or any person who is aggrieved with the conduct of a medical scheme can submit a complaint.
• It is however very important to note that a prospective complainant should always first seek to resolve complaints through the complaints mechanisms in place at the respective medical scheme before approaching the Council for assistance.
• You can contact your scheme by phone or writing to the Principal Officer of the scheme, giving her/him full details of your complaint.
• If you are not satisfied with the response from your Principal Officer, you can ask the matter to be referred to the Disputes Committee of your scheme.
• If you are not satisfied with the decision of the Disputes Committee, you can appeal against the decision within 3 months of the date of the decision to the Council. The appeal should be in the form of an affidavit directed to the Council.
• Complaints can be submitted by any reasonable means such as a letter, fax, e-mail or in person at our Offices from Mondays to Fridays during 08:00 – 17:00. The complaint form is available on www.medicalschemes.com.
Your complaints should be in writing, detailing the following:
Full names, membership number, benefit option, contact details and full details of the complaint with any documents or information that substantiates the complaint.
The Council for Medical Scheme’s Complaints Adjudication Unit also provides telephonic advice and personal consultations, when necessary.
WHO CAN YOU COMPLAIN ABOUT?
The Council for Medical Schemes governs the medical schemes industry and therefore your complaint should be related to your medical scheme.
If your complaint is related to any other aspect of the health industry, please visit the relevant websites:
• For complaints against Health Professionals (doctors) and allied health professional such as physiotherapists, occupational therapists etc. – www.hpcsa.co.za or call 012 338 9300
• For complaints against Private Hospitals – www.hasa.co.za or call 011 784 6828• For complaints against Nurses – www.sanc.co.za or call 012 420 1000• For complaints against Brokers – www.faisombud.co.za or call 012 762 5000• For complaints in respect of other health insurance products – www.osti.co.za (short term
insurance ombudsman) or call 012 762 5000 or www.ombud.co.za (long term insurance ombudsman) or call 021 657 5000
TIME LIMITS FOR DEALING WITH COMPLAINTS
• Our aim is to provide a transparent, equitable, accessible, expeditious as well as a reasonable and procedurally fair dispute resolution process.
• The Registrar’s Office will send a written acknowledgement of a complaint within 3 working days of its receipt, providing the name, reference number and contact details of the person who will be dealing with a complaint.
• In terms of Section 47 of the Medical Schemes Act 131 of 1998 a written complaint received in relation to any matter provided for in this Act will be referred to the medical scheme. The medical scheme is obliged to provide a written response to the Registrar’s Office within 30 days.
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• The Registrar’s Office shall within 4 days of receiving the complaint from the administrator, analyse the complaint and refer a complaint to a medical scheme for comments.
• Upon receipt of the response from the medical scheme, the Registrar’s Office will analyse the response in order to make a decision or ruling. Decisions/rulings will be made within 120 working days of the date of referral of a complaint and communicated to the parties.
THE REGISTRAR’S RULING AND APPEAL TO COUNCIL
Section 48 of the Act makes provision for any party who is aggrieved with the decision of the Registrar to appeal such a decision.
This appeal is at no cost to either of the parties.
An appeal must be submitted within three months and should be in the form of an affidavit directed to the Council. The operation of the decision shall be suspended pending review of the matter by the Council’s Appeals Committee.
The secretariat of the Appeals Committee will inform all parties involved of the date and time of the hearing. This notice should be provided no less than 14 days before the date of the hearing.
The parties may appear before the Committee and tender evidence or submit written arguments or explanations in person or through a representative. The Appeals Committee may after the hearing confirm or vary the decision concerned or rescind it and give another decision they deem to be just.
THE SECTION 50 APPEAL’S PROCESS
Any party that is aggrieved with the decision of the Appeals Committee may appeal to the Appeal Board. The aggrieved party has 60 days within which to appeal the decision and must submit written arguments or explanation of the grounds of his or her appeal.
The Appeal Board shall determine the date, time and venue for the hearing and all parties will be notified in writing.
The Appeal Board shall be heard in public unless the chairperson decides otherwise.
The Appeal Board shall have the powers which the High Court has to summon witnesses, to cause an oath or affirmation to be administered by them, to examine them, and to call for the production of books, documents and objects.
The decisions of the Appeal Board are in writing and a copy thereof shall be furnished to parties. The prescribed fee of R2000.00 is payable for Section 50 Appeals.
How to avoid complaints
• Make sure you have read and understood your scheme rules.• Study your benefit guide and familiarise yourself with the benefit option you have chosen.• Read all correspondence from your scheme, e.g. newsletters and statements.• Make sure your contributions are paid in full and on time each month.• Remember: Avoid complaints by informing yourself!
The Council for Medical Schemes (CMS) protects and informs the public about their medical scheme rights and obligations, ensuring that complaints raised are handled appropriately and speedily.
HOSPITAL NETWORKS
EASTERN CAPE
FREE STATEHospital Group
Hospital Town/City
Life Pasteur Hospital- dedicated to acute rehab
Bloemfontein
Life Rosepark Clinic Bloemfontein
Mediclinic Mediclinic Bloemfontein Bloemfontein
Mediclinic Mediclinic Hoogland Bloemfontein
NHN Horizon Eye Care Centre (Bloemfontein Eye Centre)
Bloemfontein
NHN Jane Keyser Clinic Bloemfontein
NHN Riemland Clinic Bloemfontein
NHN St Helena Hospital Welkom
Netcare Netcare Kroon Hospital Bloemfontein
Netcare Netcare St Augustine's Hospital
Bloemfontein
Netcare Netcare Vaalpark Hospital Bloemfontein
Netcare Pelonomi Hospital Bloemfontein
Netcare Universitas Hospital Bloemfontein
Hospital Group Hospital Town/City
Life Beacon Bay Hospital Beacon Bay North
Life East London Private Hospital East London
Life Isivivana Private Hospital Port Elizabeth
Life Mercantile Hospital Port Elizabeth
Life Queenstown Private Hospital Queenstown
Life St Dominic's Hospital East London
Life St George's Hospital Port Elizabeth
Life St James Hospital East London
Life St Mary's Private Hospital Mthatha
NHN Crossmed Mthatha Private Hospital Mthatha
NHN East London Eye Hospital East London
Netcare Netcare Cuyler Hospital Port Elizabeth
Netcare Netcare Greenacres Hospital Port Elizabeth
Netcare Port Alfred Hospital Port Alfred
Netcare Settlers Private Hospital Eastern Cape
GAUTENGHospital Group Hospital Town/City
Life Bedford Gardens Hospital Johannesburg
Life Brenthurst Clinic Johannesburg
Life Carstenhof Clinic Johannesburg
Life Dalview Clinic Johannesburg
Life Eugene Marais Hospital Pretoria
Life Faerie Glen Hospital Pretoria
Life Genesis Clinic Johannesburg
Life Groenkloof (Old name: Little Company of Mary Pretoria
Life Riverfield Lodge Johannesburg
Life Robinson Private Hospital Johannesburg
Life Roseacres Clinic Johannesburg
Life Springs Parkland Clinic Johannesburg
Life Suikerbosrand Clinic Johannesburg
Life The Glynnwood Johannesburg
Life Wilgeheuwel Hospital Johannesburg
Mediclinic Mediclinic Gynaecological Pretoria
Mediclinic Mediclinic Heart Hospital Pretoria
Mediclinic Mediclinic Medforum Pretoria
Mediclinic Mediclinic Morningside Johannesburg
Mediclinic Mediclinic Muelmed Pretoria
Mediclinic Mediclinic Sandton Johannesburg
Mediclinic Mediclinic Vereeniging Johannesburg
Mediclinic Mediclinic Wits Donald Gordon Johannesburg
NHN Fochville Hospital Johannesburg
NHN Lenmed Daxina Medical Clinic Johannesburg
NHN Lenmed Health Ahmed Kathrada Private Hospital Johannesburg
NHN Lenmed Randfontein Private Hospital Johannesburg
NHN Lenmed Zamokuhle Private Hospital Johannesburg
NHN Louis Pasteur Private Hospital Pretoria
NHN Medfem Clinic Sandton
NHN Midvaal Private Hospital Johannesburg
NHN Optimed Eye and Laser Clinic Pretoria
NHN Pretoria Eye Institute Pretoria
NHN Sunshine Hospital Johannesburg
NHNThe Fountain Private Hospital aka Leslie Williams Private Hospital
Johannesburg
SAMWUMED | MEMBER GUIDE 201944
Disclaimer: The Hospital Networks are subject change. The changes may occur as a result of the ongoing network review process during the year.
