(20120228110933 Am) Samwumed Benefitsbrochure2012 Web

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Introduction to SAMWUMED
SAMWUMED a Scheme by workers for workers
The South African Municipal Workers Union Medical Scheme (SAMWUMED) is a restricted medical aid scheme that provides cost-efficient, quality healthcare for people employed in local government and its related services. SAMWUMED is self-administered and this, combined with a prudent contribution policy, a focus on the provision of essential healthcare benefits and low overall non-health expenditure, is the key to the Schemes success.
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Choose SAMWUMED to look after your familys health in 2012


Our benefit options offer generous day-to-day and in-hospital benefits. Our contributions are very affordable with an average monthly contribution of R900 for a family that includes a *principal member, spouse and 2 children. Thousands of workers trust SAMWUMED to look after their healthcare needs. The Scheme understands workers needs and has a proud history of defending its members healthcare rights, since it was started in 1952. Please make sure that you familiarise yourself with your chosen benefit option and take note where pre-authorisations, motivations and/or letters of referral are required to access benefits.
*For a principal member who earns between R4 501 - R5 500.

Disclaimer: Every effort has been made to ensure that this benefits brochure is an accurate reflection of the benefits offered by SAMWUMED. Please note that this brochure is a summary and does not supersede the Rules of the Scheme, which takes precedence over the information contained herein.
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DAy-to-DAy bEnEfItS

Day-to-day benefits cover services that you and/or your registered dependants can access outside of a hospital such as visits to the doctor, routine dental check-ups and others as listed below.

oPtIon A
MAIN BENEFIT CATEGORY GENERAL PRACTITIONER CONSULTATIONS ANd PROCEdURES (inclUdeS COVER FOR ALTERnATIVE HEALTHCARE PRACTITIOnERS) SPECIALISTS CONSULTATIONS, PROCEdURES ANd vISITS SUB-CATEGORY In doctors rooms or home Alternative healthcare Practitioners to be registered with the Health Professions Council of South Africa (e.g. podiatrist, homeopath, naturopath, chiropractor etc.). BENEFIT LIMIT Family limit per year: M R2,270 M1 R3,610 M2 R4,600 M3+ R5,920 Beneficiary limit of R3,610 per year. Family limit, per year: M - R2,700 M1 - R4,000 M2 - R7,000 M3+ - R8,000 Beneficiary limit of R4,000 per year. Subject to referral from an appropriate first-line practitioner, such as a GP. Eight visits per family included in Specialist benefit limits above. M R1,880 M1 R2,630 M2+ R3,370 Limits and cycles as per the Schemes list of approved appliances apply. All dental procedure costs are paid for from this dentistry benefit, except for the costs of the removal of wisdom teeth in children under 7 years of age. M R2, 330 M1 R2, 780 M2 R3, 870 M3+ R4, 660 The dental limits above cover the costs of dental procedures.

Out-of-hospital

Ante-natal consultations APPLIANCES External appliances (Benefits can be accessed subject to a clinical motivation with correct tariff codes and costing for pre-authorisation by the Scheme.) dENTISTRY The Scheme does not cover the cost of cosmetic dentistry such as veneers and implants, these treatments are exclusions. Including calipers, surgical collar, orthopaedic boots, nebuliser, glucometers, hearing aids, colostomy kits.

Basic dentistry: Fillings, root canal treatments, scaling & polishing, extractions, fissure sealants, dentures and repairs (subject to prescribed cycles). Advanced dentistry includes orthodontics, crown and bridge work or any procedure that requires anaesthetics. Pre-authorisation required from Scheme for orthodontics, crown and bridge work for any procedure that requires anaesthetics. Pre-authorisation is required for all advanced dentistry. Provision is made for approval for clinically-motivated procedures to be conducted in hospital. Cover for advanced dentistry will be paid for according to the limits above. Procedure costs payable for removal of wisdom teeth or treatment for children under the age of 7 will be paid from the hospitalisation benefit. HIv/AIdS Out-of-hospital: Consultations, procedures and investigations. The Scheme has a dedicated HIV/Aids programme to help you manage your condition, it would assist you to join this Programme. Treatment will be subject to the use of Designated Service Providers. INFERTILITY Treatment for PMB conditions only. Subject to State hospitals for Hysterosalpingogram (HSG) and Diagnostic Dilatation and Curettage (DD & C). M R1,190 M1 R2,350 M2 R3,520 M3+ R4,690 Limit of R2,350 per beneficiary, per year. Limits to this benefit can be accessed after the medication limit has been exhausted. Condition-specific benefits, sub-limits and treatment plans apply. 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

