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Dependable, Affordable
Health Care Cover
SWAZIMED
CONTRIBUTIONS
AND BENEFITS
FOR
2021
SWAZILAND MEDICAL AID FUND
(SWAZIMED)
BACKGROUND PAYMENTS TO SERVICE PROVIDERS
The Swaziland Medical Aid Fund (Swazimed) is Service Providers (Hospitals, Doctors and
a Section 21 company (registered as a none- Pharmacies) who submit their claims through
profit making open-scheme) which was formed EDI are paid direct to their bank accounts (EFT)
in 1980. Membership cards are accepted by all in a seven (7) day payment-run and service
local service providers (Hospitals, Doctors and providers submitting claims manually are paid
most Pharmacies) and widely accepted in South through their bank accounts (EFT) or by cheques
Africa. The scheme is self-administered since on the seven (7) day payment-run.
January 2017, there is no change in acceptance
of cards and benefits access. REFUNDS TO MEMBERS
OFFICES Members claiming their no/low claim bonuses
or claiming refunds for cash paid accounts,
The Swazimed offices are situated in Mbabane an EFT payment will be paid through EFT for
at Nedbank Centre Building, members who submitted their banking details
Shop NC 101 at; and cheque payments to those without banking
Tel: +268 2405 8400 details in the system.
Fax: +268 2404 1601
Email: info@swazimed.com Swazimed offers nine benefit options and each
Website: www.swazimed.com individual should choose an option according to
his/her health care needs. For all the options
MEMBERSHIP CARD benefits are paid at 100% scale of benefits with
adequate annual limits.
Swazimed membership card has a Member’s
One-(1) Number-For-Life. This means that OPTIONAL SAVINGS
the members’ medical aid number will never
change even if the member changes options but All Swazimed Benefit Plans offer an optional
it will reflect the new option of the member on savings to cater for all charges above the
the system. (1 membership number for life). Swazimed Price List (SPL) and also used for
other costs above consultation and medicine
WHO CAN JOIN? limits.
Swazimed is an open-scheme which can Members are not restricted on their optional
be joined by anyone whether employed or savings but encouraged to save from E300 for
unemployed. Group members have (1) month high benefit and from E100 for all other options,
waiting period and three months waiting period plus any amount in the denominations of E100
for individuals (Direct Paying Members). on monthly basis.
Group (10 or more members)
Individuals (Direct Paying Members) All these costs must be within the member’s
Swaziland Building Society Sipatji Accounts savings.
holders
Government employees (deducted from NB: These savings are only paid cash on
Treasury dept.) termination of membership.
Students
Aged Parents of active members (no age
restriction)
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 1
A GUIDE TO CLAIMING
Nothing is more annoying than wondering where TIPS FOR CLAIMING
your refund cheque is, or not knowing what you
are allowed to claim for. Some of the answers Check that prescriptions for medicine show
to your everyday administration queries can be all your details. If the pharmacy or doctor
found in the details of your benefits structure, omits any of these details, Swazimed is
which is included in this document, but the unable to process your claim and this may
majority of your queries could be eliminated lead to delays.
by knowing how the "claim chain" at Swazimed
works. Dental treatment often requires additional
work by a dental technician. The technician
HOW TO SUBMIT YOUR ACCOUNTS then bills the dentist who adds this to
your account and attaches a copy of the
Please mail or deliver your accounts techician's account. Please submit both
as quickly as possible to the Swazimed accounts and ensure that your name and
address shown overleaf. number are reflected on both.
If you have already paid the account, attach WHEN CAN I EXPECT PAYMENT?
your receipt on the claims invoice and write
"paid" on the account. Swazimed has regular payment cycles of four
weekly payment runs per month to members
Make sure all documents sent to Swazimed and suppliers. All valid claims received by
show your membership number. Swazimed will be processed on these basis.
Check that your account shows: HOW WILL I KNOW WHAT WAS PAID?
Your name and initials; your medical aid
number; the treatment date; name of patient A claims Transaction Statement will be sent
(as indicated on the membership card and not to you if Swazimed has processed an account
a nickname); date of birth; amount charged during that month. This statement will indicate
and the tariff code where applicable. all payments made to you or on your behalf.
Stale period-only claims received within 4
months of treatment will be paid.
Members are encouraged to register on the Swazimed App and can view
member Accounts, member statements, benefits, update personal details
and many more.
To Register;
Go to www.swazimed.com or download Swazimed App on Google or
Apple Store
App
Dependable, Affordable
Health Care Cover
Click on login
As a Member
Enter your Swazimed membership number
Create and enter your password, then confirm password
Enter details (cellphone number or email) that is already in Swazimed
System
NB. Please note that the cellphone number should have the code (+268)
Page 2 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021
VALUE-ADDED BENEFITS
AMBULANCE SERVICES which to get the patient medical attention. The
next goal is the first hour after injury, known
A medical emergency can strike at any time. The as the golden hour. Responses in these times
correct treatment and proper transportation of by qualified professionals can make all the
the sick or injured patient is vital to ensure the difference between life and death.
best result.
In an emergency contact any of the following
In any medical emergency, speed is vital to ambulance services and you will receive the best
the survival and quick recovery of the patient. pre-hospital medical emergency care available.
If you are unfortunate enough to be involved If necessary, we will arrange transfers to a local
in a motor vehicle accident or suffer a heart medical facility or evacuation to hand-picked
attack, time is critical. The first ten minutes, centre of excellence for treatment.
w
known as the platinum time, is the first goal in
J o i n No
Emergency medical response by road to
the scene of a medical emergency
and your benefits
will include:
Companionship and care for stranded
minors
Transfer by road or air to the most Repatriation of patients far from home
appropriate medical facility Repatriation of mortal remains
Medically justified ambulance or inter- Emotional support and tele-counselling
hospital transfers Access to rape crisis centre Includes cover
Ambulance transfers to special care centre throughout South Africa
Transfer of life saving blood or medication
With Swazimed your family is covered for any pre-hospital medical emergency and evacuation 24
hours a day, 365 days a year within your monthly contributions.
Emergency contact numbers:
Swazico Medics:......Toll free 0911/7802 1911
Good Samaritan: ....7666 0911
Chivaz Ambulance Service: 7699 0911
EPR:...........................977
Traumalink: .............7606 0911
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 3
MEDICINE MANAGEMENT PROGRAMME
Swazimed has introduced Medicine to ensure availability of medicines without co-
Management Programme to ensure that payments being necessary - in other words,
appropriate and cost effective medicines are you will be able to afford the medicine you
prescribed to members. need without paying from your own pocket,
but you may have to select certain generics
THE MEDICINE PRICE LIST (MPL) over a brand name product or more expensive
generics. Should you prefer one of the more
MPL is a reference pricing system that uses expensive products, Swazimed will only pay
a benchmark (reference) price for generically up to the MPL reference price and you will then
similar products. The fundamental principle have to pay the difference (co-payment) to the
of any reference pricing system is that it does pharmacy.
not restrict a member's choice of medicines,
but instead limits the amount that will be paid. MPL can be downloaded from the website on
MPL reference prices are set in such a way as www.mediscor.co.za
HIV & AIDS Management Your condition will stay confidential
For many people HIV/AIDS is a frightening HIV & AIDS is a sensitive matter and every effort
disease, but today there are treatments that are is made to keep your conditions confidential. The
keeping many people living with HIV, healthy staff members at our HIV & AIDS programme
and productive. unit have all signed confidentiality agreements
and work in a confidential and secured arear.