GAUTENG (CONTINUED)
Hospital Group Hospital Town/City
NHN Urolocare Hospital Pretoria
NHN Zuid-Afrikaans Hospitaal Pretoria
Netcare Lakeview Hospital Johannesburg
Netcare Netcare Akasia Hospital Pretoria
Netcare Netcare Bell Street Hospital Krugersdorp
Netcare Netcare Bougainville Private Hospital Pretoria
Netcare Netcare Clinton Hospital Johannesburg
Netcare Netcare Femina Hospital Pretoria
Netcare Netcare Garden City Hospital Johannesburg
Netcare Netcare Jakaranda Hospital Pretoria
Netcare Netcare Krugersdorp Hospital Johannesburg
Netcare Netcare Linksfield Hospital Johannesburg
Netcare Netcare Linkwood Hospital Johannesburg
Netcare Netcare Linmed Hospital Johannesburg
Netcare Netcare Milpark Hospital Johannesburg
Netcare Netcare Montana Hospital Pretoria
Netcare Netcare Moot Algemene Hospitaal Pretoria
Netcare Netcare Mulbarton Hospital Johannesburg
Netcare Netcare N17 Hospital Johannesburg
Netcare Netcare Olivedale Hospital Johannesburg
Netcare Netcare Optiklin Eye Hospital Johannesburg
Netcare Netcare Park Lane Clinic Johannesburg
Netcare Netcare Pinehaven Hospital Johannesburg
Netcare Netcare Pretoria East Hospital Pretoria
Netcare Netcare Rand Hospital Johannesburg
Netcare Netcare Rehabilitation Hospital Johannesburg
Netcare Netcare Rosebank Hospital Johannesburg
Netcare Netcare Sunninghill Hospital Johannesburg
Netcare Netcare Sunward Park Hospital Johannesburg
Netcare Netcare Union Hospital Johannesburg
Netcare Netcare Unitas Hospital Johannesburg
Netcare Netcare Waterfall City Hospital Johannesburg
KWA-ZULU NATAL (Note: Melomed Richards Bay is an exclusive Scheme DSP)
Hospital Group Hospital Town/City
Life Chatsmed Garden Hospital Durban
Life Empangeni Garden Clinic Durban
LifeEntabeni Hospital- acute in-corporating Life St Josephs psychiatric unit
Durban
Life Life Hilton Private Hospital Pietermaritz-burg
Life Mount Edgecombe Hospital Phoenix
Life New Kensington Clin-ic-Rehab Durban
Life The Crompton Hospital Durban
Life Westville Hospital Durban
Mediclinic Mediclinic Newscastle Durban
Mediclinic Mediclinic Pietermaritzburg Pietermaritz-burg
Mediclinic Mediclinic Potschefstroom Durban
Mediclinic Mediclinic Victoria Durban
NHN Daymed Private Hospital Pietermaritz-burg
NHN Ethekwini Hospital and Heart Centre Durban
NHN Gateway Private Hospital Durban
NHN Hibiscus Private Hospital Port Shep-stone
NHN Hillcrest Private Hospital Durban
NHN Lenmed La Verna Durban
NHN Lenmed Shifa Hospital Durban
NHN Matatiele Private Hospital Durban
NHN Mooimed Hospital Potschef-stroom
NHN Nongoma Private Hospital Durban
Netcare Kokstad Hospital Durban
Netcare Netcare Alberlito Hospital Durban
Netcare Netcare Kingsway Hospital Durban
Netcare Netcare Margate Hospital Durban
Netcare Netcare Parklands Hospital Durban
Netcare Netcare St Anne's Hospital Pietermaritz-burg
Melomed Melomed Richards Bay
Netcare Netcare Umhlanga Hospital Umhlanga
SAMWUMED | MEMBER GUIDE 2019 45
LIMPOPO
Hospital Group
Hospital Town/City
Mediclinic Mediclinic Emfuleni Polokwane
Mediclinic Mediclinic Lephalale Polokwane
Mediclinic Mediclinic Limpopo Limpopo
Mediclinic Mediclinic Thabazimbi Limpopo
NHN Quality Care Private Hospital
Polokwane
NHN St Vincent's Hospital Polokwane
Netcare Netcare Pholoso Hospital Polokwane
MPUMALANGA
Hospital Group
Hospital Town/City
Life Comso Hospital Mpumalanga
Life a Midmed Hospital Middelburg
Life Piet Retief Hospital Nelspruit
Mediclinic Mediclinic Barberton Nelspruit
Mediclinic Mediclinic Ermelo Nelspruit
Mediclinic Mediclinic Highveld Nelspruit
Mediclinic Mediclinic Nelspruit Nelspruit
Mediclinic Mediclinic Secunda Nelspruit
Mediclinic Mediclinic Welkom Nelspruit
NHN Emalahleni Private Hospital (Pty) Ltd
Nelspruit
NHN Kiaat Private Hospital Nelspruit
NHN Lowveld Hospital Nelspruit
NHN Nelspruit Surgiclinic Hospital Nelspruit
NHN Zoutpansberg Private Hospital
Nelspruit
NORTH WEST
Hospital Group Hospital Town/City
Life Anncron Clinic Klerksdorp
Life La Femme Clinic Rustenburg
Life Peglerae Hospital Rustenburg
Mediclinic Mediclinic Brits Brits
Mediclinic Mediclinic Legae Mabopane
NHN Rustenburg Medicare Rustenburg
NHN Sunningdale Hospital Klerksdorp
NHN Vryburg Private Hospital Vryburg
Netcare Netcare Ferncrest Hospital Rustenburg
NORTHERN CAPE
Hospital Group Hospital Town/City
Mediclinic Mediclinic Kimberley (Gariep) Kimberley
Mediclinic Mediclinic Upington Upington
NHN Lenmed Kathu Northern Cape
NHN Royal Hospital and Heart Centre Kimberley
NHN Wilmed Park Private Hospital Klerksdorp
WESTERN CAPE (*Note: The Scheme has a DSP arrangement with the Mediclinic and Melomed group of hospitals in Cape Town and surroundings, up to a 40 km radius)
Hospital Group
Hospital Town/City
Life Bayview Private Hospital MosselBay
Life Knysna Private Hospital Knysna
Mediclinic Mediclinic Geneva George
Mediclinic Mediclinic George George
Mediclinic Mediclinic Klein Karoo Oudtshoorn
NHN Melomed Bellville Medical Centre
Cape Town
NHN Melomed Gatesville Medical Centre
Cape Town
NHN Melomed Mitchells Plain Medical Centre
Cape Town
NHN Melomed Tokai Cape Town
PHARMACY NETWORKS
EASTERN CAPE
Insititution Name Town/City
Clicks Pharmacy - Vincent Park East London
Clicks Pharmacy - Walker Drive Port Elizabeth
Clicks Pharmacy - Greenacres Port Elizabeth
John Forbes Pharmacy East London
Klinicare Lorraine Pharmacy Port Elizabeth
Klinicare Bluewater Bay Pharmacy Port Elizabeth
Clicks Pharmacy - Walmer Park Port Elizabeth
Clicks Pharmacy - Grahamstown Grahamstown
Clicks Pharmacy - Sunridge Village Port Elizabeth
SAMWUMED | MEMBER GUIDE 201946
Disclaimer: The Pharmacy Networks are subject change. The changes may occur as a result of the ongoing network review process during the year. Please refer to our website for an updated list of pharmacies.
EASTERN CAPE (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - King William's Town King William`s Town
Clicks Pharmacy - Cleary Park Ibhayi
Greenways Family Pharmacy Port Elizabeth
Clicks Pharmacy - Beacon Bay East London
Medi-Rite Pharmacy - Port Elizabeth Port Elizabeth
P Ochse Pharmacy Cradock
Medi-Rite Pharmacy - Bethelsdorp Ibhayi
Vincent Family Pharmacy East London
Amathole Valley Pharmacy King William`s Town
Medi-Rite Pharmacy - Uitenhage Uitenhage
Clicks Pharmacy - Uitenhage Uitenhage
Amayeza Ethu Pharmacy Mdantsane
Medi-Rite Pharmacy - Moffat On Main Port Elizabeth
Clicks Pharmacy - Graaff Reinet Graaff-Reinet
Netcare Port Alfred Private Hospital Pharmacy Port Alfred
Clicks Pharmacy - Fountains Mall Jeffreys Bay
Clicks Pharmacy - Port Alfred Port Alfred
Baymed Pharmacy Jeffreys Bay
Clicks Pharmacy - Kabega Park Port Elizabeth
Policlinic Pharmacy - Jeffrey's Bay Jeffreys Bay
Clicks Pharmacy - Gonubie East London
Medi-Rite Pharmacy - Amalinda East London
Medi-Rite Pharmacy - King Williams Town King William`s Town
Netcare Settler's Pharmacy Grahamstown
Dis-Chem Hemingways Mall Pharmacy East London
Clicks Pharmacy - Hemmingways East London
Clicks Pharmacy - 6th Avenue Walmer Port Elizabeth
Klinicare Belmore Pharmacy Port Elizabeth
Protea Pharmacy - Sidwell Port Elizabeth
Provincial Westbourne Pharmacy Port Elizabeth
Clicks Pharmacy - Mthatha Plaza Mthatha
Medi-Rite Pharmacy - Kwanobuhle Kwa Nobuhle
Clicks Pharmacy - Penford Uitenhage
Dis-Chem Cape Road Pharmacy Port Elizabeth
Dis-Chem Walmer Park Pharmacy Port Elizabeth
Mbizana Pharmacy Bizana
Ooskaap Pharmacy Humansdorp
Clicks Pharmacy - Oxford Street East London
Insititution Name Town/City
Klinicare Despatch Pharmacy Despatch
Medi-Rite Pharmacy - Vincent East London
Clicks Pharmacy - Moffet Retail Park Port Elizabeth
Klinicare Blooms Pharmacy Port Elizabeth
Klinicare Gelvandale Pharmacy (N N Pharmaceutical Pty Ltd) Port Elizabeth
Clicks Pharmacy - Humewood Port Elizabeth
Dis-Chem Jeffreys Bay Pharmacy Jeffreys Bay
Medi-Rite Pharmacy - Greenacres Port Elizabeth
Medi-Rite Pharmacy - Butterworth Butterworth
Medi-Rite Pharmacy - Queenstown Queenstown
Medi-Rite Pharmacy - New Brighton Port Elizabeth
Clicks Pharmacy - Nonesi Mall Queenstown
New Brighton Pharmacy Port Elizabeth
Clicks Pharmacy - Despatch Despatch
Clicks Pharmacy - New Brighton Port Elizabeth
Klinicare Kings Court Pharmacy Port Elizabeth
Clicks Pharmacy - Pier 14 Port Elizabeth
Mpilontle Pharmacy Lady Frere
Medi-Rite Pharmacy - Mthatha Mthatha
Clicks Pharmacy - B T Ngebs Mall Mthatha
Clicks Pharmacy - Baywest Port Elizabeth
Umendo Pharmacy Sterkspruit
Clicks Pharmacy - Mthatha Mthatha
Dis-Chem Baywest Mall Pharmacy Port Elizabeth
Clicks Pharmacy - Kamma Crossing Port Elizabeth
Clicks Pharmacy - Gillwell East London
Clicks Pharmacy - Mdantsane Mdantsane
Eldre Apteek Aliwal North
Clicks Pharmacy - East London (Netcare East London Dispensary) East London
Clicks Pharmacy - Westering Port Elizabeth
Watersons Pharmacy Cradock
Berea Pharmacy East London
Bonnie Doon Pharmacy East London
Greenfields Pharmacy East London
Linton Grange Pharmacy Port Elizabeth
The Medicine Chest Port Elizabeth
Rink Street Pharmacy Port Elizabeth
Troppers Pharmacy Port Elizabeth
Klinicare Mosel Pharmacy Uitenhage
EASTERN CAPE (CONTINUED)
SAMWUMED | MEMBER GUIDE 2019 47