MEdICATION

Prescribed or dispensed acute medicine includes alternative healthcare medication as prescribed and must be registered with the Medicines Control Council; injections and related materials.

Primary Healthcare Benefit Programme (PHC)

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Please take note where pre-authorisation or motivation is required before you can access certain benefits. Cover for Prescribed Minimum Benefits is not limited to the benefit limits provided below.

oPtIon b
MAIN BENEFIT CATEGORY GENERAL PRACTITIONER ANd SPECIALIST CONSULTATIONS ANd vISITS
(inclUDES cOvEr fOr AlTErnATivE hEAlThcARE prAcTiTiOnErS)

SUB-CATEGORY In rooms or home Alternative healthcare Practitioners to be registered with the Health Professions Council of South Africa (e.g. podiatrist, homeopath, naturopath, chiropractor etc.)

BENEFIT LIMIT Family limit per year: M R2,610 M1 R4,210 M2 R5,750 M3+ R7,180 Beneficiary limit of R4, 210 per year.

Ante-natal consultations GENERAL PRACTITIONER & SPECIALIST PROCEdURES & TESTS APPLIANCES External appliances (Medical and Surgical) In rooms or home (including scopes)

Eight visits per family included in Specialist benefit above. R5,430 per family, per year.

Including calipers, surgical collar, orthopaedic boots, nebuliser, glucometers, hearing aids, colostomy kits. Specialist consultations subject to referral from an appropriate first-line practitioner. Benefits can be accessed subject to a clinical motivation with correct tariff codes and costing for pre-authorisation by the Scheme. All dental procedure costs are paid for from this dentistry benefit, except for the costs of the removal of wisdom teeth in children under 7 years of age.

R3,890 per family per year. Limits and cycles as per the Schemes list of approved appliances apply.

dENTISTRY The Scheme does not cover the cost of cosmetic dentistry such as veneers and implants, these treatments are exclusions.

M R4, 980 M1 R5, 720 M2 R6, 670 M3+ R7, 480 The dental limits above cover the costs of dental procedures.

Basic dentistry: Fillings, root canal treatments, scaling & polishing, extractions, fissure sealants, dentures and repairs (subject to prescribed cycles). Advanced dentistry includes orthodontics, crown and bridge work or any procedure that requires anaesthetics. Pre-authorisation is required from the Scheme for orthodontics, crown and bridge work for any procedure that requires anaesthetics. HIv/AIdS Out-of-hospital: Consultations, procedures and investigations. Cover for advanced dentistry will be paid for according to the limits above Procedure costs payable for removal of wisdom teeth or treatment for children under the age of 7 will be paid from the hospitalisation benefit. The Scheme has a dedicated HIV/Aids Programme to help you manage your condition, it would assist you to join this Programme. Treatment will be subject to the use of Designated Service Providers. Subject to State hospitals for Hysterosalpingogram (HSG) and Diagnostic Dilatation and Curettage (DD & C). M R2, 350 M1 R3, 080 M2 R4, 690 M3+ R 6, 170 Limit of R3, 080 per beneficiary, per year. Limits to this benefit can be accessed after the Rand limit has been exhausted. Condition-specific benefits, sub-limits and treatment plans apply. 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), 2 Urticaria: skin rashes, insect bites and stings, 2 Treatment of wounds and/or infections of the skin/subcutaneous tissues (excl. post-operative wound care), 2 Benefit covered according to medicines on Chronic Disease List (CDL) and subject to the use of Designated Service Provider.

INFERTILITY

Treatment for PMB conditions only.