Action and Information They use separate telephone, fax and private
mailbag facilities. Patients must use these
The first step is to find out whether you have facilities to maintain confidentiality.
been infected with HlV and what you can do
to stay healthy to protect yourself and your You must register on our HIV & AIDS
loved ones. Medicine can attack the virus while Management programme
vitamins, good nutrition and exercise can play
a critical role in keeping your body strong and If your test shows you are HIV-positive, your
healthy. Starting treatment at the right time doctor must register you with AID for AIDS as
improves quality of life and decreases the risk soon as possible to make use of this benefit
of serious infections or other complications.
Our HIV & AIDS programme can help you access You are not covered within the first 3 months of
benefits to assist you with the management of joining the fund.
HIV/AIDS.
After you have registered
We can help you to manage your condition
After registration, a highly qualified medical team
Your medical scheme has a benefit amount will examine your details and if necessary, discuss
specifically for HIV/AIDS related medicine. This cost effective and appropriate treatment with
benefit amount is used to pay for medicine to your doctor.
attack the virus, vaccinations to protect against
illnesses such as TB and flu and vitamins to Once treatment has been agreed upon, you and
boost your immune system. your doctor will be sent a detailed treatment plan,
which explains the approved medicines as well as
Page 4 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021the regular tests that needs to be done to ensure the most appropriate time.
that the drugs are working correctly and safely, Treatment to prevent opportunistic
infections like certain serious pneumonias
What the HIV/AIDS Management programme and TB
offers you? Regular monitoring of disease progression
and response to therapy
AID for AIDS is a complete HIV disease Ongoing patient support
management programme that offers both Clinical guidelines and telephonic support
members and beneficiaries: for providers.
Medicine to treat HIV (including drugs to Help in finding a registered counsellor for
prevent mother-to-child transmission and emotional support.
infection after rape or needle stick injury) at
Important
If you are exposed to HIV infection through rape or needle-stick injury please ask your doctor
to contact HIV/AIDS Management programme to authorise special antiretroviral medicine to
help prevent possible HIV infection.
It is best to take prophylaxis treatment as soon as possible after exposure. If the incident
putting you at risk occurs over the weekend, make sure you get the necessary medication on
time.
You or your doctor can contact the HIV & AIDS programme on the first working day to arrange
authorisation of the drugs for payment by your medical scheme.
Contact Number: 2405 8400 Email Address: info@swazimed.com
WELLNESS BENEFITS
The objective is early identification of common risk factors, reduction in co-morbities and general
improvement in the health status of members
Service Clinical Criteria for Access
Consultation with Limited to one (1) long consultation per year. During this consultation, the
general practictioner DR will assess blood pressure, body mass index and glucose.
Pneumococial
For all beneficiaries aged 65 years & older.
Vaccine
For all female beneficiaries aged 21 years and older, limited to one test
Pap Smear
every two years.
For all beneficiaries aged 29 years and older, limited to one test every two
Total Cholesterol
years One (1) lipogram every 5 years.
For all male beneficiaries aged 45 years & older, limited to one test every
PSA
two years.
Colo-rectal Screening
For all male beneficiaries aged 50 years & older, every year.
(faecal occult blood)
Densitometry For all beneficiaries aged 50 years & old.
Mammogramm For all female beneficiaries aged 50 to 74years.
Flue Vaccine For all beneficiaries aged 6 years & older.
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 5CHRONIC MEDICINES BENEFIT Self-inflicted injuries.
Injuries arising from professional sport or
All members with their registered dependants speed contests.
who have accomplished a three months waiting Conditions which were specifically excluded
period with the fund are entitled to a chronic when you joined the fund.
medicine benefit based on the option they belong Pregnancy within the first nine months of
to. The cover includes; hypertension, diabetic, joining the fund.
asthma, epileptic, ulcer, bipolar, schizophrenia, Items which can be purchased from
allergic rhinitis chronic obstructive pulmonary supermarkets i.e. shampoo.
disease, cardiac failure and cardiomyopathy, More than one months' supply of medication.
coronary artery disease, hyperlipidaemia, Vitamin supplements unless younger than
gout and hypothyroidism, multiple sclerosis, 5 or older than 60 years.
glaucoma, chrohn’s disease, Parkinson’s Immunisations.
disease, addison’s disease and osteoporosis Injury on duty which is paid by Workman's
Compensation.
FUNERAL POLICY Heart operation, renal failure, oncology (24
months), organ transplant within first 12
All members of the scheme are automatically months of joining the fund.
covered for the Swazimed funeral policy which Any condition existing before or during
is insured through the Eswatini Royal Insurance waiting period.
Corporation. The members and their registered Optical benefits within the first 12 months
dependants in the event of death are covered; of joining the fund.
Member/Spouse/Parents - E15,000.00 Important
Child: 14-21 years - E15,000 00
1-13 years - E7,500.00 Contact your Swazimed offices before
0-1 year - E3 750.00 undergoing any treatment. Should you sustain
injuries as a result of an accident, an assault or
What will the fund not pay for? an injury on duty, please contact your Swazimed
offices to discuss what you should do.
Costs above Scale of Benefits, or above your
annual or category limits. A detailed list of the benefits excluded can be
Treatment for obesity and artificial obtained from the Swazimed membership
insemination. department.
Cosmetic surgery which includes plastic and
reconstructive surgery, breast reductions
or enlargements, removal of excess fat and
skin grafts.
Page 6 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021WHO CAN BELONG?
Who can join? you have a child or adopt one
the child is not dependant on you any more
Anyone can join the fund: (for example, if your child stops studying
Group (10 or more members) and starts working)
Individual
Swaziland Building Society Sipatji Account Do I have to wait before I can claim benefits?
holders
Government employees Yes, you can only claim from the second month
Students after you have joined the fund. For individuals
Aged Parents of active members. and companies with less than ten members, the
waiting period is three months.
Important
Aged parents for group employees (plus 20
You may not be a member or dependant of more members) will have 6 months waiting period,
than one medical scheme at a time. You may not whilst direct paying members and groups with
join the fund if your age is above 60, unless in less than 20 members will have 24 months
case of a parent of an active member. waiting period.
How do I join? The financial year for benefits begins on 1
January each year.
Complete the membership application form
and send it to Swazimed. On the membership What happens if I join during the year?
form you must register your dependants and
attach marriage, birth certificates, member's ID Your benefits will be pro-rated. For example,
and proof of banking details. You will receive a should you join the fund in July you will only be
confirmation of membership from Swazimed. entitled to 50% of the allocated benefit value.