Insititution Name Town/City
Arcade Pharmacy - Humansdorp Humansdorp
Hendricks Pharmacy King William`s Town
Clicks Pharmacy - Summerstrand Port Elizabeth
Klinipharm Pharmacy Port Elizabeth
Schuin Villa Apteek & Medisyne Depot Port Elizabeth
Korsten Pharmacy Port Elizabeth
Klinicare Pharmacy - Uitenhage Uitenhage
Netcare Greenacres Hospital Dispensary Port Elizabeth
Klinimed Pharmacy Port Elizabeth
Clicks Pharmacy - Buffelsfontein Road (Netcare Walmer Dispensary) Port Elizabeth
Clicks Pharmacy - Westering Port Elizabeth
Clicks Pharmacy - East London (Netcare East London Dispensary) East London
Clicks Pharmacy - East London (Netcare East London Dispensary) East London
Netcare Cuyler Pharmacy Uitenhage
Harrison's Pharmacy King William`s Town
Dorans Pharmacy Aliwal North
Klinicare Mill Park Pharmacy Port Elizabeth
Klinicare Oval Pharmacy Port Elizabeth
Mountweg Pharmacy Port Elizabeth
EASTERN CAPE (CONTINUED)
FREE STATE
Insititution Name Town/City
Clicks Pharmacy - Bayswater Bloemfontein
Clicks Pharmacy - Fleurdal Bloemfontein
Clicks Pharmacy - Fichardtpark Bloemfontein
Central Park Pharmacy Bloemfontein
Clicks Pharmacy - Loch Logan Bloemfontein
Vrystaat Pharmacy Bloemfontein
Netcare Universitas Pharmacy Bloemfontein
Medi-Rite Pharmacy - Bloemfontein Bloemfontein
Bothaville Pharmacy Bothaville
Medi-Rite Pharmacy - Westdene Bloemfontein
Kroonstad Pharmacy Kroonstad
Clicks Pharmacy - Dynarc Walk Bloemfontein
Medi-Chem Westdene Pharmacy Bloemfontein
Medi-Chem Pharmacy - Universitas Bloemfontein
Medi-Chem Rosepark Pharmacy Bloemfontein
FREE STATE (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Bloemfontein C B D Bloemfontein
Clicks Pharmacy - Mimosa Mall Bloemfontein
Clicks Pharmacy - Welkom Welkom
Clicks Pharmacy - Bethlehem Bethlehem
Edenburg Pharmacy Edenburg
Wesselsbron Apteek Wesselsbron
Netcare Pelonomi Private Hospital Pharmacy Bloemfontein
Mangaung Pharmacy Mangaung
Dis-Chem Bloemfontein Pharmacy Bloemfontein
Clicks Pharmacy - Sasolburg Sasolburg
Medirex Pharmacy Bloemfontein
Medi-Rite Pharmacy - Welkom Welkom
Masupatsela Pharmacy Welkom
Medi-Rite Pharmacy - Heidedal Bloemfontein
Heidedal Pharmacy Bloemfontein
Medi-Rite Pharmacy - Sentraal Bloemfontein
Langenhovenpark Pharmacy Bloemfontein
Dis-Chem Loch Logan Pharmacy Bloemfontein
Clicks Pharmacy - Kroonstad (Cross Street) Kroonstad
Clicks Pharmacy - Kroonstad (Cnr Van Zyl & North Street) Kroonstad
Medi-Rite Pharmacy - Kroonstad Kroonstad
Jurg Van Der Westhuizen Pharmacy Frankfort
Clicks Pharmacy - Goldfields Mall Welkom
Clicks Pharmacy - Harrismith Harrismith
Medi-Rite Pharmacy - Goldfields Welkom
Clicks Pharmacy - Dihlabeng Bethlehem
U Pharmacy - Riebeeckstad Welkom
Clicks Pharmacy - Ficksburg Ficksburg
Redicare Pharmacy Bloemfontein
Dis-Chem Langenhovenpark Pharmacy Bloemfontein
Clicks Pharmacy - Woodland Hills Bloemfontein
Rockville Alpha Pharmacy Mangaung
Clicks Pharmacy - Boitumelo Junction Welkom
Clicks Pharmacy - Botshabelo Botshabelo
The Towers Pharmacy Bloemfontein
Lengau Alpha Pharmacy Bloemfontein
Clicks Pharmacy - Heidedal Bloemfontein
Bloemfontein Pharmacy Bloemfontein
SAMWUMED | MEMBER GUIDE 201948
FREE STATE (CONTINUED)
Insititution Name Town/City
E R Meyer Pharmacy Odendaalsrus
Avenue Pharmacy Virginia
Oranje Pharmacy Virginia
Virginia Pharmacy Virginia
Harrismith Apteek En Medisyne Depot Harrismith
Flamingo Pharmacy Welkom
Senekal Pharmacy Senekal
Netcare Parys Pharmacy Parys
Riverside Pharmacy - Sasolburg Sasolburg
Medi Bloem Pharmacy Bloemfontein
Netcare Kroon Hospital Pharmacy Kroonstad
Pharmacross Pharmacy - Bloemfontein Bloemfontein
C Kroon Apteek Viljoenskroon
Spitskop Pharmacy Bloemfontein
Wilge Apteek Frankfort
Netcare Vaalpark Hospital Pharmacy Sasolburg
The Village Pharmacy Marquard
Botshabelo Pharmacy Botshabelo
GAUTENG
Insititution Name Town/City
Netcare Mulbarton Hospital Pharmacy Johannesburg
Sunward Park Hospital Pharmacy Boksburg
Netcare Akasia Hospital Pharmacy Akasia
Pharma Valu - Queenswood Pretoria
Clicks Pharmacy - Ontdekkers Park Rood-epoort (Netcare Roodepoort Dispensary) Roodepoort
Dis-Chem Roodepoort Pharmacy Roodepoort
Clicks Pharmacy - Montana Crossing Pretoria
Doornpoort Pharmacy & Medicine Depot Pretoria
Arrie Nel Pharmacy & Medisyne Depot Pretoria
Netcare Bougainville Private Hospital Pharmacy Pretoria
Dis-Chem Centurion Pharmacy Centurion
Clicks Pharmacy - Village View Germiston
Clicks Pharmacy - Rosebank Johannesburg
Clicks Pharmacy - Menlyn Retail Park Pretoria
Clicks Pharmacy - Midrand Midrand
Dis-Chem Northgate Pharmacy Randburg
Dis-Chem Parkmeadows Pharmacy Johannesburg
GAUTENG (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Eastgate (Bruma) Germiston
Empilweni Pharmacy Soweto
Clicks Pharmacy - Campus Square Johannesburg
Clicks Pharmacy - Town Square Roodepoort
Clicks Pharmacy - Clearwater Mall Roodepoort
Eldoraigne Village Pharmacy Centurion
Netcare Clinton Pharmacy Alberton
Wilgers Apteek Pretoria
Dis-Chem Olympus Pharmacy Pretoria
Dis-Chem Lynnwood Road Pharmacy Pretoria
Dis-Chem Benmore Gardens Pharmacy Sandton
Dahya's Pharmacy Randburg
Clicks Pharmacy - Saxby (Netcare Saxby Pharmacy) Centurion
Netcare Olivedale Pharmacy Randburg
Clicks Pharmacy - Fourways Gardens Sandton
Duxmed Pharmacy Lenasia South
Dis-Chem Cresta Pharmacy Randburg
Ferngate Pharmacy Randburg
Pick N Pay Pharmacy - Faerie Glen Pretoria
Park Central Pharmacy Johannesburg
Rant-En-Dal Pharmacy Krugersdorp
Clicks Pharmacy - Cresta Centre Randburg
Pick N Pay Pharmacy - Bedworth Vereeniging
Dis-Chem Montana North Pharmacy Pretoria
Clicks Pharmacy - Northgate Randburg
Sacks Pharmacy Krugersdorp
Farrar Care Pharmacy Benoni
Blairgowrie Pharmacy Randburg
Medi-Rite Pharmacy - Kempton Park Kempton Park
Medi-Rite Pharmacy - Roodepoort Roodepoort
Pick N Pay Pharmacy - Boksburg Boksburg
Menlo Park Pharmacy Pretoria
Medi-Rite Pharmacy - Centurion Centurion
Medi-Rite Pharmacy - Menlyn Pretoria
Medi-Rite Pharmacy - Vanderbijlpark Vanderbijlpark
Pick N Pay Pharmacy - Norwood Johannesburg
Dis-Chem Norwood Gardens Pharmacy Johannesburg
Clicks Pharmacy - Silverwater Crossing Pretoria
Medi-Rite Pharmacy - Eastgate Germiston
SAMWUMED | MEMBER GUIDE 2019 49
GAUTENG (CONTINUED)
Insititution Name Town/City
Medi-Rite Pharmacy - Edenvale Edenvale
Medi-Rite Pharmacy - Sandton Sandton
Dis-Chem Boksburg North Pharmacy Boksburg
Clicks Pharmacy - Featherbrook Roodepoort
Medi-Rite Pharmacy - Fourways Sandton
Clicks Pharmacy - Edenmeadow Edenvale
Clicks Pharmacy - Springs Springs
Clicks Pharmacy - Killarney Mall Johannesburg
Medi-Rite Pharmacy - Montana Pretoria
Clicks Pharmacy - Sandton City Sandton
Clicks Pharmacy - Mall@reds Centurion
Clicks Pharmacy - Festival Mall Kempton Park
Brooklyn Pharmacy Pretoria
Clicks Pharmacy - Alberton Alberton
Clicks Pharmacy - Carnival Mall Brakpan
Pick N Pay Pharmacy - Steeledale Johannesburg South
Clicks Pharmacy - Lakeside Mall Benoni
Clicks Pharmacy - Lonehill Sandton
Clicks Pharmacy - Sanridge Square Midrand
Clicks Pharmacy - Brooklyn Mall Pretoria
Medi-Rite Pharmacy - Westgate Roodepoort
Medi-Rite Pharmacy - Marks Park Vereeniging
Clicks Pharmacy - Midway Mews Midrand
Wonderpark Pharmacy Akasia
Clicks Pharmacy - Jacaranda Centre Pretoria
Olivewood Pharmacy Pretoria
Barclay Square Pharmacy Pretoria
Clicks Pharmacy - Trade Route Mall Lenasia South
Dis-Chem Carlswald (Midrand) Pharmacy Midrand
Dis-Chem Greenstone Mall Pharmacy Lethabong
Dis-Chem Strubens Valley Pharmacy Roodepoort
Clicks Pharmacy - Wonderpark Akasia
Medi-Rite Pharmacy - Ontdekkers Roodepoort
Gallo Manor Pharmacy Sandton
Dis-Chem Vaal Mall Pharmacy Vanderbijlpark
Clicks Pharmacy - Eco Boulevard Centurion
Medi-Rite Pharmacy - Balfour Park Johannesburg
Clicks Pharmacy - Silverlakes Pretoria
Clicks Pharmacy - Riverside Boulevard Vanderbijlpark
GAUTENG (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Vaal Mall Vanderbijlpark
Clicks Pharmacy - Lambton Germiston
Clicks Pharmacy - Jabulani Mall Soweto
Medi-Rite Pharmacy - Mayville Pretoria
Medi-Rite Pharmacy - Parklands Boksburg
Clicks Pharmacy - Menlyn Pretoria
Clicks Pharmacy - Columbine Square Johannesburg South
Pick N Pay Pharmacy - Centurion Centurion
Pick N Pay Pharmacy - Montana Pretoria
Joburg City Pharmacy Johannesburg
Clicks Pharmacy - Southdowns Centurion
Clicks Pharmacy - Bellairs Randburg
Clicks Pharmacy - East Rand Mall Boksburg
Clicks Pharmacy - Greenstone Mall Lethabong
Kungwini Pharmacy Bronkhorst-spruit
Pick N Pay Pharmacy - Greenstone Lethabong
Clicks Pharmacy - Cedar Road Sandton
Dis-Chem Hazeldean Pharmacy Pretoria
Dis-Chem Athol Oaklands Pharmacy Johannesburg
Dis-Chem Farramere Pharmacy Benoni
Clicks Pharmacy - Maponya Mall Pimville
Medi-Rite Pharmacy - Arcon Park Vereeniging
Medi-Rite Pharmacy - Quagga Pretoria
Pick N Pay Pharmacy - Soweto Soweto
Clicks Pharmacy - Fourways Mall Sandton
Clicks Pharmacy - Key West Krugersdorp
Clicks Pharmacy - the Glen Johannesburg South
Medi-Rite Pharmacy - Glenvista Johannesburg South
Clicks Pharmacy - Southgate Johannesburg South
Dis-Chem Woodmead Pharmacy Sandton
Clicks Pharmacy - Bedford Centre Germiston