MEdICATION

Prescribed or dispensed acute medicine includes alternative healthcare medication as prescribed and must be registered with the Medicines Control Council; injections and related materials.

Primary Healthcare Benefit Programme (PHC)

Chronic medication

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oPtIon A
MAIN BENEFIT CATEGORY MEdICATION SUB-CATEGORY BENEFIT LIMIT Bacterial conjunctivitis: eye infection, 2 Urinary tract infection (acute uncomplicated cystitis), 1 Urticaria: skin rashes, insect bites and stings, 2 Treatment of wounds and/or infections of the skin/subcutaneous tissues (excl. post-operative wound care), 1 Chronic medication Benefit covered according to medicines on Chronic Disease List (CDL) and subject to the use of Designated Service Providers. Treatment is covered according to approved treatment plans and the use of Designated Service Providers. The Scheme has a dedicated HIV/Aids Programme to look after you and your dependants medication needs, it would assist you to join this Programme. Pharmacy-Advised Therapy (PAT)(medication bought over the counter). Limited to R420 per family, per year. Sub-limit of R90 per day. The limits for PAT are included with overall prescribed, dispensed or acute medication limit stated above. R10,830 per family per year (Included with the hospitalisation benefit). Benefits can be accessed subject to registration with Disease Management Programme for psychiatric disorders. PMB conditions unlimited at Designated Service Providers.

HIV/Aids: Subject to treatment protocols and generic reference pricing.

MENTAL HEALTH ANd SUBSTANCE dEPENdENCY

Consultations/visits and procedures, subject to: Referral from an Employee Assistance Programme (EAP) or GP required for substance dependency. Referral from specialist required for mental health conditions. Clinical motivation for the authorisation of continued consultations after the first two initial assessments. Out-of-hospital

ONCOLOGY

Subject to available overall annual limit and State Hospitals. Medication to be obtained from State Hospitals. R3,330 per family, subject to prescribed cycles. Repairs to spectacles are not included in this benefit limit. Other exclusions may apply. Ophthalmologist visits are covered subject to referral from an Optometrist or GP. Frames: R540 limit per beneficiary. White lenses: 100% of the lower of cost or Optical Assistant tariff Photochromic lenses: 100% of the lower of cost or Optical Assistant tariff up to a maximum of R270 per pair and subject to a prescription of +0.50/-0.50 and above. Fixed or gradient tints up to 35%: 100% of the lower of costs or Optical Associations tariff. 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 R1,740 per beneficiary, subject to a two year cycle. At Optical Assistant tariff, limited to one consultation per beneficiary, per annum. Subject to optical limit for the family, as stated above. Subject to available overall annual limit and State Hospitals. Medication to be obtained from State Hospitals. Pre-authorisation from Scheme is required and treatment plans will apply.

OPTICAL

Spectacle lenses and contact lenses cannot be obtained at the same time (i.e. during one benefit year).

Frames Lenses

Contact lenses

Eye test

ORGAN TRANSPLANT

Out-of-hospital

OUT-PATIENT

Consultations, visits and procedures at State out-patient facilities.

M R1,010 M1 R1,340 M2+ R1,690 Subject to State Out-Patient facilities. Included with Specialist benefit limit amount.

PATHOLOGY

Out-of-hospital

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oPtIon b
MAIN BENEFIT CATEGORY MEdICATION SUB-CATEGORY HIV/Aids: Subject to treatment protocols and generic reference pricing. BENEFIT LIMIT Treatment is covered according to approved treatment plans and the use of Designated Service Providers. The Scheme has a dedicated HIV/Aids Programme to look after you and your dependants medication needs, it would assist you to join this Programme. Limited to R710 per family, per year. Sub-limit of R100 per day. The limits for PAT are included with overall prescribed, dispensed or acute medication limit stated above. R14,640 per family, per year. Benefits can be accessed subject to registration with Disease Management Programme for psychiatric disorders.