The following information is printed on the
membership card; Who can I register as dependants?
your membership number Your spouse or any other immediate family
principal members details members for whom the member is liable for
the names and surnames of your registered family care and support. Your children as long
dependants as they are under 21, not married and not
the date from which you are entitled to earning more than E100 per month.
receive benefits
the address of the fund MEMBER CATEGORIES
M0 Single member
Please look after your medical aid card. Do not M1 Member with one dependant
lend it to anyone other than your registered M2 Member with two dependants
dependants. Fraudulent use of membership M3 Member with three dependants
cards may lead to suspension, termination of
M4 Member with four dependants
your membership and / or recovery of defrauded
amount. Report all lost cards immediately. M5+ Member with five dependants or more
Important Special conditions
You must let the fund know on a special form if: You can apply for your children to stay on the
you change your address fund when they are over 21 in special situations:
you get married or divorced
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 7 Children who are studying can stay on the When does my membership stop?
fund until they are 27. You must show proof
that they are studying full-time. You stop being a member if you leave your job
Children who are disabled or mentally or if your employer withdraws from the fund.
handicapped can also stay on the fund. The When you leave, you must give your membership
Board of Trustees will decide on all special card to your employer who will send it back
applications. (A doctors confirmation will be to the fund. For individuals and government
required). employees, termination may only be allowed at
Other special dependants will have six the end of the year with a three months notice of
months waiting period at a monthly termination. Subject to approval by the scheme.
premium of E680 for all options.
Important
What about pensioners and surviving
spouses? Group members are allowed to terminate
membership in December and only if the
Retired members and spouses of deceased employer decides to withdraw all her
members are entitled to the same benefits employees at the end of December and
as other members and pay the first income a three months notice will be required.
category contributions. Retirement age 60 is Individuals are not allowed to withdraw
considered unless retired due to ill-health. voluntarily.
Group terminations before December will
pay contributions for the remaining period
until December or otherwise the benefits
proration rule will apply
For treatment/coverage abroad, members
are advised to take a separate cover.
Page 8 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021CASHBACK / LOW CLAIM BONUS
Swazimed offers nine benefit options and each fund the balance of the savings will remain
individual should choose an option according to with the fund and the member may claim the
his/her health care needs. For all the options 20% yearly. The current year balance will be
benefits are paid at Swazimed scale of benefit paid only if the member leaves by the end of
(SPL) with adequate annual limits. December.
NO/ LOW CLAIM BONUS 100% CASH BACK CLAIMS
Members who have completed a twelve- Members who have terminated their
month membership (calendar year; January- membership may claim 100% savings balance
December) are entitled to a percentage of their and payment will be processed after the lapse
contributions which is claimed before the end of of the stale period (4 months) from the date of
March of the following year. Only High benefit, termination. Members may use their savings
Standard benefit, Medium benefit and Savings for future medical expenses/contributions if
plan members are entitled to these claims. preferred not to claim back as cash.
Members are encouraged to write claims letters
to Swazimed for tax purposes thus there is no WHAT HAPPENS TO MY SAVINGS WHEN I
automatic payments of bonuses. CHANGE OPTIONS?
Members on High, Standard and Medium option Member's savings will be transferred to the
from January to December will be allowed to newly selected option and members may claim
write a letter to claim a 30% incentive bonus 20% of the savings balance on annual basis.
for the previous year before the end of March Applications can be sent before the end of
in the following year. To qualify for the bonus March the following year.
members should have cleared all contribution
arrears by March of the following year. Payment WHAT HAPPENS TO MY SAVINGS WHEN
will be between June and October. I TERMINATE MEMBERSHIP DURING THE
YEAR?
SAVINGS OPTIONS
Members on high benefit, standard benefit,
Swazisave members can claim a 20% savings medium benefit and savings plan forfeits their
balance only if the member has 12 months savings or claims for the incomplete current
membership from the beginning of the year. If financial period (January-December). Members
the member on the savings option leaves the may only claim for a full financial period.
EX-GRATIA ASSISTANCE
Ex-gratia is a conditional assistance which is granted to a member who has exhausted the normal
benefit and there is a clinical indication that if the treatment is not received the members life will
be in danger.
Terms and conditions apply.
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 9SWAZIMED CONTRIBUTIONS AND
Page 10
BENEFITS FOR 2021
STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
OVERALL ANNUAL LIMIT
Unlimited per family 745,500 per family 35,000 per family 1,597,500 per family 1,597,500 per family 28,857 per family
(OAL)
per
1,500,000 per beneficiary 404,700 per beneficiary 692,250 692,250 per beneficiary 1,100,000 per family
beneficiary
OUT PATIENT (OHEB) n/a n/a n/a n/a n/a 9,333 per beneficiary 2,814 per family
NO / LOW CLAIM BONUS Yes Yes Yes No
No 20% of previous year savings No No
30% of contributions minus all 30% of contributions minus 30% of contributions
balance is refunded to the
claims all claims minus all claims
member
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
Level 1: 1,200
Level 2: 2,400
Level 3: 3,600
Level 4: 4,800
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021
Level 5: 6,000
Level 6: 7,200
Level 7: 8,400
Level 8: 9,600
Level 9: 10,800
Level 10: 12,000
Level 11: 13,200
Level 12: 14,400
SAVINGS BENEFIT No No No No Level 13: 15,600 No No
Level 14: 16,800
Level 15: 18,000
Level 16: 19,200
Level 17: 20,400
Level 18: 21,600
Level 19: 22,800
Level 20: 24,000
Level 21: 25,200
Level 22: 26,400
Level 23: 27,600
Level 24: 28,000
Level 25: 30,000
Extra Savings Benefit (optional) Level of choice Level of choice Level of choice Level of choice No Level of choice Level of choice
Page 11STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
FUNERAL POLICY
Page 12
Member/Spouse 15,000 15,000 15,000 15,000 15,000 15,000 15,000
Children: 14 - 21 15,000 15,000 15,000 15,000 15,000 15,000 15,000
Children: 1 - 13 7,500 7,500 7,500 7,500 7,500 7,500 7,500
Children: 0 - 1 3,750 3,750 3,750 3,750 3,750 3,750 3,750