Pick 'n Pay Pharmacy - Woodmead Sandton
Clicks Pharmacy - Kolonade Pretoria
Clicks Pharmacy - Meyerton Meyerton
Medi-Rite Pharmacy - Gezina Pretoria
Clicks Pharmacy - Hatfield Plaza Pretoria
Clicks Pharmacy - Randfontein Randfontein
SAMWUMED | MEMBER GUIDE 201950
GAUTENG (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Carletonville Carletonville
Clicks Pharmacy - Fedsure Forum Pretoria
Clicks Pharmacy - Hyde Park Sandton
Clicks Pharmacy - Carlton Centre Johannesburg
Clicks Pharmacy - Norkem Mall Kempton Park
Clicks Pharmacy - Northvaal Arcade Pretoria
Dis-Chem Wonderboom Pharmacy Pretoria
Clicks Pharmacy - Rivonia Sandton
Dis-Chem Raslouw Pharmacy Centurion
Clicks Pharmacy - the Zone Johannesburg
Medi-Rite Pharmacy - Lenasia Lenasia
Medi-Rite Pharmacy - Moreleta Park Pretoria
Clicks Pharmacy - Quagga Centre Pretoria
Clicks Pharmacy - Brackenhurst Alberton
Clicks Pharmacy - Sunninghill Sandton
Medi-Rite Pharmacy - Raslouw Centurion
Clicks Pharmacy - Sunnypark Pretoria
Clicks Pharmacy - Atlasville Boksburg
Clicks Pharmacy - Gezina Pretoria
Clicks Pharmacy - Brightwater Commons Randburg
Clicks Pharmacy - Glenvista Johannesburg South
Greenways Lambton Pharmacy Germiston
Clicks Pharmacy - Percegold Pretoria
Clicks Pharmacy - Bryanston Sandton
Clicks Pharmacy - Woodbridge Mall Kempton Park
Medi-Rite Pharmacy - Atteridgeville Pretoria
Clicks Pharmacy - Rand City Mall (2nd Avenue) Alberton
Clicks Pharmacy - Randburg Randburg
Clicks Pharmacy - Southdale Johannesburg South
Clicks Pharmacy - Parkrand Boksburg
Clicks Pharmacy - River Square Vereeniging
Clicks Pharmacy - Broadacres Sandton
Medi-Rite Pharmacy - Palm Springs Springs
Medi-Rite Pharmacy - Jabulani Soweto
Medi-Rite Pharmacy - Greenstone Lethabong
Clicks Pharmacy - Wonderboom Pretoria
Van Heerden Pharmacy - Parkview Pretoria
Dis-Chem the Glen Pharmacy Johannesburg South
GAUTENG (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Bronkhorstspruit Bronkhorst-spruit
Clicks Pharmacy - Fourways Crossing Sandton
Clicks Pharmacy - Northmead Square Benoni
Medi-Rite Pharmacy - Jan Smuts Kempton Park
Clicks Pharmacy - the Angelo - Nigel Nigel
Clicks Pharmacy - Lynridge Mall Pretoria
Medi-Rite Pharmacy - Randburg Randburg
Medi-Rite Pharmacy - Grey Owl Olifantsfontein
Medi-Rite Pharmacy - Horizon View Roodepoort
Medi-Rite Pharmacy - Bartlett Boksburg
Irene Pharmacy Centurion
Clicks Pharmacy - the Village@moreleta Pretoria
Clicks Pharmacy - Northpark Pretoria
Clicks Pharmacy - Lyttleton Centurion
Clicks Pharmacy - the Grove Pretoria
Clicks Pharmacy - Comaro View Johannesburg South
Clicks Pharmacy - Olivedale Randburg
Clicks Pharmacy - Valley Centre Randburg
Dis-Chem Krugersdorp Pharmacy Krugersdorp
Dis-Chem Brooklyn Mall Pharmacy Pretoria
Clicks Pharmacy - Losberg Fochville
Medi-Rite Pharmacy - Braam Fisher Randburg
Dis-Chem Woodlands Boulevard Pharmacy Pretoria
Clicks Pharmacy - Waverley Pretoria
Pick N Pay Pharmacy - Hurlingham Sandton
Dis-Chem Clearwater Mall Pharmacy Roodepoort
Khanyisa Sosh Pharmacy Soshanguve
Clicks Pharmacy - Selcourt Towers Springs
Medi-Rite Pharmacy - Daspoort Pretoria
Medi-Rite Pharmacy - Dobsonville Soweto
Waterkloof Corner Pharmacy Pretoria
Medi-Rite Pharmacy - Chris Hani Crossing Vosloorus
Medi-Rite Pharmacy - Brakpan Brakpan
Medi-Rite Pharmacy - Benoni Lake Benoni
Dis-Chem Verdi Pharmacy Randburg
Clicks Pharmacy - Heathway Square Randburg
Clicks Pharmacy - Lemon Tree Alberton
Clicks Pharmacy - Appletons Village Randburg
SAMWUMED | MEMBER GUIDE 2019 51
GAUTENG (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Chris Hani Crossing Vosloorus
Clicks Pharmacy - Tembisa Tembisa
Clicks Pharmacy - Village @ Horizon - Roodepoort Roodepoort
Clicks Pharmacy - Honey Ridge Randburg
Firstcare Courier Pharmacy Krugersdorp
Clicks Pharmacy - Eldo Square Centurion
Clicks Pharmacy - Melrose Arch Johannesburg
Clicks Pharmacy - Farrarmere Benoni
Dis-Chem Three Rivers Pharmacy Vereeniging
Dis-Chem Victory Park Pharmacy Randburg
Dis-Chem Carnival Mall Pharmacy Brakpan
Medi-Rite Pharmacy - Golden Walk Germiston
Dis-Chem Direct Oncology Pharmacy Midrand
Clicks Pharmacy - Jubilee Mall Hammansk-raal
Clicks Pharmacy - Centurion Lifestyle Centre Centurion
Dis-Chem Glenfair Pharmacy Pretoria
Netcare Waterfall City Hospital Pharmacy Midrand
Medi-Rite Pharmacy - Carnival City Brakpan
Oakdene Pharmacy Johannesburg South
Medi-Rite Pharmacy - Southgate Johannesburg South
Medi-Rite Pharmacy - Northcliff Corner Randburg
Dis-Chem Nicolway Pharmacy Sandton
Medi-Rite Pharmacy - Three Rivers Vereeniging
Clicks Pharmacy - Birchleigh North Kempton Park
Clicks Pharmacy - Elspark Germiston
Clicks Pharmacy - Meyersdal Alberton
Medi-Rite Pharmacy - Silver Lakes Pretoria
Medi-Rite Pharmacy - Protea Glen Mall Soweto
Clicks Pharmacy - Flora Centre Roodepoort
Pick N Pay Pharmacy - the Falls Roodepoort
Clicks Pharmacy - Protea Gardens Soweto
Pick N Pay Pharmacy - Brentwood Park Benoni
Clicks Pharmacy - Tsakane Brakpan
Clicks Pharmacy - Cavendish Glen Kempton Park
Dis-Chem Westgate Pharmacy Roodepoort
Clicks Pharmacy - Crowthorne Midrand
Pick N Pay Pharmacy - Lonehill Sandton
GAUTENG (CONTINUED)
Insititution Name Town/City
Van Heerden Pharmacy - Herfsblaar Pretoria
Medi-Rite Pharmacy - Randfontein Randfontein
Clicks Pharmacy - Diepkloof Square Diepkloof
Albemarle Pharmacy Germiston
Clicks Pharmacy - Protea Glen Soweto
Dis-Chem Festival Mall Pharmacy Kempton Park
Medi-Rite Pharmacy - Riverview Krugersdorp
Clicks Pharmacy - Cradlestone Mall Krugersdorp
Dis-Chem Cradlestone Pharmacy Roodepoort
Dis-Chem Rosebank Pharmacy Johannesburg
Dis-Chem Wonderpark Pharmacy Akasia
Clicks Pharmacy - Mamelodi Crossing Pretoria
Clicks Pharmacy - Norwood Mall Johannesburg
Clicks Pharmacy - Parkview Pretoria
Clicks Pharmacy - Cosmo City Randburg
Clicks Pharmacy - Mabopane Mabopane
Pick N Pay Pharmacy - Randfontein (Helikonpark Pharmacy) Randfontein
Clicks Pharmacy - Forest Hill Centurion
Clicks Pharmacy - Balfour Park Johannesburg
Clicks Pharmacy - Soshanguve Crossing Soshanguve
Clicks Pharmacy - Eyethu Orange Farm Orange Farm
Lennymed Pharmacy Westonaria
Medi-Rite Pharmacy - Pretoria North Pretoria
Dis-Chem Park Station Pharmacy Johannesburg
Dis-Chem Southgate Mall Pharmacy Johannesburg South
Dis-Chem Heidelberg Mall Pharmacy Heidelberg - GP
Dis-Chem Glen Acres Pharmacy Kempton Park
Pharmacy @ Spar - Willow Way Pretoria
Dis-Chem Vanderbijlpark Pharmacy Vanderbijlpark
Clicks Pharmacy - Heidelberg Mall Heidelberg - GP
Clicks Pharmacy - Newtown Junction Johannesburg
Dis-Chem Jean Avenue Pharmacy Centurion
Dis-Chem Bedford Square Pharmacy Germiston
Clicks Pharmacy - Mark Park Vereeniging
Clicks Pharmacy - Dainfern Square Sandton
U Pharmacy - Nevada Alberton
Dis-Chem Direct Courier Pharmacy Midrand
Dis-Chem Killarney Mall Pharmacy Johannesburg
SAMWUMED | MEMBER GUIDE 201952
GAUTENG (CONTINUED)
Insititution Name Town/City
Dis-Chem Dainfern Square Pharmacy Sandton
Clicks Pharmacy - Sancardia Pretoria
Dis-Chem Mall of the South Pharmacy Johannesburg South
Clicks Pharmacy - Mall of the South Johannesburg South
Dis-Chem Sunninghill Pharmacy Sandton
Pick N Pay Pharmacy - Glen Balad Kempton Park
Pharmacy @ Spar - Evaton Sebokeng
Clicks Pharmacy - Golden Walk Germiston
U Pharmacy - Vorna Valley Midrand
Clicks Pharmacy - Waterfall Corner Midrand
Clicks Pharmacy - Blue Hills Midrand
Stix Morewa Memorial Hospital Pharmacy Johannesburg
U Pharmacy - Waverley Pretoria
Clicks Pharmacy - Wingtip Pretoria
Clicks Pharmacy - Northmead Mall Benoni
Dis-Chem Direct Oncology Pharmacy Midrand
Clicks Pharmacy - Olympus Village Pretoria
Dis-Chem Mall of Africa Pharmacy Midrand
Medi-Rite Pharmacy - Mall of Africa Midrand
Clicks Pharmacy - Mall of Africa Midrand
Clicks Pharmacy - Carletonville Mall Carletonville
Clicks Pharmacy - Oakfields Benoni
Clicks Pharmacy - Thabong Sebokeng
Clicks Direct Medicines Randburg
Clicks Pharmacy - Equestria Pretoria
Dis-Chem Newmarket Mall Pharmacy Alberton
Northriding Pharmacy Randburg
Dis-Chem Menlyn Park Pharmacy Pretoria
Clicks Pharmacy - Sinoville Pretoria
Dis-Chem Maponya Mall Pharmacy Soweto
Dis-Chem Greenvalley Pharmacy Lethabong
Winternest Pharmacy Akasia
Kelly Road Pharmacy Randburg
Pharmacy @ Spar - Clubview (Ashmed Pharmacy) Centurion
Dorite Pharmacy @ Spar - Jean Avenue Centurion
Clicks Pharmacy - Daveyton Mall Benoni
Clicks Pharmacy - Menlyn Maine Pretoria
Atlyn Pharmacy Pretoria
GAUTENG (CONTINUED)
Insititution Name Town/City
Medicare Pharmacy - Grosvenor Sandton
Linksfield Park Clinic Pharmacy Johannesburg
Clicks Pharmacy - Rynfield Square Benoni
Clicks Pharmacy - Springs Mall Springs
Dawn Park Pharmacy Boksburg
Dis-Chem Springs Mall Pharmacy Springs
Clicks Pharmacy - Alex Mall Alexandra
Docmed Pharmacy Vanderbijlpark
Dis-Chem Rynfield Terrace Pharmacy Benoni
Clicks Pharmacy - Irene Village Mall Centurion
Dis-Chem Randfontein Pharmacy Randfontein
Dis-Chem Jubilee Mall Pharmacy Hammansk-raal
Kilburn Pharmacy Roodepoort
Clicks Pharmacy - Kyalami Corner Midrand
Clicks Pharmacy - Middestad Pretoria Pretoria
Clicks Pharmacy - Katlehong Katlehong