Pharmacy-Advised Therapy (PAT) (medication bought over the counter)

Consultations/visits and procedures: Referral from an Employee Assistance Programme (EAP) or GP required for substance dependency. Referral from specialist required for mental health conditions. MENTAL HEALTH ANd SUBSTANCE dEPENdENCY Consultations/visits and procedures: Referral from an Employee Assistance Programme (EAP) or GP required for substance dependency. Referral from specialist required for mental health conditions. Out-of-hospital

R14,640 per family, per year. Benefits can be accessed subject to registration with Disease Management Programme for psychiatric disorders. PMB conditions unlimited at Designated Service Providers. Subject to available overall annual limit and State Hospitals. Medication to be obtained from State Hospitals.

ONCOLOGY

OPTICAL

Spectacle lenses and contact lenses cannot be obtained simultaneously (i.e. during one benefit year).

R3,990 per family, subject to prescribed cycles. Repairs to spectacles are not included in this benefit limit. Other exclusions may apply. Ophthalmologist visits are covered subject to referral from Optometrist.

Frames Lenses

Frames: R670 limit per beneficiary. White lenses: 100% of the lower of cost or Optical Assistant tariff. Photochromic lenses: 100% of the lower of cost or Optical Assistant tariff up to a maximum of R270.00 per pair and subject to a prescription of +0.50/-0.50 and above. Fixed or gradient tints up to 35%: 100% of the lower of costs or Optical Associations tariff.

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 R1,740 per beneficiary, subject to a two year cycle. At Optical Assistant tariff, limited to one consultation per beneficiary per annum. Subject to optical limit for the family, as stated above.

Eye test

ORGAN TRANSPLANT

Out-of-hospital

Subject to available overall annual limit and State Hospitals. Medication to be obtained from State Hospitals. Pre-authorisation from the scheme is required and treatment plans will apply.

PATHOLOGY

In- and out-of-hospital

R4,690 per family, per year.

PHYSIOTHERAPY

In- and out-of-hospital Clinical motivation required for authorisation of continued consultations after first two visits.

R3,080 per family, per year.

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oPtIon A
MAIN BENEFIT CATEGORY PHYSIOTHERAPY SUB-CATEGORY Out-of-hospital: Clinical motivation required for authorisation of continued consultations after first two visits. BENEFIT LIMIT Included with Specialist benefit limit amount.

RAdIOLOGY ANd RAdIOGRAPHY

General radiology (including Ultrasound) Out-of-hospital Specialised radiology For scans such as: MRI/CAT scans, Angiograms or similar.

R 1,240 per family, per year. Includes two ultrasounds per pregnancy. R 5,630 per family, per year. This limit covers in- and out-ofhospital specialised radiology. Subject to pre-authorisation with the Scheme. Limited to 2 scans per family, per year. Included with Specialist benefit for out-of-hospital treatment.

REMEdIAL THERAPY

Out-of-hospital treatment for occupational and speech therapy, audiology & dieticians.

oPtIon A

overall annual limit: M - R100,000 M1 - R120,000 M2 - R160,000 M3+ - R200,000

key M M1 M2 M3+

Single member Member with 1 dependant Member with 2 dependants Member with 3 or more dependants

Emergency benefits
MAIN BENEFIT CATEGORY Ambulance services SUB-CATEGORY Road and air. BENEFIT LIMIT Unlimited for emergency assistance only at the preferred service provider. netcare 911 is the preferred provider. Sub-limit of R790 per family, per year. This limit is included with the GP consultations, procedures and visits amount stated above.

GP consultations, visits and procedures.

Emergency treatment and Procedures.

Hospitalisation benefits The benefits below are all those that you and your registered dependants may access when you require care in hospital. The benefits and limits are as listed in the Scheme Rules.
MAIN BENEFIT CATEGORY In-patient hospitalisation benefit SUB-CATEGORY This benefit covers hospitalisation costs including: BENEFIT LIMIT M - R75,000; M1 - R94,000; M2 - R113,000; M3+ - R132, 000 Unlimited benefits for PMB conditions subject to pre-authorisation at a dSP. All benefits are subject to pre-authorisation with the Scheme. Alternatives to hospitalisation limit: R7 770 per family, per year (included in the overall limit above).