Parents 15,000 15,000 15,000 15,000 15,000 15,000 15,000
1 GP consultation per
1 GP consultation per beneficiary per annum 1 GP consultation per 1 GP consultation per 1 GP consultation per 1 GP consultation per
1 GP consultation per
beneficiary per annum covering: beneficiary per annum beneficiary per annum beneficiary per annum beneficiary per annum
beneficiary per annum covering:
covering: - GP consultation fee covering: covering: covering: covering:
- GP consultation fee
- GP consultation fee - Blood pressure - GP consultation fee - GP consultation fee - GP consultation fee - GP consultation fee
- Blood pressure
- Blood pressure - Cholesterol - Blood pressure - Blood pressure - Blood pressure - Blood pressure
- Cholesterol
- Cholesterol - Blood glucose - Cholesterol - Cholesterol - Cholesterol - Cholesterol
- Blood glucose
WELLNESS BENEFITS - Blood glucose - Papsmear for female - Blood glucose - Blood glucose - Blood glucose - Blood glucose
- Papsmear for female
Limited to 1 GP consultation per - Papsmear for female beneficiaries - Papsmear for female - Papsmear for female - Papsmear for female - Papsmear for female
beneficiaries
beneficiary per annum. beneficiaries - Prostate test for beneficiaries beneficiaries beneficiaries beneficiaries
- Prostate test for male
(For more details refer to notes on - Prostate test for male male beneficiaries - Prostate test for male - Prostate test for male - Prostate test for male - Prostate test for male
beneficiaries
wellness benefits) beneficiaries - BMI beneficiaries beneficiaries beneficiaries beneficiaries
- BMI
- BMI Osteoporosis - BMI - BMI - BMI - BMI
Osteoporosis screening
Osteoporosis screening screening Osteoporosis screening Osteoporosis screening Osteoporosis screening Osteoporosis screening
Mammogram for female
Mammogram for female Mammogram for Mammogram for female Mammogram for female Mammogram for female Mammogram for female
beneficiaries
beneficiaries female beneficiaries beneficiaries beneficiaries beneficiaries beneficiaries
Flu vaccine
Flu vaccine Flu vaccine Flu vaccine Flu vaccine Flu vaccine Flu vaccine
Pneumococcal vaccine
Pneumococcal vaccine Pneumococcal Pneumococcal vaccine Pneumococcal vaccine Pneumococcal vaccine Pneumococcal vaccine
vaccine
ALCOHOLISM AND DRUG
100% SPL 100% SPL 100% SPL 100% Cost 100% SPL
DEPENDENCY No Benefit No Benefit
(Substance abuse) 2,176 per family 2,016 per family 1,709 per family Subject to available Savings 1,709 per family
ALTERNATIVE HEALTHCARE 100% SPL, subject to
100% SPL 100% SPL 100% SPL No Benefit 100% Cost
PRACTITIONERS OHEB
(Chiropractors (including No Benefit
X-Rays), Homeopathy and
4,987 per family 4,052 per family 3,209 per family No Benefit Subject to available Savings 2,814 per family
Naturopathy
(Including medicines))
AMBULANCE SERVICES 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
(Emergency only) 28,857 per family 13,528 per family 8,461 per family 13,528 per family 13,528 per family 80,269 per beneficiary 8,461 per family
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
APPLIANCES - MEDICAL AND
13,621 per family 10,550 per family 4,202 per family 4,906 per beneficiary 4,202 per family
SURGICAL
Wheelchairs - within above limit 7,918 per family 6,372 per family 2,309 per family No Benefit Subject to available Savings 4,906 per beneficiary 2,309 per family
Hearing Aids - within above limit 8,149 per family 5,979 per family 2,655 per family 4,906 per beneficiary 2,655 per family
BLOOD AND BLOOD
100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
PRODUCTS
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021
CONSULTATIONS AND VISITS 100% SPL, subject to
100% SPL, subject to OHEB
OHEB
(General Practitioners, M0 7,099 M0 4,733 M0 2,863 M0 2,814
No Benefit
Specialists & Nurse
M1 8,115 M1 5,587 M1 3,728 10 visits per beneficiary per M1 2,814
Practitioners) Subject to available Savings
annum
Rooms or Home
(OUTPATIENT) M2+ 9,477 M2+ 6,764 M2+ 4,733 M2+ 2,814
In Hospital 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
DENTISTRY
100% SPL 100% SPL 100% Cost
Advanced Dentistry/Oral Surgery
M0 5,887 M0 4,040
(Inlays, Crowns, Bridges, Study
Models, Metal Base, Oral medicines M1 10,042 M1 7,272
by: No Benefit No Benefit No Benefit No Benefit
Orthodontists, Periodontists, Subject to available Savings
Prosthodontists and Dental
M2+ 13,851 M2+ 10,504
Technicians)
100% SPL, subject to
emergency treatment
100% SPL 100% SPL 100% Cost 100% SPL, subject to OHEB
only at network
Basic/Ordinary & Restorative
provider
(Including Plastic Dentures, Dental
No Benefit No Benefit
Technicians & Dental Therapist)
Joint limit with Advanced Dentistry M0 2,436 M0 1,858 M0 464
4,479
M1 4,456 M1 3,521 M1 881 Subject to available Savings - per beneficiary
-
M2+ 6,233 M2+ 4,987 M2+ 1,246
Page 13STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
Osseointegrated Implants 100% Cost
Page 14
(Including hospitalisation,
Dental Practitioner,
Anaesthetist) 100% SPL 100% SPL 100% SPL No Benefit No Benefit 100% SPL
Subject to available Savings
Joint limit with Advanced
Dentistry
Maxillo Facial Surgery 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
HOSPITALISATION
In-patient 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
(Accommodation - General Ward,
Theatre Fees, Medicines, Materials &
Equipment)
per
TTO’s/Take Home Medicine 554 per admission 554 per admission 554 554 per admission 554 per admission 554 per admission 554 per admission
admission
100% Cost
100% SPL 100% SPL 100% SPL No Benefit 100% SPL 100% SPL
Subject to available Savings
In-patient 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
(Hospital Visits/Consultations) M0 1,558 M0 1,258 M0 785 M0 1,558 M0 1,558 M0 785
1,628
M1 1,939 M1 1,477 M1 1,085 M1 1,939 M1 1,939 - per beneficiary M1 1,085
-
M2+ 2,320 M2+ 1,778 M2+ 1,397 M2+ 2,320 M2+ 2,320 M2+ 1,397
Alternatives to Hospitalisation 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
Step down nursing Facilities,
Private Nursing, Frail
19,542 per family 19,542 per family 11,855 per family 19,542 per family 19,542 per family 19,542 per beneficiary 11,855 per family
Care, Hospice & Physical
rehabilitation in hospital)
IMMUNE DEFICIENCY (related
to HIV/AIDS)
3 months exclusion
100% SPL 100% SPL 100% SPL 100% SPL 100% SPL No Benefit No Benefit
(Services, Materials, Medicines)
Limited to acute medicine and
consultation benefit
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
MEDICINES & INJECTION MATERIAL
Chronic Medicines
3 Months Waiting Period
M0 3,971 M0 2,508 M0 1,259 M0 1,259 M0 1,259 Subject to Acute medicine
Only cover for: hypertension,
3,767 limit
diabetic, asthma, epileptic, ulcer, per
M1 7,260 M1 4,381 M1 2,508 M1 2,508 M1 2,508 -
bipolar, schinzophrenia, allergic beneficiary
-
rhinitis, arthritis, chronic obstructive M2+ 8,680 M2+ 6,275 M2+ 3,132 M2+ 3,132 M2+ 3,132
pulmonary disease, cardiac failure
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021
and cardiomyopathy, coronary artery
disease, hyperlipidaemia, gout and
hypothyroidism,multiple sclerosis,
glaucoma, Chrohn’s Disease,
Parkinson’s Disease, Addison’s
Disease, Osteoporosis.