Clicks Pharmacy - Ontdekkers Park Rood-epoort (Netcare Roodepoort Dispensary) Roodepoort
Clicks Pharmacy - the Berg (Netcare Schoongezicht Pharmacy) Randburg
Clicks Pharmacy - Carlswald Midrand
Clicks Pharmacy - Constantia (Netcare Constantia Pharmacy) Pretoria
Clicks Pharmacy - Nimrod Park (Netcare Monument Dispensary) Kempton Park
Clicks Pharmacy - Kembirch (Netcare Kembirch Dispensary) Kempton Park
Clicks Pharmacy - Pretoria North (Netcare Pretoria North Dispensary) Pretoria
Clicks Pharmacy - Saxby (Netcare Saxby Pharmacy) Centurion
Clicks Pharmacy - Silverton Pretoria Street (Netcare Silverton Dispensary) Pretoria
Dis-Chem Valley View Pharmacy Krugersdorp
The Local Choice Pharmacy - Village Centre Pretoria
The Local Choice Pharmacy - Village Centre Pretoria
Dis-Chem Soshanguve Pharmacy Soshanguve
Dis-Chem Meadowdale Mall Pharmacy Germiston
Clicks Pharmacy - Germiston Germiston
Clicks Pharmacy - Benoni Benoni
Nelson Mandela Children's Hospital - Pharmacy Johannesburg
SAMWUMED | MEMBER GUIDE 2019 53
GAUTENG (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Pretoria West (Netcare Pretoria West Dispensary) Pretoria
Clicks Pharmacy - Vereeniging (Netcare Vereeniging Pharmacy) Vereeniging
Clicks Pharmacy - Edenvale Edenvale
Clicks Pharmacy - Boksburg (Netcare Boksburg Dispensary) Boksburg
Clicks Pharmacy - Sophia Town (Netcare Sophiatown Pharmacy) Johannesburg
Clicks Pharmacy - Rabie Street Randburg
Clicks Pharmacy - Krugersdorp Krugersdorp
Clicks Pharmacy - Dalpark Brakpan
Clicks Pharmacy - Selection Park Springs
Dis-Chem Melville Pharmacy Johannesburg
Dis-Chem Morningside Pharmacy Sandton
Dis-Chem Mall @ 55 Pharmacy Centurion
Dis-Chem Gandhi Square Pharmacy Johannesburg
Benns Pharmacy Brakpan
Ackermans Apteek Germiston
Heidelberg Apteek Heidelberg - GP
El Corro Link Pharmacy Randburg
Dis-Chem Mondeor Pharmacy Johannesburg South
Rosebank Clinic Pharmacy Johannesburg
Milpark Hospital Dispensary Johannesburg
Rox Pharmacy Johannesburg
Adlams Pharmacy - Carletonville Carletonville
Vanderwalt Pharmacy Meyerton
Nigel Apteek Nigel
Eastwood Park Pharmacy Pretoria
Kramer's Pharmacy Pretoria
Randgate Pharmacy Randfontein
Alpha Petersfield Pharmacy Springs
Strubenvale Pharmacy Springs
Netcare Rand Clinic Dispensary Johannesburg
Cullinan Pharmacy Cullinan
Netcare Park Lane Pharmacy Johannesburg
Clicks Pharmacy - Doringkloof Centurion
Tileba Apteek Akasia
Harmelia Apteek Germiston
Bronberrik Pharmacy Centurion
Netcare Union Pharmacy Alberton
GAUTENG (CONTINUED)
Insititution Name Town/City
Medi-Park Apteek Kempton Park
Ferryvale Pharmacy Nigel
De Wiekusweg Apteek Kempton Park
Moreletapark Apteek Pretoria
Jacqueline Pharmacy Alberton
Dis-Chem Randridge Medicine Centre Pharmacy Randburg
Mega Apteek & Medisyne Depot Vereeniging
Station Pharmacy - Mayfair Johannesburg
Adlams Pharmacy Oberholzer Carletonville
Netcare Krugersdorp Hospital Pharmacy Krugersdorp
Netcare Unitas Hospital Pharmacy Centurion
Clicks Pharmacy - Woodlands Boulevard Pretoria
Netcare Jakaranda Hospital Pharmacy Pretoria
Serene Apteek Pretoria
Panorama Pharmacy Centurion
Pharma Valu - Die Hoek Pretoria
Netcare Garden City Hospital Pharmacy Johannesburg
Baker Street Pharmacy Edenvale
Kagiso Pharmacy Krugersdorp
Dr S K Matseke Memorial Hospital Pharmacy Diepkloof
Dis-Chem the Mall Pharmacy Sandton
Bronkhorstspruit Hospital Dispensary Bronkhorst-spruit
Clicks Pharmacy - Centurion Centre (Hyper-Pharm Centurion) Centurion
Henda Pharmacy Pretoria
Van Heerden Apteek & Medisyne Depot - Hamilton Pretoria
Netcare Sunninghill Pharmacy Sandton
Netcare Linmed Pharmacy Benoni
Colony Pharmacy Randburg
Netcare Linksfield Park Retail Pharmacy Johannesburg
Netcare Bell St Pharmacy Krugersdorp
Clicks Pharmacy - Boksburg (Netcare Boksburg Dispensary) Boksburg
Clicks Pharmacy - Edenvale Edenvale
Clicks Pharmacy - Kembirch (Netcare Kembirch Dispensary) Kempton Park
Clicks Pharmacy - Gezina (Netcare Gezina Dispensary) Pretoria
Clicks Pharmacy - Gezina (Netcare Gezina Dispensary) Pretoria
SAMWUMED | MEMBER GUIDE 201954
GAUTENG (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Rabie Street Randburg
Clicks Pharmacy - Silverton Pretoria Street (Netcare Silverton Dispensary) Pretoria
Arrie Nel Montana Pharmacy Pretoria
Clicks Pharmacy - the Berg (Netcare Schoongezicht Pharmacy) Randburg
Clinix Botshelong - Empilweni Private Hospital Pharmacy Vosloorus
Clicks Pharmacy - Watermeyer Pretoria
Clicks Pharmacy - Pretoria North (Netcare Pretoria North Dispensary) Pretoria
Clicks Pharmacy - Vereeniging (Netcare Vereeniging Pharmacy) Vereeniging
Van Heerden Lynriff Apteek Pretoria
Clicks Pharmacy - Selection Park Springs
Clinix Tshepo-Themba Private Hospital Pharmacy Soweto
Clicks Pharmacy - Germiston Germiston
Clicks Pharmacy - Krugersdorp Krugersdorp
Clicks Pharmacy - Constantia (Netcare Constantia Pharmacy) Pretoria
Hanrimed Medisyne Depot Brakpan
Van Heerden Glen Village Pharmacy Pretoria
Netcare Femina Hospital Pharmacy Pretoria
Clicks Pharmacy - Pretoria West (Netcare Pretoria West Dispensary) Pretoria
Clicks Pharmacy - Sophia Town (Netcare Sophiatown Pharmacy) Johannesburg
Clicks Pharmacy - Benoni Benoni
Clicks Pharmacy - Nimrod Park (Netcare Monument Dispensary) Kempton Park
Netcare Pretoria East Hospital Pharmacy Pretoria
Veganview Dispensary Edenvale
Lily Pharmacy Germiston
Clicks Pharmacy - Atterbury Pretoria
Clinix Naledi-Nkanyezi Private Hospital Pharmacy Sebokeng
Dis-Chem Bracken Gardens Pharmacy Alberton
Eldo Park Pharmacy - Wierda Park Centurion
Oak Avenue Pharmacy (Oaklaan-Germis-ton Apteek) Boksburg
Muntu Medicine Depot Boksburg
Clicks Pharmacy - Noordheuwel Krugersdorp
Netcare Montana Private Hospital Pharmacy Pretoria
Pharmacentre - Kyalami Midrand
GAUTENG (CONTINUED)
Insititution Name Town/City
Dis-Chem East Rand Pharmacy Boksburg
Netcare N17 Pharmacy Springs
Clicks Pharmacy - Mayville Pretoria
Clicks Pharmacy - Westgate (Ontdekkers Road) Roodepoort
Clicks Pharmacy - Cornwall View Pretoria
Dis-Chem Rynfield Terrace Pharmacy Benoni
Falls Apteek En Medisyne Depot Benoni
Netcare Moot General Hospital Pharmacy Pretoria
S Buys Park Pharmacy Carletonville
KWA-ZULU NATAL
Insititution Name Town/City
Newlands City Pharmacy & Medicine Depot
Newlands West
Hayfields Pharmacy Pietermaritz-burg
Clicks Pharmacy - La Lucia La Lucia
Durdoc Clinic Pharmacy Durban
Hasmed Pharmacy Phoenix
Netcare Margate Hospital Pharmacy Margate
Glenwood Village Pharmacy Berea
Medi-Rite Pharmacy - Chatsworth Chatsworth
Clicks Pharmacy - Liberty Midlands Mall Pietermaritz-burg
Clicks Pharmacy - Gateway Umhlanga
Medi-Rite Pharmacy - Gateway Umhlanga
Medi-Rite Pharmacy - Pavilion Westville
Clicks Pharmacy - Shelly Beach Margate
Clicks Pharmacy - Pavilion Westville
Clicks Pharmacy - Pinetown Pinetown
Shepmed Pharmacy Pinetown
Clicks Pharmacy - Richards Bay Richards Bay
Dis-Chem Glen Lucia Pharmacy La Lucia
Medi-Rite Pharmacy - Richards Bay Richards Bay
Pick N Pay Pharmacy - Durban North Durban North
Just Health Pharmacy Durban
Clicks Pharmacy - Kensington Square Durban North
Springmed Pharmacy Durban
Clicks Pharmacy - Westville Mall Durban
Clicks Pharmacy - Hayfields Pietermaritz-burg
SAMWUMED | MEMBER GUIDE 2019 55
KWA-ZULU NATAL (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Amajuba Mall Newcastle
Netcare Alberlito Hospital - Pharmacy Dolphin Coast
Dis-Chem Hillcrest Pharmacy Hillcrest
Medi-Rite Pharmacy - Shallcross Queensburgh
Clicks Pharmacy - Ballito Lifestyle Dolphin Coast
Medi-Rite Pharmacy - Shelley Beach Port Shep-stone
Dis-Chem Westville Pharmacy Westville
D-Med Pharmacy Durban
Umhlanga Medical Centre Pharmacy Umhlanga
Clicks Pharmacy - Montclair Durban South
Clicks Pharmacy - Scottburgh Scottburgh/Umzinto North
Clicks Pharmacy - Empangeni Empangeni
Clicks Pharmacy - Windermere Berea
Endumeni Pharmacy Dundee
Medi-Rite Pharmacy - Boardwalk Richards Bay
Clicks Pharmacy - the Bluff Bluff
Clicks Pharmacy - Game City Durban
Medi-Rite Pharmacy - Bluff Bluff
Pick N Pay Hypermarket Pharmacy - South Coast
Amanzimtoti
Medi-Rite Pharmacy - Newcastle Newcastle
Milmed Pharmacy Durban
Clicks Pharmacy - Chatsworth Chatsworth
Clicks Pharmacy - Westguard Durban
Clicks Pharmacy - the Workshop Durban
Clicks Pharmacy - South Coast Mall Margate
Cosmed Pharmacy Margate
Clicks Pharmacy - the Galleria Aman-zimtoti
Amanzimtoti
Dis-Chem Amanzimtoti Pharmacy Amanzimtoti
Medi-Rite Pharmacy - Galleria Amanzimtoti
Medi-Rite Pharmacy - Margate Margate
Clicks Pharmacy - Kokstad Kokstad
Medi-Rite Pharmacy - Bridge City Iqadi
Dis-Chem Ballito Junction Regional Mall Pharmacy
Dolphin Coast
Clicks Pharmacy - Pietermaritzburg Pietermaritz-burg
Clicks Pharmacy - Victoria Pietermaritz-burg
The Dundee Trading Pharmacy Dundee
KWA-ZULU NATAL (CONTINUED)
Insititution Name Town/City
People's Choice Pharmacy Kokstad
Dis-Chem Richards Bay Pharmacy Richards Bay
Clicks Pharmacy - Southway Mall Durban South
Clicks Pharmacy - Ladysmith Ladysmith
Link Hills Pharmacy Waterfall
Clicks Pharmacy - Musgrave Berea
Clicks Pharmacy - Queensburgh Durban
Eastbury Pharmacy Phoenix
Clicks Pharmacy - Margate Margate