Alternatives to hospitalisation (private nursing, frail care, hospice and/or step-down facility) Blood transfusion services Confinement: Ceasarian section normal delivery Spontaneous abortions: Threatened Incomplete

Included in the overall limit above. R20 510 per family, per year (included in the overall limit above). R11 720 per family, per year (included in the overall limit above). Abortions are covered as follows: Threatened: R4 980 per family, per year. Incomplete: R13 930 per family, per year.

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oPtIon b
MAIN BENEFIT CATEGORY RAdIOLOGY ANd RAdIOGRAPHY SUB-CATEGORY General radiology (including Ultrasound) In- and out-of-hospital BENEFIT LIMIT R4,690 per family, per year. Includes two ultrasounds per pregnancy. R 9,250 per family, per year. Subject to pre-authorisation with the Scheme. Limited to 2 scans per family, per year. R3,080 per family, per year.

Specialised radiology In- and out-of-hospital: for scans such as: MRI/CAT scans, Angiograms or similar. REMEdIAL THERAPY

In- and out-of-hospital

oPtIon b

overall annual limit: unlimited

Emergency benefits
MAIN BENEFIT CATEGORY AMBULANCE SERvICES SUB-CATEGORY Road and air BENEFIT LIMIT Unlimited for emergency assistance only at the preferred service provider. netcare 911 is the preferred provider.

Hospitalisation benefits The benefits below are all those that you and your registered dependants may access when you require care in hospital. The benefits and limits are as listed in the Scheme Rules.
MAIN BENEFIT CATEGORY IN-PATIENT HOSPITALISATION BENEFIT SUB-CATEGORY This benefit covers hospitalisation costs including: Alternatives to hospitalisation (private nursing, frail care, hospice and/or step-down facility) Blood transfusion services Confinement: Ceasarian section normal delivery In-hospital GP consultations In-hospital HIV/Aids treatment BENEFIT LIMIT R300 000 per family, per year. Unlimited benefits for PMB conditions subject to pre-authorisation at a dSP. All benefits are subject to pre-authorisation with the Scheme. Alternatives to hospitalisation limit: R10 250 per family, per year (included in the overall limit above). Included in the overall limit above. R21 970 per family, per year (included in the overall limit above). R14 640 per family, per year (included in the overall limit above). Included in the overall limit above. Included in the overall limit above. Subject to use of DSP and registration on the HIV YourLife Programme.

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oPtIon A
MAIN BENEFIT CATEGORY In-patient hospitalisation benefit SUB-CATEGORY Inevitable In-hospital GP consultations In-hospital HIV/Aids treatment Mental Health and Substance Dependency hospitalisation (subject to referral from an Employee Assistance Programme or GP; referral from specialist required for mental health conditions) In-hospital oncology In- hospital organ transplant In-hospital pathology In-hospital physiotherapy Internal prostheses External prostheses (including artificial eyes and limbs) In-hospital radiology and radiography In-hospital remedial therapy Renal dialysis In-hospital specialist consultations, visits and procedures BENEFIT LIMIT Inevitable: R13 930 per family, per year. Included in the overall limit above. Included in the overall limit above. Subject to use of DSPs and registration on the HIV YourLife Programme. R10,830 per family, per year Subject to pre-authorisation with Disease Management Programme and use of Designated Service Providers.

Included in the overall limit above. Subject to the use of Designated Service Providers. Included in the overall limit above. Subject to the use of Designated Service Providers. Pathology limit: R2 330 per family, per year (included in the overall limit above). Physiotherapy limit: R1 390 per family, per year (included in the overall limit above). Internal prostheses limit: R18 100 per family per year (included in the overall limit above). Subject to the submission of a clinical motivation and costing for pre-authorisation with the Scheme. External prostheses limit: R9 280 per family per year (included in the overall limit above). Subject to the submission of a clinical motivation and costing for pre-authorisation with the Scheme. Included in the overall limit above. Specialised radiography in-and-out of hospital limit R56,300 per family, per year. Limited to 2 scans per family. Remedial therapy limit: Included in the Specialist benefit limit. Renal dialysis subject to Designated Service Providers. Included in the overall limit above

