and benefits for 2017 - swazimed contributions and benefits for 2017.pdf · and benefits for...

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CATEGORY 15,000 15,000 7 500 3 750 15,000 15,000 15,000 15,000 15,000 15,000 15,000 7 500 3 750 15,000 15,000 7 500 3 750 15,000 15,000 7 500 3 750 15,000 15,000 7 500 3 750 15,000 15,000 7 500 3 750 15,000 15,000 7 500 3 750 19,000 7,000 One in 2 year claiming period starting from 1 January 2016 to 31 December 2017 (12 months exclusions) (Sleep Studies is paid only when authorised by the Fund) limited to 1 study per family ,3 months exclusion Take treatment out (TTO’s) / Take home medicines for specialists Limited to 1 GP consultation per beneficiary per annum (see more details on the back-notes) 15,000 15,000 within OAL within OAL within OAL SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2017 - No/low claim bonus formula: (only payable to if membership is for a calendar year January to December). Application letters should be submitted before 31 March of the following year. Payments between June and October. (optional) Private nursing-normal consultation is paid as long as the benefit is available even if there is no authorisation acquired excluded for the first 8 months of joining the fund Member / Spouse Children: 14 - 21 Children: 6 - 13 Children: 0 - 5 Parents Ordinary Members The total monthly contributions, based in the income of the member and dependants registered is payable by the member and employer in accordance with the contributions as set out in the tables above. Contributions must be paid to the fund not later than the seventh day of the month, following the month to which contribution payments apply. Pensioners / surviving spouses The contributions shall be in accordance with the first income band (0-3000) of the applicable contribution table and the number of registered dependants. Contribution for second wife Contributions payable for the second wife (after the first wife) shall be the equivalent of a single member in the monthly income band of the principal member. Aged Parents (Registration as a member) The Contribution payable for aged parents shall be an equivalent rate of a single member in the income band of a principal member. Aged parents contribute 3 months in advance. Individual Members Members categorised as individuals pay in the last income band and contributes 3 months in advance. Student Members One year contributions upfront on a monthly subscriptions of E406 and enjoy medium option benefits. No incentive bonus for students. NB: Members on the new generation plan will be allowed to change option during the year only if they attain the age of 40. SWAZIMED HIGH BENEFIT CONTRIBUTIONS (POLICY 1) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 3,000 2 164 2 942 3 308 3 478 3 564 3 792 3,001 - 4,000 2 296 3 134 3 546 3 694 3 808 4 032 4,001 - 5,000 2 314 3 192 3 598 3 766 3 884 4 106 5001 - 6,000 2 372 3 216 3 622 3 808 3 900 4 144 6,001 - PLUS 2 390 3 246 3 638 3 830 3 922 4 184 SWAZIMED STANDARD BENEFIT CONTRIBUTIONS (POLICY 2) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 3,000 1 874 2 560 2 872 3 008 3 122 3 284 3,001 - 4,000 1 888 2 582 2 904 3 030 3 162 3 302 4,001 - 5,000 1 908 2 632 2 942 3 090 3 180 3 374 5001 - 6,000 1 926 2 648 2 976 3 140 3 194 3 414 6,001 - PLUS 1 962 2 670 2 996 3 166 3 228 3 450 SWAZIMED LOW COST OPTION CONTRIBUTIONS (POLICY 7) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 2,000 356 612 630 662 704 734 2,001 - 3,000 376 644 664 696 740 772 3,001 - 6,000 394 678 698 734 778 812 6,001 - PLUS 510 870 904 948 1 002 1 048 SWAZIMED MEDIUM BENEFIT CONTRIBUTIONS (POLICY 3) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 4,000 600 1 028 1 