100% Cost, subject to
Acute Medicines 100% SPL 100% SPL 100% SPL 100% SPL 100% Cost, subject to OHEB
OHEB
M0 5,171 M0 3,798 M0 2,078 No Benefit M0 2,078
5,656
M1 10,077 M1 6,949 M1 3,359 Subject to available Savings - per beneficiary M1 2,814
-
M2+ 14,255 M2+ 9,534 M2+ 4,305 M2+ 2,814
Pharmacy Advised Therapy
(OTC)
Within acute medicine limit M0 1,293 M0 935 M0 612 M0 566
No Benefit Subject to acute medicine
Schedule 0, 1 and 2 only M1 2,447 M1 1,755 M1 970 Subject to available Savings M1 900
limit
M2+ 3,509 M2+ 2,355 M2+ 1,258 M2+ 1,166
242 per script 242 per script 242 per script 242 per script 242 per script 242 per script
100% SPL 100% SPL 100% SPL Subject to available Savings 100% Cost 100% Cost
No Benefit
Contraceptives (oral)
115 per script 115 per script 115 per script 115 per script 115 per script 115 per script
Within acute medicine limit
MENTAL HEALTH - In and out
100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
of hospital
33,936 per family 20,800 per family 5,264 per family 20,800 per family 20,800 per family 21,885 per beneficiary 5,264 per family
MOTOR VEHICLE
100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
ACCIDENTS - In hospital 100% SPL 100% SPL
(Subject to MVA Protocols) 288,572 per family 253,943 per family 230,858 per family 230,858 per family 931,510 per beneficiary
Page 15STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
NON-SURGICAL PROCEDURES AND TESTS
Page 16
In Hospital 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
Out of Hospital 100% Cost
100% SPL, subject to
(Sleep Studies is paid only 100% SPL 100% SPL 100% SPL No Benefit 100% SPL, subject to OHEB
Subject to available Savings OHEB
when authorised by the Fund)
OPTOMETRY
100% SPL, subject to
Frames, Lenses, Readers 100% SPL 100% SPL OHEB and network Subject to available Savings 100% SPL, subject to OHEB
provider (SpecSavers)
One in 2 year claiming period M0 4,386 M0 2,863 No Benefit No Benefit
548 3,047
M1 6,591 M1 5,148 - per -
Subject to available Savings per beneficiary
M2+ 7,157 M2+ 5,760 - beneficiary -
- -
4,386 per beneficiary 2,863 per beneficiary
100% SPL, subject to
Eye Examinations 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL, subject to OHEB
OHEB
No Benefit
One per beneficiary One per beneficiary per One per beneficiary per
One per beneficiary per annum One per beneficiary per annum Subject to available Savings
per annum annum annum
Refractive Surgery 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL
(Radial Keratotomy/ Excimer No Benefit No Benefit
3,324 per family 2,424 per family 2,424 per family Subject to available Savings 2,424 per family
Laser)
ORGAN TRANSPLANTS 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
100% SPL withing overall
For pathology & radiology the 100% SPL
208,926 per family 199,692 per family 170,835 per family 170,835 per family 208,926 per beneficiary limit
separate benefit limits apply
ONCOLOGY
Radiotherapy and
100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
Chemotherapy
100% SPL 100% SPL
(Including medicine, radiology per
333,760 per family 290,881 per family 232,012 per family 232,012 per family 573,681
and pathology.) beneficiary
Bracytherapy 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
100% SPL per 100% SPL
(Within oncology limit above) 49,784 per family 49,784 per family 49,784 per family 49,784 per family 49,784
beneficiary
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
PATHOLOGY AND MEDICAL TECHNOLOGY
In Hospital 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
per 100% SPL
46,472 per family 27,911 per family 392 23,236 per family 23,236 per family 392 per admission
admission
100% SPL, subject to
Out of Hospital 100% SPL 100% SPL 100% SPL 100% Cost
No Benefit 100% SPL, subject to OHEB OHEB
6,880 per family 4,202 per family 2,574 per family Subject to available Savings 2,574 per family
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021
PHYSIOTHERAPY AND BIOKINETICS
In Hospital 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
(Only applicable when there is a
3,982 per family 2,666 per family 1,766 per family 1,766 per family 1,766 per family 1,628 per family 1,651 per family
referring doctor)
100% SPL, subject to
Out of Hospital 100% SPL 100% SPL 100% SPL 100% Cost 100% SPL, subject to OHEB
OHEB
M0 2,043 M0 1,708 M0 1,016 No Benefit M0 1,016
1,708
per
M1 4,052 M1 3,047 M1 1,708 Subject to available Savings - M1 1,708
beneficiary
-
M2+ 6,095 M2+ 4,052 M2+ 2,355 M2+ 2,355
PREGNANCY/CONFINEMENT
Hospitalisation 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
(Accomodation, Theatre Fees,
Labouir Ward Fees, Drugs,
Dressings, Medicines and
Materials.)
Physio will only be applicable
per
to post caesarean cases during 37,006 per family 37,006 per family 14,509 per family 35,033 per family 35,033 per family 44,752 14,509 per family
beneficiary
hospital stay.
Abnormal vaginal delivery
will be considered for
physiotherapy on application
and authorisation.
Global fee for delivery 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
per
Within Maternity limit above 7,214 per family 7,214 per family 3,705 per family 6,891 per family 6,891 per family 7,676 3,705 per family
beneficiary
Page 17STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
2 x post natal midwife 2 x post natal midwife
Page 18
4 x post natal midwife 4 x post natal midwife 4 x post natal midwife 4 x post natal midwife
consultations per No Benefit consultations per
consultations per pregnancy consultations per pregnancy consultations per pregnancy consultations per pregnancy
pregnancy pregnancy
Services (Consultations, Visits
100% Cost
& Scans)
Ante-natal consults are from the 100% SPL 100% SPL 100% SPL No Benefit 100% SPL 100% SPL
Consultation benefit and
Subject to available Savings
Scans from Radiology benefit
and scans are limited to two.
PROSTHESIS
Internal (e.g. Knee & Hip
per
Replacements, etc.) - surgically 63,948 per family 42,362 per family 2,216 per family 30,011 per family 30,011 per family 17,891 2,216 per family
beneficiary
implanted
External (Includes External
41,324 per family 22,278 per family 2,666 per family No Benefit Subject to available Savings No Benefit 2,666 per family
Fixators)
RENAL DIALYSIS 100% SPL 100% SPL 100% SPL 100% SPL
Acute & Chronic - for Pathology No Benefit No Benefit No Benefit
& Radiology the separate 208,600 per family 102,270 per family 77,684 per family 77,684 per family
benefit limits apply.