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oPtIon b
MAIN BENEFIT CATEGORY IN-PATIENT HOSPITALISATION BENEFIT SUB-CATEGORY Mental Health and Substance Dependency hospitalisation (subject to referral from an Employee Assistance Programme or GP; referral from specialist required for mental health conditions) In-hospital oncology In- hospital organ transplant In-hospital pathology In-hospital physiotherapy Internal prostheses External prostheses (including artificial eyes and limbs) In-hospital radiology and radiography In-hospital remedial therapy Renal dialysis In-hospital specialist consultations, visits and procedures BENEFIT LIMIT R14, 640 per family, per year (included in the overall limit above).Subject to available to preauthorisation with Disease Management Programme for psychiatric disorders, overall annual limit below and use of Designated Service Providers.

Included in the overall limit above. Subject to the use of Designated Service Providers. Included in the overall limit above. Subject to the use of Designated Service Providers. Included in day-to-day limit. Included in day-to-day limit. Internal prostheses limit: R18 470 per family per year (included in the overall limit above). Subject to the submission of a clinical motivation and costing for pre-authorisation with the Scheme. External prostheses limit: R10 830 per family per year (included in the overall limit above). Subject to the submission of a clinical motivation and costing for pre-authorisation with the Scheme. Included in the day-to-day limit. Remedial therapy limit: Included in the day-to-day limit. Renal dialysis subject to Designated Service Providers. Included in the overall limit above.

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Why choose SAMWUMED to care for your family?


SAMWUMED is the largest restricted medical scheme in local government. This means that more people trust the Scheme to look after their healthcare needs than any other Scheme in the sector. SAMWUMED offers excellent value for money. Its benefits payouts are in line with the contributions paid by its members, while most of its competitors have benefit payouts that are much lower than the contributions they receive. SAMWUMED was started for workers by workers in 1952. The Scheme has a proud history of providing for the specific healthcare needs of its members. SAMWUMED is financially strong. Its solvency ratio has been significantly higher than its competitors since 2001 and well above the 25% minimum requirement set by the Council for Medical Schemes. SAMWUMEDs non-healthcare costs are very low. The Scheme makes sure that the money its members pay is used to provide the best quality healthcare their contributions can buy. The Scheme sees its role not just as a facilitator for healthcare transactions but as a guardian to ensure fairness for its members and a defender of healthcare rights for the whole population. Medical aid members have the right to: Know everything about their condition, ask questions and request more information from their healthcare provider about their illness, the treatment options that are available and long term prognosis. Receive information in easy to understand terms without the use of confusing or technical language. Be aware of all the costs they will be liable for before receiving treatment. Healthcare providers must advise members of the difference between the rates they intend to charge as opposed to the Scheme rate for the same services/procedures/goods. Insist on giving informed consent, having it explained to them within a reasonable time period before a procedure or treatment and without undue pressure to sign documents. To amend indemnity forms that hospitals provide for their signature. Negotiate with a healthcare service provider. Obtain a second opinion and select and alternative provider if they choose to do so. Complain and to receive a formal response to a complaint.

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How much will it cost?

how much you pay for cover depends on how much you earn and how many people youll be registering with on the Scheme. Your medical aid contribution is made of two portions, your portion (which can be 40% or 30% depending

oPtIon A
the amounts in the table below indicate the full cost of cover on this option. these are the contribution amounts that your employer would pay over to the Scheme on your behalf. In cases where your dependants are not subsidised by your employer, this is the amount (see 100% contribution below) that you would pay to the Scheme via a debit order.
Salary Band A: 0 - 1500 B: 1501 - 2500 C: 2501 - 3500 D: 3501 - 4500 E: 4501 - 5500 F: 5501+ Principal Member R 596 R 655 R 715 R 774 R 834 R 894 Adult Dependant R 596 R 655 R 715 R 774 R 834 R 894 Child Dependant R 209 R 229 R 250 R 271 R 292 R 313 Member + Spouse R 1 192 R 1 310 R 1 430 R 1 548 R 1 668 R 1 788 Member + Spouse + 1 Child R 1 401 R 1 539 R 1 680 R 1 819 R 1 960 R 2 101 Member + Spouse + 2 Children R 1 610 R 1 768 R 1 930 R 2 090 R 2 252 R 2 414 Member + Spouse + 3 Children R 1 819 R 1 997 R 2 180 R 2 361 R 2 544 R 2 727