062 1 116 1 186 1 234 4,001 - 6,000 628 1 078 1 110 1 164 1 236 1 290 6,001 - PLUS 714 1 214 1 260 1 320 1 398 1 462 SWAZIMED HOSPITAL BENEFIT CONTRIBUTIONS (POLICY 4) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 580 912 972 1 036 1 098 1 116 1,001 - 2,000 832 1 142 1 302 1 348 1 364 1 452 2,001 - PLUS 892 1 204 1 352 1 430 1 454 1 578 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 1 - E1,200 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 680 1 012 1 072 1 136 1 198 1 216 1,001 - 2,000 932 1 242 1 402 1 448 1 464 1 552 2,001 - PLUS 992 1 304 1 452 1 530 1 554 1 678 Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 780 1 112 1 172 1 236 1 298 1 316 1,001 - 2,000 1 032 1 342 1 502 1 548 1 564 1 652 2,001 - PLUS 1 092 1 404 1 552 1 630 1 654 1 778 SWAZIMED SAVINGS PLAN CONTRIBUTIONS- LEVEL 3 - E3,600 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 880 1 212 1 272 1 336 1 398 1 416 1,001 - 2,000 1 132 1 442 1 602 1 648 1 664 1 752 2,001 - PLUS 1 192 1 504 1 652 1 730 1 754 1 878 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 4 - E4,800 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 980 1 312 1 372 1 436 1 498 1 516 1,001 - 2,000 1 232 1 542 1 702 1 748 1 764 1 852 2,001 - PLUS 1 292 1 604 1 752 1 830 1 854 1 978 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 5 - E6,000 (POLICY 5) SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 6 - E7,200 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 1 180 1 512 1 572 1 636 1 698 1 716 1,001 - 2,000 1 432 1 742 1 902 1 948 1 964 2 052 2,001 - PLUS 1 492 1 804 1 952 2 030 2 054 2 178 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 7 - E8,400 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 1 280 1 612 1 672 1 736 1 798 1 816 1,001 - 2,000 1 532 1 842 2 002 2 048 2 064 2 152 2,001 - PLUS 1 592 1 904 2 052 2 130 2 154 2 278 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 8 - E9,600 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 1 380 1 712 1 772 1 836 1 898 1 916 1,001 - 2,000 1 632 1 942 2 102 2 148 2 164 2 252 2,001 - PLUS 1 692 2 004 2 152 2 230 2 254 2 378 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 9 - E10,800 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 1 480 1 812 1 872 1 936 1 998 2 016 1,001 - 2,000 1 732 2 042 2 202 2 248 2 264 2 352 2,001 - PLUS 1 792 2 104 2 252 2 330 2 354 2 478 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 10 - E12,000 (POLICY 5) Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 1 580 1 912 1 972 2 036 2 098 2 116 1,001 - 2,000 1 832 2 142 2 302 2 348 2 364 2 452 2,001 - PLUS 1 892 2 204 2 352 2 430 2 454 2 578 Income Band M+0 M+1 M+2 M+3 M+4 M5+ All 982 1 678 n/a n/a n/a n/a 2 000 000 per family 700 000 per family 25 000 per family 1 500 000 per family 1 500 000 per family 20 000 per family 1 200 000 per beneficiary 380 000 per beneficiary 650 000 per beneficiary 650 000 per beneficiary 1 050 000 per beneficiary 7 970 per beneficiary 2 400 per family Level 1: 1 200 Level 2: 2 400 Level 3: 3 600 Level 4: 4 800 Level 5: 6 000 Level 6: 7 200 Level 7: 8 400 Level 8: 9 600 Level 9: 10 800 Level 10:12 000 1 770 1 640 1 390 per family 1 390 per family 4 060 per family 3 300 2 610 2 400 per family 13 800 11 000 6 880 11 000 11 000 65 300 6 880 11 100 8 580 3 420 3 990 3 420 6 440 5 180 1 890 3 990 1 890 6 630 4 860 2 170 3 990 2 170 5 770 3 850 2 330 2 330 6 600 4 540 3 030 2 400 7 710 5 500 3 850 2 400 4 790 3 280 8 170 5 930 11 300 8 550 1 980 1 510 3 620 2 860 5 060 4 060 Osseointegrated Implants (Including hospitalisaon, Dental Praconer, Anaesthest) Joint limit with Advanced Denstry 450 per admission 450 per admission 450 per admission 450 per admission 450 per admission 450 per admission 450 