RADIOLOGY & RADIOGRAPHY
In Hospital 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
General and Specialised
per
(including CT Scans, MRI 27,414 per family 18,192 per family 4,652 per family 18,192 per family 18,192 per family 29,504 4,652 per family
beneficiary
Scans, etc)
100% SPL, subject to
Out of Hospital 100% SPL 100% SPL 100% SPL 100% Cost
No Benefit 100% SPL, subject to OHEB OHEB
Within Radiology limit above 2,811 per family 2,309 per family 2,147 per family Subject to available Savings 1,985 per family
1 per family per
PET SCAN and PET-CT Scans 1 per family per annum 1 per family per annum 1 per family per annum 1 per family per annum 1 per beneficiary per annum 1 per family per annum
annum
1 per family per
Bone Densitometry 1 per family per annum 1 per family per annum 1 per family per annum 1 per family per annum 1 per beneficiary per annum 1 per family per annum
annum
Within Radiology limit above
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021STANDARD MEDIUM HOSPITAL NEW LOW COST
CATEGORY HIGH BENEFIT SWAZI-SAVE
BENEFIT BENEFIT PLAN GENERATION OPTION
REMEDIAL, OTHER
100% SPL, subject to zero 100% SPL, subject to
THERAPIES & PARAMEDICAL 100% SPL 100% SPL 100% SPL
savings balance OHEB
SERVICES
(Occupational Therapy, No Benefit No Benefit
Orthoptics, Podiatry, Speech
Therapy, Audiology, Dieticians, 9,027 per family 7,457 per family 6,048 per family 3,728 per family 2,814 per family
Hearing Aid Acousticians,
Genetic Councelling.)
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021
SURGICAL PROCEDURES 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL 100% SPL
ABBREVIATIONS
SPL: Swazimed Price List. All benefits are paid at 100% SPL.
NHRPL (SA): National Health Reference Price List (inside South Africa).
SAOA: South African Optometrists Association.
OHEB: Out of Hospital Benefits.
Page 19SWAZIMED CONTRIBUTION TABLE 2021
SWAZIMED HIGH BENEFIT CONTRIBUTIONS (POLICY1)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 3,000 2,470 3,358 3,774 3,970 4,068 4,328
3,001 - 4,000 2,620 3,578 4,048 4,216 4,346 4,602
4,001 - 5,000 2,642 3,644 4,106 4,298 4,432 4,684
5001 - 6,000 2,708 3,670 4,134 4,344 4,450 4,730
6,001 - PLUS 2,728 3,704 4,152 4,370 4,476 4,776
Optinal Savings
300+ 300+ 300+ 300+ 300+ 300+
(incremental of E100)
SWAZIMED STANDARD BENEFIT CONTRIBUTIONS (POLICY 2)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 3,000 2,140 2,920 3,278 3,432 3,564 3,748
3,001 - 4,000 2,154 2,948 3,314 3,458 3,608 3,768
4,001 - 5,000 2,178 3,004 3,356 3,528 3,630 3,852
5001 - 6,000 2,200 3,022 3,398 3,584 3,644 3,898
6,001 - PLUS 2,238 3,048 3,418 3,614 3,686 3,936
SWAZIMED MEDIUM BENEFIT CONTRIBUTIONS (POLICY 3)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 4,000 684 1,174 1,212 1,276 1,354 1,408
4,001 - 6,000 718 1,232 1,266 1,330 1,412 1,474
6,001 - PLUS 816 1,386 1,436 1,508 1,596 1,668
SWAZIMED HOSPITAL BENEFIT CONTRIBUTIONS (POLICY 4)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 662 1,040 1,112 1,182 1,252 1,276
1,001 - 2,000 952 1,302 1,484 1,538 1,558 1,656
2,001 - PLUS 1,018 1,374 1,542 1,634 1,660 1,800
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 1 - E1,200 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 762 1,140 1,212 1,282 1,352 1,376
1,001 - 2,000 1,052 1,402 1,584 1,638 1,658 1,756
2,001 - PLUS 1,118 1,474 1,642 1,734 1,760 1,900
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 2 - E2,400 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 862 1,240 1,312 1,382 1,452 1,476
1,001 - 2,000 1,152 1,502 1,684 1,738 1,758 1,856
2,001 - PLUS 1,218 1,574 1,742 1,834 1,860 2,000
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 3 - E3,600 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 962 1,340 1,412 1,482 1,552 1,576
1,001 - 2,000 1,252 1,602 1,784 1,838 1,858 1,956
2,001 - PLUS 1,318 1,674 1,842 1,934 1,960 2,100
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 1,062 1,440 1,512 1,582 1,652 1,676
1,001 - 2,000 1,352 1,702 1,884 1,938 1,958 2,056
2,001 - PLUS 1,418 1,774 1,942 2,034 2,060 2,200
Page 20 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 5 - E6,000 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 1,162 1,540 1,612 1,682 1,752 1,776
1,001 - 2,000 1,452 1,802 1,984 2,038 2,058 2,156
2,001 - PLUS 1,518 1874 2,042 2,134 2,160 2,300
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 1,162 1,640 1,712 1,782 1,852 1,876
1,001 - 2,000 1,552 1,902 2,084 2,138 2,158 2,256
2,001 - PLUS 1,618 1,974 2,142 2,234 2,260 2,400
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 1,262 1,740 1,812 1,882 1,952 1,976
1,001 - 2,000 1,652 2,002 2,184 2,238 2,258 2,356
2,001 - PLUS 1,718 2,074 2,242 2,334 2,360 2,500
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 1,362 1,840 1,912 1,982 2,052 2,076
1,001 - 2,000 1,752 2,102 2,284 2,338 2,358 2,456
2,001 - PLUS 1,818 2,174 2,342 2,434 2,460 2,600
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 1,462 1,940 2,012 2,082 2,152 2,176
1,001 - 2,000 1,852 2,202 2,384 2,438 2,458 2,556
2,001 - PLUS 1,918 2,274 2,442 2,534 2,560 2,700
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 1,562 2,040 2,112 2,182 2,252 2,276
1,001 - 2,000 1,952 2,302 2,484 2,538 2,558 2,656
2,001 - PLUS 2.018 2,374 2.542 2,634 2,660 2,800
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 11 - E13,200 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 1,662 2,140 2,212 2,282 2,352 2,376
1,001 - 2,000 2,052 2,402 2,584 2,638 2,658 2,756
2,001 - PLUS 2,118 2,474 2,642 2,734 2,760 2,900
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 12 - E14,400 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 1,762 2,240 2,312 2,382 2,452 2,476
1,001 - 2,000 2,152 2,502 2,684 2,738 2,758 2,856
2,001 - PLUS 2,218 2,574 2,742 2,834 2,860 3,000
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 13 - E15,600 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 1,862 2,340 2,412 2,482 2,552 2,576
1,001 - 2,000 2,252 2,602 2,784 2,838 2,858 2,956
2,001 - PLUS 2,318 2,674 2,842 2,934 2,960 3,100
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 21SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 14 - E16,800 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 1,962 2,440 2,512 2,582 2,652 2,676
1,001 - 2,000 2,352 2,702 2,884 2,938 2,958 3,056
2,001 - PLUS 2,418 2,774 2,942 3,034 3,060 3,200
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 15 - E18,000 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,062 2,540 2,612 2,682 2,752 2,776
1,001 - 2,000 2,452 2,802 2,984 3,038 3,058 3,156
2,001 - PLUS 2,518 2,874 3,042 3,134 3,160 3,300
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 16 – E19,200 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,162 2,640 2,712 2,782 2,852 2,876