the amounts in the table below are what your employers portion is (60%)
Salary Band A: 0 - 1500 B: 1501 - 2500 C: 2501 - 3500 D: 3501 - 4500 E: 4501 - 5500 F: 5501+ Principal Member R 358 R 393 R 429 R 464 R 500 R 536 Adult Dependant R 358 R 393 R 429 R 464 R 500 R 536 Child Dependant R 125 R 137 R 150 R 163 R 175 R 188 Member + Spouse R 715 R 786 R 858 R 929 R 1 001 R 1 073 Member + Spouse + 1 Child R 841 R 923 R 1 008 R 1 091 R 1 176 R 1 261 Member + Spouse + 2 Children R 966 R 1 061 R 1 158 R 1 254 R 1 351 R 1 448 Member + Spouse + 3 Children R 1 091 R 1 198 R 1 308 R 1 417 R 1 526 R 1 636

the amounts in the table below are your contribution (where your contribution is 40%) without the employers portion
Salary Band A: 0 - 1500 B: 1501 - 2500 C: 2501 - 3500 D: 3501 - 4500 E: 4501 - 5500 F: 5501+ Principal Member R 238 R 262 R 286 R 310 R 334 R 358 Adult Dependant R 238 R 262 R 286 R 310 R 334 R 358 Child Dependant R 84 R 92 R 100 R 108 R 117 R 125 Member + Spouse R 477 R 524 R 572 R 619 R 667 R 715 Member + Spouse + 1 Child R 560 R 616 R 672 R 728 R 784 R 840 Member + Spouse + 2 Children R 644 R 707 R 772 R 836 R 901 R 966 Member + Spouse + 3 Children R 728 R 799 R 872 R 944 R 1 018 R 1 091

the amounts in the table below are your contribution (where your contribution is 30%)
Salary Band A: 0 - 1500 B: 1501 - 2500 C: 2501 - 3500 D: 3501 - 4500 E: 4501 - 5500 F: 5501+ Principal Member R 179 R 197 R 215 R 232 R 250 R 268 Adult Dependant R 179 R 197 R 215 R 232 R 250 R 268 Child Dependant R 63 R 69 R 75 R 81 R 88 R 94 Member + Spouse R 358 R 393 R 429 R 464 R 500 R 536 Member + Spouse + 1 Child R 420 R 462 R 504 R 546 R 588 R 630 Member + Spouse + 2 Children R 483 R 530 R 579 R 627 R 676 R 724 Member + Spouse + 3 Children R 546 R 599 R 654 R 708 R 763 R 818

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where you are employed) and your employers subsidy (which can be 70% or 60%). These portions are combined to make up your 100% contribution to the Scheme. This full contribution is paid to the Scheme by your employer. Please note that SAMWUMED will not have access to your salary at any time.

oPtIon b
the amounts in the table below indicate the full cost of cover on this option. these are the contribution amounts that your employer would pay over to the Scheme on your behalf. In cases where your dependants are not subsidised by your employer, this is the amount (see 100% contribution below) that you would pay to the Scheme via a debit order.
Salary Band A: 0 - 3000 B: 3001 - 4000 C: 4001 - 5000 D: 5001 - 6000 E: 6001 - 7000 F: 7001 + Principal Member R 962 R 1 034 R 1 106 R 1 155 R 1 178 R 1 203 Adult Dependant R 962 R 1 034 R 1 106 R 1 155 R 1 178 R 1 203 Child Dependant R 337 R 362 R 387 R 404 R 412 R 421 Member + Spouse R 1 924 R 2 068 R 2 212 R 2 310 R 2 356 R 2 406 Member + Spouse + 1 Child R 2 261 R 2 430 R 2 599 R 2 714 R 2 768 R 2 827 Member + Spouse + 2 Children R 2 598 R 2 792 R 2 986 R 3 118 R 3 180 R 3 248 Member + Spouse + 3 Children R 2 935 R 3 154 R 3 373 R 3 522 R 3 592 R 3 669