Medi-Rite Pharmacy - Edendale Mall Pietermaritz-burg
Clicks Pharmacy - Westville Village Westville
Clicks Pharmacy - Umhlali Dolphin Coast
Dis-Chem Liberty Midlands Mall Phar-macy
Pietermaritz-burg
Clicks Pharmacy - Cascades Pietermaritz-burg
Clicks Pharmacy - Westwood Westville
Clicks Pharmacy - Reservoir Hills Durban
Clicks Pharmacy - Meer En See Richards Bay
Medi-Rite Pharmacy - Cascades Pietermaritz-burg
Medi-Rite Pharmacy - Castle Rock Newcastle
Clicks Pharmacy - Newcastle Mall Newcastle
Waterloo Pharmacy Blackburn
Clicks Pharmacy - Lillies Quarter Hillcrest
Clicks Pharmacy - Edendale Pietermaritz-burg
Clicks Pharmacy - Scottsville Mall Pietermaritz-burg
Clicks Pharmacy - Bridge City KwaMashu
Pick N Pay Pharmacy - Pavillion Westville
Clicks Pharmacy - the Crescent - Um-hlanga
Umhlanga
Clicks Pharmacy - Howick Howick
Clicks Pharmacy - Stanger KwaDukuza
Dis-Chem Overport Pharmacy Durban
Umtshezi Pharmacy Estcourt
Clicks Pharmacy - Vryheid Vryheid
T L C Umdloti Pharmacy Umdloti
Newkwa Pharmacy Newlands West
Dis-Chem the Pavilion Pharmacy Westville
SAMWUMED | MEMBER GUIDE 201956
KWA-ZULU NATAL (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Kloof Kloof
Clicks Pharmacy - Amazimtoti (Seadoone Mall)
Amanzimtoti
Clicks Pharmacy - Phoenix Plaza Phoenix
Dis-Chem Watercrest Mall Pharmacy Waterfall
Isandlwana Pharmacy Vryheid
Clicks Pharmacy - Brookside Mall Pietermaritz-burg
Medi-Rite Pharmacy - Brookside Mall Pietermaritz-burg
Clicks Pharmacy - Pongola Pongola
Clicks Pharmacy - Kwamnyandu Umlazi
Clicks Pharmacy - Watercrest Mall Waterfall
Clicks Pharmacy - Dundee Dundee
Clicks Pharmacy - Ulundi Ulundi
Caremed Pharmacy Pietermaritz-burg
Crystal Pharmacy - Kokstad Kokstad
Pharmacy @ Spar - Port Edward Port Edward
Durban North Pharmacy Umhlanga
Dis-Chem the Bluff Pharmacy Bluff
Pharmacy @ Spar - Bridge City KwaMashu
Clicks Pharmacy - Smith Street Durban
Clicks Pharmacy - Mtubatuba Mtubatuba
Dis-Chem Pinecrest Pharmacy Pinetown
Clicks Pharmacy - Kingsburgh Amanzimtoti
Hilton Health Pharmacy Hilton
Main Pharmacy - Hill Street Pinetown
Mpop-Med Pharmacy Umhlabuyalin-gana Rural
Pharmacy @ Spar - Winkle Kingsburgh
Clicks Pharmacy - Umlazi Mega City Umlazi
Ekuphileni Pharmacy Newcastle
Medi-Rite Pharmacy - Mangusi Hluhluwe
Ahmed Al-Kadi Private Hospital Pharmacy Durban
Nature's Health Pharmacy Chatsworth
Clicks Pharmacy - Ballito Junction Regional Mall
Dolphin Coast
Dis-Chem Southcoast Mall Pharmacy Margate
Clicks Pharmacy - Berea Centre Berea
Clicks Pharmacy - Conabor Street Durban
Clicks Pharmacy - Hillcrest Corner Hillcrest
KWA-ZULU NATAL (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Hayfields Mall Pietermaritz-burg
Skinmed Pharmacy Durban
Clicks Pharmacy - the Bluff Lighthouse Road
Bluff
Clicks Pharmacy - Meller Road Pinetown
Mdlovane Pharmacy Greytown
Dis-Chem Cornubia Pharmacy Mount Edge-combe
Clicks Pharmacy - Cornubia Mount Edge-combe
Dis-Chem Newcastle Pharmacy Newcastle
Medi-Rite Pharmacy - Cornubia Mount Edge-combe
Ladysmith Pharmacy Ladysmith
Pharmacy @ Spar Ramsgate Margate
Aquarius Pharmacy Port Shep-stone
Medicare Pharmacy - Verulam Verulam
Randeree's Pharmacy Durban
Maxwell Centre Pharmacy Durban
Linmed Pharmacy Tongaat
Delta Pharmacy Pietermaritz-burg
Netcare Kingsway Hospital Pharmacy Amanzimtoti
Scott Street Day & Nite Pharmacy Scottburgh/Umzinto North
Naveen's Pharmacy Newcastle
Remedia Pharmacy Vryheid
Netcare Parklands Hospital Pharmacy Durban
Whitehouse Mall Pharmacy Port Shep-stone
Netcare St Augustine's Hospital - Dis-pensary
Berea
Parkgate Pharmacy & Medicine Depot Phoenix
Motalas Pharmacy Durban
Stanger Pharmacy KwaDukuza
Netcare St Anne's Hospital Pharmacy Pietermaritz-burg
Stonebridge Pharmacy & Medicine Depot Phoenix
Medpharm Pharmacy Pietermaritz-burg
Pointmed Pharmacy Durban
Clicks Pharmacy - the Bluff Lighthouse Road
Bluff
SAMWUMED | MEMBER GUIDE 2019 57
KWA-ZULU NATAL (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Conabor Street Durban
Clicks Pharmacy - Hayfields Mall Pietermaritz-burg
Clicks Pharmacy - Meller Road Pinetown
The Bay Hospital - Pharmacy Richards Bay
Murray Square Pharmacy & Medicine Depot
Pinetown
Netcare Umhlanga Hospital - Pharmacy Umhlanga
Rinaldo Pharmacy Durban North
Medfield Pharmacy Durban
LIMPOPO
Insititution Name Town/City
Clicks Pharmacy - Polokwane 2 Polokwane
Mokopane Pharmacy - Potgietersrus Mokopane
Van Heerden Pharmacy - Tzaneen Tzaneen
Thulamela Pharmacy Thohoyandou
Van Heerden Pharmacy - Thabazimbi Thabazimbi
Peacemed Pharmacy Tzaneen
Clicks Pharmacy - Polokwane C B D Polokwane
Clicks Pharmacy - Cycad Polokwane
Medi-Rite Pharmacy - Polokwane Polokwane
Masingita Pharmacy Giyani
Clicks Pharmacy - Tzaneen Tzaneen
Clicks Pharmacy - Phalaborwa Phalaborwa
Van Heerden Pharmacy - Nylstroom 2 Modimolle
Clicks Pharmacy - Savannah Centre Polokwane
Ladanna Pharmacy Polokwane
Clicks Pharmacy - Thornhill Polokwane
T J Healthcare Pharmacy Thohoyandou
Dis-Chem Savannah Mall Pharmacy Polokwane
Dis-Chem Platinum Park Pharmacy Polokwane
Clicks Pharmacy - Mall of the North Polokwane
Medi-Rite Pharmacy - Mall of the North Polokwane
Dis-Chem Mall of the North Pharmacy Polokwane
Pick N Pay Pharmacy - Mall of the North Polokwane
Clicks Pharmacy - Ellisras Lephalale
Clicks Pharmacy - Louis Trichardt Louis Trichardt
Nyeleti Pharmacy Greater Tza-neen Rural
Clicks Pharmacy - Tubatse Crossing Burgersfort
LIMPOPO (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Modi Mall Modimolle
Clicks Pharmacy - Mall@lebo (Lebowak-gomo)
Lepele-Nkum-pi Rural
Pharmacy @ Spar City Centre Polokwane
Clicks Pharmacy - Thaba Mall Thabazimbi
Clinix Phalaborwa Private Hospital Pharmacy Phalaborwa
Clicks Pharmacy - Lephalale Mall Lephalale
Tzaneen Pharmacy Tzaneen
Modjadji Pharmacy - Duiwelskloof Modjadjiskloof
Bophelomed Pharmacy Lepele-Nkum-pi Rural
Tsusanang Pharmacy Burgersfort
Clicks Pharmacy - Mokopane Mokopane
Ripfumelo Pharmacy Greater Tza-neen Rural
Parks-Med Pharmacy Polokwane
Mutakalo Pharmacy Thohoyandou
Lombard Pharmacy Tzaneen
Sebola Pharmacy Bela-Bela
Clicks Pharmacy - Musina Mall Musina
Clicks Pharmacy - Groblersdal Groblersdal
Hospitality Pharmacy Louis Trichardt
Clicks Pharmacy - Thavhani Mall Thohoyandou
Mogolaneng Pharmacy Polokwane
Weldon's Apteek Louis Trichardt
Potgietersrus Pharmacy Mokopane
Muldok Pharmacy Mokopane
Watts Apteek Mokopane
Van Heerden Apteek & Medisyne Depot Head Office (Warmbaths) Bela-Bela
Van Heerden Pharmacy - Nylstroom Modimolle
Groblersdal Pharmacy Groblersdal
Sanbonani Pharmacy Groblersdal
Medline Pharmacy Bela-Bela
The Local Choice Pharmacy - Polokwane Polokwane
Cure-O-Pharm Pharmacy Polokwane
SAMWUMED | MEMBER GUIDE 201958
MPUMALANGA
Insititution Name Town/City
Clicks Pharmacy - Highland Mews Witbank Ext 16
Clicks Pharmacy - Saveways Witbank
Van Heerden Pharmacy - Sonpark - Nelspruit
Sonheuwel
Van Heerden Pharmacy - Nelspruit Sonheuwel
Medico Medisyne Depot Secunda
Medi-Rite Pharmacy - Nelspruit Nelspruit
Clicks Pharmacy - Midwater Centre Aerorand
Protea Medi-Wise Pharmacy Secunda
Greylingstad Pharmacy Balfour
Clicks Pharmacy - Standerton Standerton
Clicks Pharmacy - Highveld Mall Witbank
Clicks Pharmacy - Riverside Mall Nelspruit
Clicks Pharmacy - Middelburg Middelburg
Van Heerden Pharmacy - Sabie Sabie
Cosmos Pharmacy Bethal
Laeveld Pharmacy White River
Clicks Pharmacy - Hazyview Hazyview
Medi-Rite Pharmacy - Ermelo Ermelo
Medi-Rite Pharmacy - Bell Street Nelspruit
Dis-Chem Nelspruit Pharmacy Nelspruit
Medi-Rite Pharmacy - Klipfontein Klipfontein
Clicks Pharmacy - Delmas Delmas
Mopani Pharmacy - Ilanga Mall Nelspruit
Dis-Chem Witbank Pharmacy Witbank
Russells Pharmacy Nelspruit
Rixile Pharmacy Bushbuckridge
Clicks Pharmacy - Ermelo Ermelo
Clicks Pharmacy - Ilanga Mall Nelspruit
Medi-Rite Pharmacy - Lydenburg Lydenburg
Zamantungwa Pharmacy - Amersfoort Amersfoort
Pick N Pay Pharmacy - Middelburg Middelburg
Clicks Pharmacy - Middelburg Mall Middelburg
Medi-Rite Pharmacy - Middelburg Mall Middelburg
Clicks Pharmacy - Ben Fleur Witbank
Mopani Pharmacy - White River White River
Vigilcare Pharmacy - Mhluzi Mhluzi Ext 4
Dis-Chem Secunda Pharmacy Secunda
Clicks Pharmacy - Secunda Regional Mall Secunda
U Pharmacy - Kriel Kriel
MPUMALANGA (CONTINUED)
Insititution Name Town/City
Dis-Chem Middelburg Mall Pharmacy Middelburg
Mpumelelo Pharmacy Witbank
U Pharmacy - Emalahleni Witbank
U Pharmacy - Transvalia Secunda
Clicks Pharmacy - Barberton Barberton
Clicks Pharmacy - Mall @ Emba Embalenhle
Medi-Rite Pharmacy - Secunda Secunda
Clicks Pharmacy - K G Mall Emalahleni
Clicks Pharmacy - Malelane Ingwe Centre Malelane
Clicks Pharmacy - Mall @ Mfula Piet Retief
Clicks Pharmacy - Nelspruit (Netcare Nelspruit Pharmacy)
Nelspruit
Clicks Pharmacy - Tonga Mall Tonga
Clicks Pharmacy - Phola Park Kwamhlanga
M G Eksteen Apteek Barberton
Van Biljon Apteek Belfast
Kark Apteek Bethal
Leading Pharmacy Delmas
Melrow Pharmacy Ermelo
Bhyat Pharmacy Ermelo
Evander Pharmacy Evander
Eastdene Pharmacy Middelburg
Hazyview Apteek Hazyview
Komati Pharmacy Komatipoort
Tasbet Park Apteek Emalahleni