1,001 - 2,000 2,552 2,902 3,084 3,138 3,158 3,256
2,001 - PLUS 2,618 2,974 3,142 3,234 3,260 3,400
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 17 – E20,400 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,262 2,740 2,812 2,882 2,952 2,976
1,001 - 2,000 2,652 3,002 3,184 3,238 3,,258 3,356
2,001 - PLUS 2,718 3,074 3,242 3,334 3,360 3,500
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 18 – E21,600 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,362 2,840 2,912 2,982 3,052 3,076
1,001 - 2,000 2,752 3,102 3,284 3,338 3,358 3,456
2,001 - PLUS 2,818 3,174 3,342 3.434 3,460 3,600
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 19 – E22,800 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,462 2,940 3,012 3,082 3,52 3,176
1,001 - 2,000 2,852 3,202 3,384 3,438 3,458 3,556
2,001 - PLUS 2,918 3,274 3,442 3,534 3,560 3,700
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 20 – E24,000 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,562 3,040 3,112 3,182 3,252 3,276
1,001 - 2,000 2,952 3,302 3,484 3,538 3,558 3,656
2,001 - PLUS 3,018 3,374 3,542 3,634 3,660 3,800
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 21 – E25,200 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,662 3,140 3,212 3,282 3.352 3,376
1,001 - 2,000 3,052 3.402 3,584 3,638 3,658 3,756
2,001 - PLUS 3,118 3,474 3,642 3,734 3,760 3,900
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 22 – E26,400 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,762 3,240 3,312 3,382 3,452 3,476
1,001 - 2,000 3,152 3,502 3,684 3,738 3,758 3,856
2,001 - PLUS 3,218 3,574 3,742 3,834 3,860 4,000
Page 22 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 23 – E27,600 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,862 3,340 3,412 3,482 3,552 3,576
1,001 - 2,000 3,252 3,602 3,784 3,838 3,858 3.956
2,001 - PLUS 3,318 3,674 3,842 3,934 3,960 4,100
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 24 – E28,800 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 2,962 3,440 3,512 3,582 3,652 3,676
1,001 - 2,000 3,352 3,702 3,884 3,938 3,958 4,056
2,001 - PLUS 3,418 3,774 3,942 4,034 4,060 4,200
SWAZIMED SAVINGS PLAN CONTRIBUTIONS - LEVEL 25 – E30,000 (POLICY 5)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 1,000 3.062 3,540 3,612 3,682 3,752 3,776
1,001 - 2,000 3,452 3,802 3,984 4,038 4,058 4,156
2,001 - PLUS 3,518 3,874 4,042 4,134 4,160 4,300
SWAZIMED NEW GENERATION PLAN CONTRIBUTIONS- (POLICY 6)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
All 1,122 1,916 n/a n/a n/a n/a
SWAZIMED LOW COST OPTION CONTRIBUTIONS- (POLICY 7)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 2,000 406 698 720 756 802 838
2,001 - 3,000 432 734 760 794 844 882
3,001 - 6,000 450 776 796 838 888 926
6,001 - PLUS 580 994 1032 1082 1,144 1,196
SWAZIMED LOW COST OPTION CONTRIBUTIONS- (POLICY 7)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 - 2,000 406 698 720 756 802 838
2,001 - 3,000 432 734 760 794 844 882
3,001 - 6,000 450 776 796 838 888 926
6,001 - PLUS 580 994 1032 1082 1,144 1,196
Optinal Savings
100+ 100+ 100+ 100+ 100+ 100+
(incremental of E100)
PRIMARY CARE OPTION (POLICY 8)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 – 4,000 294 502 520 546 580 604
4,001 – 6,000 308 530 544 570 606 632
6,001 - PLUS 348 594 618 648 684 716
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 23PRIMARY CARE OPTION - POLICY NO. 8
Swazimed introduced a Primary Care Option (policy No. 8) which offers members primary care. Studies have proved
that primary care is an essential need in order to minimize high cost illnesses. Primary care reduces the risk of hospital
admission thus this policy does not cover hospitilization but only out-patient treatment.
BENEFITS
CATEGORY PRIMARY CARE OPTION
Extra Savings Benefit (Optional) No
FUNERAL POLICY
Member/Spouse E15,000
Children: 14-21 E15,000
Children: 1-13 E7,500
Children: 0-1 E3,750
Parents E15,000
CONSULTATIONS AND VISITS 100% SPL
M0: 2 863
Rooms or Home
M1: 3 728
(General Practitioners, Specialits & Nurse Practitioners)
M2+: 4 733
OPTOMERY No benefit
Frames, Lenses, Readers
One in 2 year claiming period starting from 1 January 2016 to 31
No benefit
December 2017
(12months exclusions)
Eye Examinations
One per beneficiary per annum
Refractive Surgery (Radial Keratotomy/ Excimer Laser)
PATHOLOGY AND MEDICAL TECHNOLOLGY 100% SPL
Out of Hospital 2451
PHYSIOTHERAPY - Out of Hospital 2574
RADIOLOGY & RADIOGRAPHY
No benefit
In Hospital
Radiology and Specialised (including CT Scans, MRI Scans, etc) 100% SPL
Out Hospital 2147
Within Radiology limit above
No benefit
PET SCAN and PET-CT scans
Limited and included in Wellness benefit.
• One GP consultation per beneficiary per annum covering:
• One GP consultation fee per beneficiary (tariff code 07344)
• One Cholesterol for all beneficiaries aged 40 years and older, every year.
(tariff code 4025) pathology test
• One Cholesterol for all beneficiaries aged 29-39 years and older, every
year. One lipogram every 5 years.
• Blood pressure
• One Blood glucose
WELLNESS BENEFITS • One Pap Smear for all female beneficiaries aged 21yrs and older.
• Limited to one test, every two years. (tariff code 4559/4566) pathology
Limited to 1 GP consultation per beneficiary
test
per annum
• One Prostate (PSA) for males aged 45yrs and older. Limited to one test
(see more details on the back-notes) every two years. (tariff Code 4519) pathology test
• One Colo- rectal screening (faecal occult blood) for all beneficiaries aged
50 years and older every year. (tariff 4351) pathology test.
• One osteoporosis Screening (bone densitometry) for all beneficiaries
aged 50 years and older every 2 years.
• One breast cancer screening (Mammogram) female beneficiaries aged
50-74 years every 2 years.
• Annual Flu vaccine for all beneficiaries age 6 years and older.
• One pnuemococcal vaccine for beneficiaries age 65 years and older per
life time.
M0: 1 372
MEDICINES & INJECTION MATERIAL (100% SPL) M1: 2 643
M2+: 3 301
M0: 612
Pharmacy Advised Therapy (OTC) (100% SPL) M1: 970
M2+: 1 258
Script limit 242 per script MPL
Contraceptives (oral) within acute medicine limit 111 per script MPL
RADIOLOGY & RADIOGRAPHY
2 147 per family
Out of Hospital
PRIMARY CARE OPTION (POLICY 8)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
0 – 4,000 284 484 500 524 558 580
4,001 – 6,000 296 510 524 548 582 608
6,001 - PLUS 336 572 594 622 658 688
Page 24 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021STUDENT OPTION - POLICY NO. 9
SwaziMed has introduced a student option which will cover full-time students (below 27 years) in school, tertiary and
University. The students pay contributions in advance, annually.