per admission Out-paent (Facility fee, consultaon and medicine) Inpaent General Praconer Consultaons 1 270 1 020 635 1 270 1 270 635 1 580 1 200 885 1 580 1 580 885 1 890 1 450 1 140 1 890 1 890 1 140 15 900 per family 15 900 per family 9 640 per family 15 900 per family 15 900 per family 15 900 per beneficiary 9 640 per family 3 230 2 150 1 080 1 080 1 080 5 910 3 760 2 150 2 150 2 150 7060 5 380 2 690 2 690 2 690 4 210 3 090 1 690 1 690 8 200 5 650 2 730 2 400 11 600 7 760 3 500 2 400 1 050 760 495 460 1 990 1 430 785 730 2 850 1 920 1 020 950 200 200 200 200 200 90 13 800 8 460 2 140 8 460 8 460 8 900 2 140 189 000 152 000 127 000 127 000 758 000 3 570 2 330 5 360 4 190 5 820 4 690 3 570 2 330 2 700 1 970 1 970 1 970 170 000 162 000 139 000 139 000 170 000 253 000 237 000 189 000 189 000 467 000 40 500 40 500 40 500 40 500 40 500 37 800 22 700 315 18 900 18 900 315 5 600 3 420 2 090 2090 1 090 715 355 355 355 330 2 170 1 440 715 715 715 665 3 240 2 170 1 440 1 440 1 440 1 340 1 660 1 390 830 830 3 300 2 480 1 390 1 390 4 960 3 300 1 920 1 920 30 100 30 100 11 800 28 500 28 500 36 400 11 800 5 870 5 870 3 010 5 610 5 610 6 250 3 010 52 000 34 500 1 800 24 400 24 400 14 500 1 800 33 600 18 100 2 170 2 170 92 100 83 200 63 200 63 200 22 300 14 800 3 780 14 800 14 800 24 000 3 780 1 890 1 640 1 520 1 410 PET SCAN and PET-CT Scans Bone Densitometry Within Radiology limit above (Occupaonal Therapy, Orthopcs, Podiatry, Speech Therapy, Audiology, Diecians, Hearing Aid Acouscians, Genec Councelling.) 3 670 3 030 2 460 2 400 SPL: Swazimed Price List NHRPL (SA) : Naonal Health Reference Price List (inside South Africa) SAOA: South African Optometrists Associaon Only cover for: hypertension, diabec, asthma, epilepc, ulcer, bipolar, schinzophrenia, allergic rhinis, arthris, chronic obstrucve pulmonary disease, cardiac failure and cardiomyopathy, coronary artery disease, hyperlipidaemia, gout and hypothyroidism. 100% SPL 3 230 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL, subject to OHEB 100% SPL, subject to OHEB 100% SPL 100% SPL 100% SPL 100% SPL, subject to OHEB 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL 100% SPL Subject to available Savings 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 1 390 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 1 320 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL, subject to OHEB 100% SPL, subject to OHEB 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL, subject to OHEB 100% SPL, subject to OHEB Subject to available Savings 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL Subject to available Savings 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL No Benefit 100% SPL, subject to OHEB 2 480 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL, subject to OHEB 100% SPL / SAOA, subject to OHEB 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL No Benefit 100% Cost 100% SPL, subject to OHEB 100% SPL, subject to OHEB Subject to available Savings 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% Cost, subject to OHEB 100% Cost, subject to OHEB 4 600 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 1 320 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL No Benefit 100% Cost Subject to available Savings 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 3 640 per beneficiary 100% SPL 100% SPL 100% SPL No Benefit 100% Cost No Benefit 100% SPL Subject to available Savings 100% SPL 100% SPL 100% Cost 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL, subject to OHEB 100% SPL 100% SPL, subject to OHEB 100% SPL / (SA), subject to OHEB Subject to available Savings 1 GP consultaon per beneficiary per annum covering: - GP consultaon fee - Blood pressure - Cholesterol - Blood