Clicks Pharmacy - Nelspruit (Netcare Nelspruit Pharmacy)
Nelspruit
Rivermall Pharmacy Nelspruit
NORTH WEST
Insititution Name Town/City
Blackmode Pharmacy Rustenburg
Clicks Pharmacy - Mafikeng Mmabatho
Clicks Pharmacy - Wilkoppies Klerksdorp
Clicks Pharmacy - Potchefstroom Potchefstroom
Clicks Plus Pharmacy - Waterfall Mall Rustenburg
Klerksdorp Pharmacy Klerksdorp
Ifafi Pharmacy Hartbeespoort
Clicks Pharmacy - Klerksdorp Klerksdorp
Krishna Medi Pharmacy Brits
Taljaard Aptekers Coligny
SAMWUMED | MEMBER GUIDE 2019 59
NORTH WEST (CONTINUED)
Insititution Name Town/City
Giggs Pharmacy Rustenburg
Wilge-Park Pharmacy Potchefstroom
Schoemansville Pharmacy Hartbeespoort
Kampus Apteek Potchefstroom
Tuscany Pharmacy Rustenburg
Medi-Rite Pharmacy - Klerksdorp Klerksdorp
Molemo Pharmacy Mmabatho
Dis-Chem Rustenburg Pharmacy Rustenburg
Clicks Pharmacy - Thabo Mbeki Rustenburg
Biblio Plaza Pharmacy Rustenburg
Ridder Street Pharmacy Rustenburg
Clicks Pharmacy - Brits Brits
Clicks Pharmacy - Mooi River Potchefstroom
Mesemed Pharmacy Ventersdorp
Medi-Rite Pharmacy - Mooirivier Potchefstroom
Clicks Pharmacy - Rustenburg Rustenburg
Medi-Rite Pharmacy - Hartebeespoort Hartbeespoort
Clicks Pharmacy - Vryburg Vryburg
Clicks Pharmacy - Hartebeespoortdam Hartbeespoort
Clicks Pharmacy - Zeerust Zeerust
Clicks Pharmacy - Mafikeng Crossing Mmabatho
Mooinooi Apteek Mooinooi
Dis-Chem Potchefstroom Pharmacy Potchefstroom
Wollies Pharmacy Wolmarans-stad
Medi-Rite Pharmacy - Waterberg Rustenburg
Clicks Pharmacy - Brits Mall Brits
Brits Mall Pharmacy Brits
Medi-Rite Pharmacy - Brits Mall Brits
Dis-Chem Klerksdorp Pharmacy Klerksdorp
Ibiza Pharmacy Rustenburg
Nu Horizon Pharmacy Cc Rustenburg
Clicks Pharmacy - Lichtenburg Lichtenburg
Medi-Rite Pharmacy - Taung Taung
Dis-Chem Hartbeespoort Pharmacy Hartbeespoort
Medi-Rite Pharmacy - Platinum Junction Rustenburg
Minty's Pharmacy Klerksdorp
Clicks Pharmacy - Lichtenburg Mall Lichtenburg
Clicks Pharmacy - Moruleng Mall Rustenburg
Clinix Itokolle-Victoria Private Hospital Dispensary
Mmabatho
NORTH WEST (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Matlosana Mall Klerksdorp
Molemo Good Health Pharmacy Mmabatho
Valumed Sun City Pharmacy Rustenburg
Clicks Pharmacy - Boitekong Rustenburg
Clicks Pharmacy - Thabo Mbeki Rustenburg
Clicks Pharmacy - Lombard Street Potchefstroom
Bloemhof Apteek Bloemhof
Saambou Pharmacy Klerksdorp
Springbok Apteek - Klerksdorp Klerksdorp
Atomic Pharmacy Orkney
Orkney Pharmacy Orkney
Mooi River Pharmacy Potchefstroom
Nissen's Pharmacy Rustenburg
Deka Apteek Stilfontein
Andre Pharmacy Rustenburg
Chris Gibson Pharmacy Rustenburg
Waldorf Pharmacy & Medicine Depot Klerksdorp
Nel 3 Pharmacy Brits
Van Rensburg Pharmacy & Med Depot Brits
Vryburg Apteek Vryburg
Hartbeesfontein Pharmacy Hartbeesfon-tein
Clicks Pharmacy - Lombard Street Potchefstroom
Wilmed Park Pharmacy Klerksdorp
Netcare Ferncrest Hospital Pharmacy Tlhabane
Pharmacy @ Spar - Lautzlaan Klerksdorp
Nel 2 Apteek Brits
Oryx Pharmacy Upington
Zest Pharmacy Kimberley
Clicks Pharmacy - Kimberley Kimberley
Clicks Pharmacy - Diamond Pavillion Kimberley
Kathu Pharmacy Kathu
Medi-Rite Pharmacy - Kimberley Kimberley
Medi-Rite Pharmacy - Diamond Pavilion Kimberley
Clicks Pharmacy - Upington Upington
Clicks Pharmacy - North Cape Mall Kimberley
Clicks Pharmacy - Kathu Kathu
Clicks Pharmacy - Springbok Springbok
Medi-Rite Pharmacy - Upington Upington
Dis-Chem Kimberley Pharmacy Kimberley
Palmae Pharmacy Kuruman
SAMWUMED | MEMBER GUIDE 201960
NORTH WEST (CONTINUED)
Insititution Name Town/City
Palmae Pharmacy Kuruman
Clicks Pharmacy - Hartswater Hartswater
Clicks Pharmacy - Kalahari Mall Upington
Ons Apteek Aggeneys
Clicks Pharmacy - Kuruman Mall Kuruman
Medi-Rite Pharmacy - Kuruman Kuruman
Clicks Pharmacy- Kameeldoorn Kathu
Clicks Pharmacy - Stone Street (Netcare Kimberley Pharmacy)
Kimberley
Richmond Pharmacy Kimberley
Assembley Pharmacy Kimberley
Port Nolloth Pharmacy Port Nolloth
Clicks Pharmacy - Stone Street (Netcare Kimberley Pharmacy)
Kimberley
WESTERN CAPE
Insititution Name Town/City
Medi-Rite Pharmacy - Somerset West Somerset
Symphony Pharmacy Cape Town
Clicks Pharmacy - Glengariff Cape Town
King George Pharmacy George
Clicks Pharmacy (Table View) Netcare Table view Pharmacy Cape Town
Clicks Pharmacy - Stellenbosch (Eikestad Mall) Stellenbosch
Caledon Pharmacy Caledon
Mini-Kem Pharmacy Goodwood Cape Town
Clicks Pharmacy - Edgemead Cape Town
Netcare Kuils River Hospital - Pharmacy Cape Town
Parow Family Pharmacy Cape Town
Clicks Pharmacy - Parklands Intercare Cape Town
Clicks Pharmacy - Melkbos Cape Town
Esack's Pharmacy Cape Town
Medi-Rite Pharmacy - Parow Cape Town
Dis-Chem Somerset Mall Pharmacy Cape Town
Nu-Crane Pharmacy - Mitchell's Plain Cape Town
Medi-Rite Pharmacy - N1 City Cape Town
Riverside Pharmacy - George George
Fairbairn Pharmacy Worcester
Clicks Pharmacy - Blue Route Cape Town
Clicks Pharmacy - Canal Walk Cape Town
Clicks Pharmacy - Golden Acre Cape Town
WESTERN CAPE (CONTINUED)
Insititution Name Town/City
Medi-Rite Pharmacy - Atlantis Cape Town
Medi-Rite Pharmacy - Cape Gate Cape Town
Clicks Pharmacy - V & A Waterfront Cape Town
Clicks Pharmacy - Intercare Tyger Valley Cape Town
Medi-Rite Pharmacy - Table View Cape Town
Pick n Pay Pharmacy-Ottery Cape Town
Clicks Pharmacy - Cape Gate Cape Town
Clicks Pharmacy - Tygervalley Cape Town
Clicks Pharmacy - Somerset Mall Cape Town
Clicks Pharmacy - Kenilworth Centre Cape Town
Medi-Rite Pharmacy - Blue Route (Tokai) Cape Town
Dis-Chem Paarl Mall Pharmacy Paarl
Dis-Chem Tygervalley - Willowbridge Pharmacy Cape Town
Dis-Chem Claremont Pharmacy Cape Town
Clicks Pharmacy - Garden Route Mall George
Clicks Pharmacy - Promenade Cape Town
Clicks Pharmacy - N1 City Cape Town
Essential Health Pharmacy - Arcade Cape Town
Clicks Pharmacy - Paarl Mall Cape Town
Clicks Pharmacy - Mountain Mill Worcester
Clicks Pharmacy - Parow Centre Parow East Cape Town
Clicks Pharmacy - Langeberg Mall Mossel Bay
Clicks Pharmacy - Vangate Mall Cape Town
Clicks Pharmacy - Knysna Knysna
Pick N Pay Pharmacy - Brackenfell Cape Town
Medi-Rite Pharmacy - Sea Point Cape Town
Waterstone Pharmacy Cape Town
Clicks Pharmacy - Rondebosch Cape Town
Netcare Blaauwberg Pharmacy Cape Town
Clicks Pharmacy - Hermanus Hermanus
Pick N Pay Pharmacy - Plattekloof Cape Town
Clicks Pharmacy - Westcoast Village Cape Town
Essential Health Pharmacy - Protea Heights Cape Town
Clicks Pharmacy - Ceres Ceres
Pick N Pay Pharmacy - Table View Cape Town
Medi-Rite Pharmacy - Paarl Paarl
Medi-Rite Pharmacy - Mountain Mill Cape Town
Medi-Rite Pharmacy - Khayelitsha Cape Town
Clicks Pharmacy - Waterstone Village Cape Town
SAMWUMED | MEMBER GUIDE 2019 61
WESTERN CAPE (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Southgate Cape Town
Medi-Rite Pharmacy - Weltevreden Mitchell's Plain Cape Town
Clicks Pharmacy - Cobble Walk Cape Town
Clicks Pharmacy - Oudtshoorn Oudtshoorn
Clicks Pharmacy - Paarl Paarl
Pick N Pay Pharmacy - Claremont Cape Town
Medi-Rite Pharmacy - Eerste Rivier Cape Town
Medi-Rite Pharmacy - Kenilworth Cape Town
Essential Health Pharmacy - Kuils River Cape Town
Clicks Pharmacy - Langebaan Langebaan
Clicks Pharmacy - Zevenwacht Cape Town
Clicks Pharmacy - Soneike Cape Town
Clicks Pharmacy - Burg Street Cape Town
Medi-Rite Pharmacy - Bothasig Cape Town
Akmed Pharmacy Cape Town
Medi-Rite Pharmacy - Witteklip Vredenburg
Franschhoek Pharmacy Franschoek
Gansbaai Pharmacy Gansibaai
Clicks Pharmacy - Graanendal Cape Town
Clicks Pharmacy - Robertson Robertson
Clicks Pharmacy - Constantia Cape Town
Clicks Pharmacy-Malmesbury Malmesbury
Medi-Rite Pharmacy - Blue Downs Cape Town
Clicks Pharmacy - Weskus Mall Vredenburg
Clicks Pharmacy - Fairbridge Mall Cape Town
Clicks Pharmacy - Sable Square Cape Town
Clicks Pharmacy - Adelphi Centre Cape Town
Medi-Rite Pharmacy - Middestad Cape Town
Medi-Rite Pharmacy - Gugulethu Cape Town
Clicks Pharmacy - Pinelands (Howard Centre) Cape Town
Clicks Pharmacy - Central Square Pinelands Mossel Bay
Medi-Rite Pharmacy - Heiderand Cape Town
Medi-Rite Pharmacy - De Grendel Cape Town
Medi-Rite Pharmacy - Vineyard Cape Town
Medi-Rite Pharmacy - Bishop Lavis Cape Town
Clicks Pharmacy - Hout Bay Wellington
Clicks Pharmacy - Wellington Cape Town
Clicks Pharmacy - Gardens Centre Bredasdorp
Medi-Rite Pharmacy - Bredasdorp George
WESTERN CAPE (CONTINUED)
Insititution Name Town/City
Dis-Chem George Pharmacy Cape Town
Golden Acre Pharmacy Cape Town
Clicks Pharmacy - Durbanville Cape Town
Clicks Pharmacy - Bellville (Teddington St) George
Clicks Pharmacy - George C.B.D. Beaufort West
Clicks Pharmacy - Beaufort West Paarl
Medi-Rite Pharmacy - Berg River Cape Town
Clicks Pharmacy - Cavendish Connect Cape Town
Clicks Pharmacy - Gugulethu Square Hermanus
Medi-Rite Pharmacy - Hermanus Citrusdal
Citrusdal Pharmacy Stellenbosch
Clicks Pharmacy - Stellenbosch Square Cape Town
Pick N Pay Pharmacy - Somerset Mall Cape Town
Dis-Chem Bayside Pharmacy Cape Town
Clicks Pharmacy - Regent Road Langebaan
Langebaan Pharmacy Mossel Bay
Clicks Pharmacy - Mossel Bay Mall Cape Town