CATEGORY STUDENT OPTION Osseointegrated Refractive Surgery
2,324
OVERALL ANNUAL per Implants (Radial Keratotomy/
Unlimited per beneficiary
LIMIT (OAL) beneficiary (Including hospitalisation, Excimer Laser)
Subject to available
per Dental Practitioner, ORGAN TRANSPLANTS
Unlimited benefits
beneficiary Anaesthetist) For pathology &
Joint limit with Advanced Subject to available
OUT PATIENT (OHEB) n/a radiology the separate
Dentistry benefits
NO / LOW CLAIM benefit limits apply,
BONUS Subject to available ONCOLOGY
No Maxillo Facial Surgery
benefits Radiotherapy and
HOSPITALISATION Chemotherapy Subject to available
SAVINGS BENEFIT No
In-patient Subject to available (Including medicine, benefits
(Accommodation - benefits radiology and pathology.)
General Ward, Theatre Bracytherapy
Fees, Medicines, Subject to available
per (Within oncology limit benefits
Extra Savings Benefit Materials & Equipment) 531
No admission above)
(optional) TTO’s/Take Home
Medicine PATHOLOGY AND MEDICAL TECHNOLOGY
FUNERAL POLICY
100% SPL In Hospital 376 per admission
Member 15,000
In-patient Consultation Out of Hospital 2,468 per beneficiary
ALCOHOLISM AND Subject to available M0 753
DRUG DEPENDENCY benefits Alternatives to 11,366 PHYSIOTHERAPY AND BIOKINETICS
1,638 Hospitalisation per family In Hospital
(Substance abuse) 1,693 per beneficiary
per beneficiary IMMUNE DEFICIENCY (related to HIV/AIDS) Referral letter required
ALTERNATIVE (Services, Materials, Out of Hospital MO 974
HEALTHCARE Medicines) PREGNANCY/CONFINEMENT
PRACTITIONERS Subject to available
benefits Limited to acute 100% SPL Hospitalisation No Benefit
(Chiropractors (including 3,077 medicine and Global fee No Benefit
X-Rays), Homeopathy per family consultation benefit
and Naturopathy Ante-natal consults No Benefit
MEDICINES & INJECTION MATERIAL Scans from Radiology
(Including medicines)) No Benefit
Chronic Medicines benefit
AMBULANCE Subject to available 100% SPL
3 Months Waiting Period PROSTHESIS 100% SPL
SERVICES benefits
Only cover for: M0 1,208 Internal 2,125 per beneficiary
(Emergency only) Unlimited per family
(refer to the notes for list
APPLIANCES - External 2,556 per beneficiary
of chronic illnesses)
MEDICAL AND 100% Cost RENAL DIALYSIS No Benefit
Acute Medicines 100% SPL
SURGICAL RADIOLOGY & RADIOGRAPHY
M0 1,992
per In Hospital
4,028 Pharmacy Advised
beneficiary 100% SPL
Therapy (OTC) General and Specialised 4,460
Wheelchairs - within per (including CT Scans, per beneficiary
2,213 Within acute medicine
above limit beneficiary M0 587 MRI Scans, etc)
limit
Hearing Aids - within per Out of Hospital
2,545 Schedule 0, 1 and 2 only 232 per script 2,058
above limit beneficiary
Within Radiology limit per beneficiary
BLOOD AND BLOOD Contraceptives (oral) 100% SPL
100% Cost above
PRODUCTS Within acute medicine per script
limit 111 PET SCAN and PET-CT
CONSULTATIONS MPL 1 per family per annum
Scans
AND VISITS (General MENTAL HEALTH - In 2,523
Bone Densitometry 1 per family per annum
Practitioners, Specialists M0 2,745 and out of hospital per beneficiary
& Nurse Practitioners) REMEDIAL, OTHER THERAPIES & PARAMEDICAL
MOTOR VEHICLE ACCIDENTS - In hospital
Rooms or Home SERVICES
(Subject to MVA
100% SPL (Occupational
In Hospital for Specialist 100% SPL Protocols)
Therapy, Orthoptics,
DENTISTRY NON-SURGICAL PROCEDURES AND TESTS Podiatry, Speech
Advanced Dentistry/Oral In Hospital 100% SPL 100% SPL
No Benefit Therapy, Audiology,
Surgery 2,900 per beneficiary
Out of Hospital Dieticians, Hearing Aid
Subject to OHEB (Sleep Studies is paid Subject to available Acousticians, Genetic
Basic/Ordinary & 4,294 only when authorised by benefits Councelling.)
Restorative per
- the Fund) SURGICAL PROCEDURES - 100% SPL
beneficiary
- OPTOMETRY SPL: Swazimed Price List
Frames, Lenses, Subject to OHEB NHRPL (SA): National Health Reference Price List
Readers One in 2 year per (inside South Africa)
claiming period 2,922 SAOA: South African Optometrists Association
beneficiary
OHEB: Out of Hospital Benefits
One per beneficiary per
Eye Examinations
annum
STUDENT OPTION (POLICY NO. 9)
Income Band M+0 M+1 M+2 M+3 M+4 M5+
All 434 n/a n/a n/a n/a n/a
NB: Students to pay annual contributions upfront (434x12=5208)
SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021 Page 25NOTES ON CONTRIBUTIONS
Ordinary Members Aged parents contribute 3 months in advance.
(Applicable to direct paying aged parents).
The total monthly contributions, based in
the income of the member and dependants Group Anti-selection
registered is payable by the member and
employer in accordance with the contributions An employer which practices on anti-selection
as set out in the tables. will be required to pay an additional contribution
of 50% of their monthly premiums for remaining
Contributions must be paid to the fund not later staff members.
than the seventh day of the month, following the
month to which contribution payments apply. Individual Members/Direct Paying Members
(DPM)
Pensioners / surviving spouses
Members categorised as individuals pay in the
The contributions shall be in accordance with last income band and contributes 3 months in
the first income band (0-3000) of the applicable advance.
contribution table and the number of registered
dependants. Only applicable to Swazimed No incentive bonus for students.
members with minimum 5 year membership.
NB:
Contribution for second wife Members on the new generation plan will be
allowed to change option during the year only if
Contributions payable for the second wife (after they attain the age of 40.
the first wife) shall be the normal dependant Members on savings plan are allowed to top-up
rate equivalent of a single member in the their levels during the year.
monthly income band of the principal member
on the contribution table. Later joiner fees
Aged Parents (Registration as a member) Direct Paying Members joining the scheme after
50 years of age will be liable for a plus 50% of
The Contribution payable for aged parents contributions penalties on monthly basis for
shall be an equivalent rate of a single member the duration of his/her membership. This is not
in the income band of a principal member. applicable for group members.
Page 26 SWAZIMED CONTRIBUTIONS AND BENEFITS FOR 2021You can also read