the amounts in the table below are what your employers portion is (60%)
Salary Band A: 0 - 3000 B: 3001 - 4000 C: 4001 - 5000 D: 5001 - 6000 E: 6001 - 7000 F: 7001 + Principal Member R 577 R 620 R 664 R 693 R 707 R 722 Adult Dependant R 577 R 620 R 664 R 693 R 707 R 722 Child Dependant R 202 R 217 R 232 R 242 R 247 R 253 Member + Spouse R 1 154 R 1 241 R 1 327 R 1 386 R 1 414 R 1 444 Member + Spouse + 1 Child R 1 357 R 1 458 R 1 559 R 1 628 R 1 661 R 1 696 Member + Spouse + 2 Children R 1 559 R 1 675 R 1 792 R 1 871 R 1 908 R 1 949 Member + Spouse + 3 Children R 1 761 R 1 892 R 2 024 R 2 113 R 2 155 R 2 201

the amounts in the table below are your contribution (where your contribution is 40%) without the employers portion
Salary Band A: 0 - 3000 B: 3001 - 4000 C: 4001 - 5000 D: 5001 - 6000 E: 6001 - 7000 F: 7001 + Principal Member R 385 R 414 R 442 R 462 R 471 R 481 Adult Dependant R 385 R 414 R 442 R 462 R 471 R 481 Child Dependant R 135 R 145 R 155 R 162 R 165 R 168 Member + Spouse R 770 R 827 R 885 R 924 R 942 R 962 Member + Spouse + 1 Child R 904 R 972 R 1 040 R 1 086 R 1 107 R 1 131 Member + Spouse + 2 Children R 1 039 R 1 117 R 1 194 R 1 247 R 1 272 R 1 299 Member + Spouse + 3 Children R 1 174 R 1 262 R 1 349 R 1 409 R 1 437 R 1 468

the amounts in the table below are your contribution (where your contribution is 30%)
Salary Band A: 0 - 3000 B: 3001 - 4000 C: 4001 - 5000 D: 5001 - 6000 E: 6001 - 7000 F: 7001 + Principal Member R 289 R 310 R 332 R 347 R 353 R 361 Adult Dependant R 289 R 310 R 332 R 347 R 353 R 361 Child Dependant R 101 R 109 R 116 R 121 R 124 R 126 Member + Spouse R 577 R 620 R 664 R 693 R 707 R 722 Member + Spouse + 1 Child R 678 R 729 R 780 R 814 R 830 R 848 Member + Spouse + 2 Children R 779 R 838 R 896 R 935 R 954 R 974 Member + Spouse + 3 Children R 881 R 946 R 1 012 R 1 057 R 1 078 R 1 101

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How to join
Please fill in a SAMWUMED membership application form. Make sure that you have completed all the sections. If you are registering dependants, please make sure that you attach copies of the following: Birth certificate for child dependants. An affidavit: where a childs surname differs from the biological parents and when registering a life partner. in the case of adopted or foster children, please provide the Scheme with court papers indicating this. Marriage certificate if you are registering a wife or husband. please note that when registering grandchildren or dependant over 21 who arent studying, an affidavit stating financial support of dependant would be required.

Important contact details


Should you require additional information, please contact the Scheme on:

0860 104 117


The Scheme has regional representatives in all 9 nine provinces; contact our Marketing Department to make an appointment with a representative near you. Log on to our website on: www.samwumed.org or email us on [email protected] SAMWUMED Head office: Physical address: cnr Trematon and lascelles Streets, Athlone 7764 postal address: pO Box 134, Athlone 7760 Tel: 021 697 9500 Fax: 021 697 3505 or 086 510 6370 office hours: Monday Thursday 08h15 16h45 Friday 08h15 16h00 Saturday 08h30 12h00 Please note that the offices are closed on the last Saturday of the month. While this brochure provides you with essential information that will help you select the best SAMWUMED benefit option for your family, it is not a full guide to the Schemes Rules and benefits. The full Scheme Rules are available on request and a Member Guide will be posted to all members.

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