glucose - Papsmear for female beneficiaries - Prostate test for male beneficiaries - BMI Osteoporosis screening Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine 1 GP consultaon per beneficiary per annum covering: - GP consultaon fee - Blood pressure - Cholesterol - Blood glucose - Papsmear for female beneficiaries - Prostate test for male beneficiaries - BMI Osteoporosis screening Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine 1 GP consultaon per beneficiary per annum covering: - GP consultaon fee - Blood pressure - Cholesterol - Blood glucose - Papsmear for female beneficiaries - Prostate test for male beneficiaries - BMI Osteoporosis screening Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine 1 GP consultaon per beneficiary per annum covering: - GP consultaon fee - Blood pressure - Cholesterol - Blood glucose - Papsmear for female beneficiaries - Prostate test for male beneficiaries - BMI Osteoporosis screening Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine 1 GP consultaon per beneficiary per annum covering: - GP consultaon fee - Blood pressure - Cholesterol - Blood glucose - Papsmear for female beneficiaries - Prostate test for male beneficiaries - BMI Osteoporosis screening Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine 1 GP consultaon per beneficiary per annum covering: - GP consultaon fee - Blood pressure - Cholesterol - Blood glucose - Papsmear for female beneficiaries - Prostate test for male beneficiaries - BMI Osteoporosis screening Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine No Benefit 100% SPL 100% SPL 100% SPL 100% SPL / (SA), subject to OHEB 1 GP consultaon per beneficiary per annum covering: - GP consultaon fee - Blood pressure - Cholesterol - Blood glucose - Papsmear for female beneficiaries - Prostate test for male beneficiaries - BMI Osteoporosis screening Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine 100% SPL 100% SPL 100% SPL No Benefit 100% Cost 100% SPL per family per family 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 200 90 90 90 90 90 Income Band M+0 M+1 M+2 M+3 M+4 M5+ 0 - 1,000 1 080 1 412 1 472 1 536 1 598 1 616 1,001 - 2,000 1 332 1 642 1 802 1 848 1 864 1 952 2,001 - PLUS 1 392 1 704 1 852 1 930 1 954 2 078 SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 2 - E2,400 (POLICY 5) SWAZIMED NEW GENERATION PLAN CONTRIBUTIONS (POLICY 6) MPL MPL MPL MPL MPL MPL MPL MPL MPL MPL Related to MVA (subject to MVA Protocols) Labour 3 months waing period

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In an emergency contact any of the following ambulance service and you will receive the best pre-hospital medicalemergency care available. If necessary, we will arrangetransfers to a local medical facility or evacuation to hand-

picked centre of excellence for treatment.

the more expensive products, Swazimed will only pay up to

June and October

+268 2404 3718 / 2405 8400+268 2404 1601

[email protected]

E622

Contact Number: 2405 8400

For Swazimed to pay for ICU and High Care facility, the Private Hospital must comply with the following:

Proof of income (pay slips or 3 months bank statement)

?

Physical addressShop NC 101, Nedbank BuildingSwaziplaza, Mbabane

Telephone:(+268) 2405 8400

Pre-authorisation:8004001 (SD) (+268) 2404 3718 / +268 2405 [email protected]@[email protected]

Fax line: (+268) 2404 [email protected]:

www.swazimed.comWebsite:

Postal addressP.O. Box 3226, Mbabane H100Swaziland

SWAZIMEDCONTACTDETAILS

Dependable, AffordableHealth Care Cover

The

Fraud Telephone No. : 2404 0339

including list of required

Email Address: [email protected]

specialist i.e neuro-surgeon, anaesthesiologist, cardio thoracic surgeon, neurologist, paediatrician etc.