Medi-Rite Pharmacy - Vasco Cape Town
Clicks Pharmacy - Westgate Mall (Mitch-ells Plain) Mossel Bay
Kwanonqaba Pharmacy Cape Town
Medi-Rite Pharmacy - Durbanville Cape Town
Pick N Pay Pharmacy - Promenade Cape Town
Chemcare Pharmacy Plettenberg Bay
Clicks Pharmacy - Plettenberg Bay Cape Town
Medi-Rite Pharmacy - Philippi Cape Town
Clicks Pharmacy - Ashers Cape Town
Clicks Pharmacy - Adderley Street George
Pick N Pay Pharmacy - George Cape Town
Medi-Rite Pharmacy - Lansdowne Corner Cape Town
Atlantis Pharmacy Stellenbosch
Stellenbosch Square Pharmacy Cape Town
Clicks Pharmacy - Capricorn Square Cape Town
Dis-Chem Blue Route Pharmacy Cape Town
Medi-Rite Pharmacy - Mh Parklands Franschhoek
Clicks Pharmacy - Franschoek Cape Town
Clicks Pharmacy - Flamingo Square Swellendam
Clicks Pharmacy - Swellendam Stellenbosch
Eikestad Mall Pharmacy Cape Town
Medi-Rite Pharmacy - Broadway Bredasdorp
SAMWUMED | MEMBER GUIDE 201962
WESTERN CAPE (CONTINUED)
Insititution Name Town/City
Essential Health Pharmacy - Bredasdorp Cape Town
Medi-Rite Plus Pharmacy - Big Bay George
Clicks Pharmacy - George 2 (Pick N Pay) Mossel Bay
Mossel Bay Pharmacy Cape Town
Medi-Rite Pharmacy - Parow Park Cape Town
Clicks Pharmacy - Cinnamon Square Cape Town
Clicks Pharmacy - the Paddocks Cape Town
Dis-Chem Sea Point Pharmacy Caledon
Clicks Pharmacy - Caledon Cape Town
Clicks Pharmacy - Glengarry Cape Town
Clicks Pharmacy - Welgemoed Cape Town
Melopharm Pharmacy Cape Town
Clicks Pharmacy - Pinehurst Cape Town
Clicks Pharmacy - Lansdowne Vredendal
Clicks Pharmacy - Vredendal Worcester
Dis-Chem Worcester Pharmacy Cape Town
Essential Health Pharmacy - Claremont Cape Town
Clicks Pharmacy - Vergelegen Cape Town
Clicks Pharmacy - Strand Square Cape Town
Dis-Chem Zevenwacht Mall Pharmacy Cape Town
Dis-Chem Central Park Pharmacy Cape Town
Pharma-Kem Pharmacy - Strand Cape Town
Webb and Savoy Pharmacy Cape Town
Dis-Chem Noordhoek Pharmacy Cape Town
Dis-Chem Panorama Oncology Pharmacy George
Medi-Rite Pharmacy - Eden Meander Cape Town
Chemcare Pharmacy - Church Way Cape Town
Clicks Pharmacy - Atlantis Cape Town
Dis-Chem Cape Gate Pharmacy Cape Town
Medi-Rite Pharmacy - Helderberg Mall Paarl
Clicks Pharmacy - Laborie Paarl Cape Town
Melopharm Tokai Pharmacy Cape Town
Rivetts Pharmacy Cape Town
Clicks Pharmacy - 2 Long Street Mossel Bay
Dis-Chem Mosselbaai Mall Pharmacy Cape Town
Pharmacy @ Spar - Uitzicht Cape Town
Medi-Rite Pharmacy - Langa Cape Town
Dis-Chem Liberty Promenade Pharmacy Cape Town
Clicks Pharmacy - the Sanctuary Wellington
Clicks Pharmacy - Welgelee Plein Bredasdorp
WESTERN CAPE (CONTINUED)
Insititution Name Town/City
Clicks Pharmacy - Bredasdorp Cape Town
Clicks Pharmacy - Prospur Cape Town
Clicks Pharmacy - Clock Tower Cape Town
Plax Chemist Cape Town
Clicks Pharmacy - Rosmead Avenue (Netcare Kenilworth Pharmacy) Cape Town
Clicks Pharmacy - Table View (Netcare Table View Pharmacy) Cape Town
Clicks Pharmacy - Tokai (Netcare Tokai Dispensary) Cape Town
Clicks Pharmacy - Kipling Street (Netcare Langeberg Pharmacy) Worcester
Clicks Pharmacy - Worcester Hermanus
Clicks Pharmacy - Whale Coast Cape Town
Pick N Pay Pharmacy - Table Bay Cape Town
Clicks Pharmacy - Erica Square Cape Town
Clicks Pharmacy - Table Bay Mall Cape Town
Dis-Chem Table Bay Mall Pharmacy Sandbaai
Dis-Chem Hermanus Pharmacy Cape Town
Culemborg Pharmacy Cape Town
Vitacare Unikem Pharmacy - Rylands Cape Town
Sunset Pharmacy Cape Town
Wynberg Pharmacy George
Protea Pharmacy George
Ress & Van Zyl Pharmacy Cape Town
Monument Pharmacy Robertson
Robertsons Pharmacy Wellington
Bergrivier Pharmacy Worcester
Homes Pharmacy Worcester
QuΘnets Pharmacy Cape Town
Essential Health Pharmacy - Brackenfell Vredenburg
Weskem Apteek Clanwilliam
Sederkem Pharmacy Worcester
Durban Street Pharmacy - Worcester Malmesbury
Geard Apteek Cape Town
Essential Health Pharmacy - Helderzicht Paarl
Drakenstein Apteek Sedgefield
Sedgefield Pharmacy Porterville
Porterville Alpha Pharmacy Cape Town
Nu-Kem Pharmacy Cape Town
Medicare Pharmacy - Retreat Cape Town
Kem-Park Pharmacy Robertson
SAMWUMED | MEMBER GUIDE 2019 63
WESTERN CAPE (CONTINUED)
Insititution Name Town/City
Wynland Pharmacy Cape Town
Netcare Christiaan Barnard Memorial Pharmacy
Plettenberg Bay
Plett Medicine Depot Cape Town
Eikendal Pharmacy George
Medical Centre Pharmacy Cape Town
Cylnor Pharmacy Worcester
Narotam Pharmacy Cape Town
Broad Road Pharmacy Cape Town
Steenberg Pharmacy Cape Town
Hypermed Pharmacy Cape Town
Wavecrest Pharmacy Cape Town
Westgate Pharmacy Onrus
Onrus Pharmacy Cape Town
Khayelitsha Pharmacy Cape Town
Netcare N1 City Hospital Dispensary Cape Town
Mediplein Pharmacy Incorporated Stellenbosch
Die Boord Apteek Cape Town
Bel - Kem Pharmacy Cape Town
Cape Town Station Pharmacy Cape Town
Southern Suburbs Pharmacy Mossel Bay
Pharmacy @ Spar - Mosskem Cape Town
Athlone Pharmacy Cape Town
Lite-Kem Pharmacy Cape Town
Clicks Pharmacy - Parow (Netcare Parow Dispensary) Cape Town
Clicks Pharmacy - Parow (Netcare Parow Dispensary) Cape Town
Clicks Pharmacy - Rosmead Avenue (Netcare Kenilworth Pharmacy) Cape Town
Vitacare Pharmacy - Rondebosch Still Bay
Fynbos Pharmacy Cape Town
Clicks Pharmacy - Tokai (Netcare Tokai Dispensary) Cape Town
Ariefa's Pharmacy Cape Town
Clicks Pharmacy - Kipling Street (Netcare Langeberg Pharmacy) Cape Town
Koeberg Pharmacy Cape Town
Essential Health Pharmacy - Strand Paarl
Gys Smit Pharmacy Cape Town
Kemtique Pharmacy Cape Town
David Bloom Pharmacy Cape Town
Chavda's Pharmacy Cape Town
WESTERN CAPE (CONTINUED)
Insititution Name Town/City
Rondebosch East Pharmacy Cape Town
Clicks Pharmacy - Bayside Centre Cape Town
Medi-Rite Pharmacy - Brackenfell Stellenbosch
Medi-Health Pharmacy - Stellenbosch Cape Town
Medigate Pharmacy Cape Town
Medley Pharmacy Cape Town
DIis-Chem Ballito Lifestyle Pharmacy Cape Town
Clicks Pharmacy Delft Mall Cape Town
SAMWUMED | MEMBER GUIDE 201964
SAMWUMED | MEMBER GUIDE 2019 65
• WHAT IS A CO-PAYMENT?
This is the part of the account that a member might have to pay out of their own pocket where benefits do not cover the treatment or medication received.
• WHAT IS THE SCHEME TARIFF?
The rate at which the Scheme pays for health services to service providers on behalf of members. It is based on the National Reference Price List published by the Department of Health.
• MUST I GIVE NOTICE TO THE SCHEME IF I WISH TO TERMINATE MEMBERSHIP?
Yes, members must comply with the notice period stipulated in the Rules.
• CAN A MINOR BECOME A MEMBER?
Yes, based on the following:
• Only if minor was a dependant on the medical aid when the main member passed away
• CAN I OR MY DEPENDANTS BELONG TO MORE THAN ONE MEDICAL SCHEME AT A TIME?
• No, the Medical Schemes Act 131 of 1998 prohibits it. No person shall be a member or dependant of more than one (1) medical scheme.
• IS MEMBERSHIP OF A MEDICAL SCHEME AVAILABLE TO ANY PERSON?
Yes, except in a restricted membership scheme, where a particular employer, profession, trade, industry, calling or association has established a scheme exclusively for its employees or members.
• MUST MY EMPLOYER SUBSIDISE MY CONTRIBUTIONS TO THE MEDICAL SCHEME?
No, subsidies are conditions of employment and the Act does not address such conditions.
• IF I DO NOT CLAIM FROM MY MEDICAL SCHEME, MAY I RECEIVE A NO-CLAIM BONUS OR REBATE?
No, the Act prohibits the payment of bonuses, rebates or re-funding of a portion of contributions other than in respect of savings accounts in certain circumstances.
• WHAT IS A DESIGNATED SERVICE PROVIDER (DSP)?
A healthcare provider or group of providers that the Scheme has chosen to provide certain medical care for Prescribed Minimum Benefits.
FAQ'S FREQUENTLY ASKED QUESTIONS
0860 104 117 (Share Call) or 021 697 9000
OPERATING HOURSContact Centre: 08h30 - 16h00, Mon - Fri
Physical Address: Cnr Trematon & Lascelles Streets, Athlone, Cape TownPostal Address: P.O. Box 134, Athlone, 7760
Email: [email protected]: www.samwumed.org
MEDSCHEMEHospital Benefit Management: 0860 33 33 87Email: [email protected]
Chronic Medicine Management: 0860 33 33 87Email: [email protected]
Oncology Management: 0860 33 33 87Email: [email protected]
HIV MANAGEMENT - Aid for AidsMember Enquiries: 0860 100 646Email: [email protected]
FRAUD HOTLINETel: 0800 112 811 SMS: 33490 (R1,50)Email: [email protected]
TALK TO SAMWUMEDTODAY
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AMBULANCE SERVICESNETCARE 911 Tel: 082 911
DISCLAIMER:This Member Guide is prepared and distributed for purposes of providing you with essential information to help you select the best benefit option for you and your family. It is not a full guide to the Scheme Rules and Benefits and does not supersede the Scheme Rules. All contributions and benefit options presented in the Member Guide are subject to the approval by the Council for Medical Schemes. Kindly familiarise yourself with your chosen benefit option and note where pre-authorisations, motivations and or letters of referral are required to access benefits.
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