Benefits

Ambulance Services

A medical emergency can strike anytime. The correct treatment and proper transportation of the sick or injured patient is vital to ensure the best result.

In any medical emergency, speed is vital to the survival and quick recovery of the patient. If you are unfortunate enough to be involved in a motor vehicle accident or suffer a heart attack, time is critical. The first ten minutes, known as the platinum time, is the first goal in which to get the patient medical attention. The next goal is the first four hour after injury, known as the golden hour. Responses in these times by qualified professionals can make all the difference between life and death.

Swaziland has never had a resident emergency medical system with paramedics, resulting in a lack of pre-hospital care. Also, due to the small medical aid base, a full complement of specialists is not available. Trauma needs a multi-disciplinary approach for the best outcomes and evacuation to such facilities in the past has resulted in long delays of between 24 hours, which puts the patient at major risk.

In an emergency contact any of the following ambulance service and will receive the best pre-hospital medical emergency care available. If necessary, we will arrange transfers to a local medical facility or evacuation to hand- picked centre of excellence for treatment.

With Swazimed your family is covered for any pre-hospital medical emergency and evacuation 24hours a day, 365 days a year within your monthly contributions.

 


Emergency contact number

Traumalink : 7606 0911

Good Samaritan : 7666 0911

Swazico Medics : 0911 (toll free)

                             7802 1911

Pace care Investment Ambulance : 76031373

EPR : 977

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  • Emergency medical response by road to the scene of a medical emergency
  • Transfer by road or air to the most appropriate medical facility
  • Medically justified ambulance or inter-hospital transfers
  • Ambulance transfers to special care center
  • Transfer of life saving blood or medication
  • Companionship and care for stranded minors
  • Repatriation of mortal remains
  • Emotional support and tele-counselling
  • Access to rape crisis centre

Includes cover throughout South Africa

Medicine Management Programme

Swazimed has introduced Medicine Management Programme to ensure that appropriate and cost effective medicines are prescribed to members.

The Medicine Price List (MPL)

MPL is a reference pricing system that uses a benchmark (reference) price for generically similar products. The fundamental principle of any reference pricing system is that it does not restrict a member's choice of medicines, but instead limits the amount that will be paid. MPL references prices are set in such a way as to ensure availability of medicines without co-payments being necessary. In other words, you will be able to afford the medicine you need without paying from your own pocket, but you may have to select certain generics over a brand name product or more expensive generics. Should you prefer one of the most expensive products, Swaziland will only pay up to the MPL reference price and you will then have to pay the difference (co-payment) to the pharmacy.

The Medicine Exclusion List (MEL)

In addition to MPL, Medscheme also regularly compiles a Medicine Exclusion List (MEL) which excludes payment of certain medicines from the Acute/Routine benefit. Items may appear on the MEL list for various reasons which may include amoungst others:

  • Medicines not proven to have relevant clinical value
  • Medicines more expensive compared to equally effective and safe cheaper alternatives
  • Medicines prone to abuse
  • Some expensive chronic medicines that require authorisation
  • Some combination products, where it is more appropriate to use single ingredient products etc.

Ex-gracia Assistance

Ex-gracia is a conditional assistance which is granted to a memeber 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.

The requirements will include:

-Completed ex-gratia application form obtainable from Swazimed.

-Covering letter stating the specific type of treatment to be covered, the duration or frequency and total amount requested.

-Doctors' motivation letter and the medical bills or quotation.

-12 Months minimum waiting period on High, Standard and Savings level 10-25

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

The Medicine Exclusion List (MEL)

In addition to MPL, Medscheme also regularly compiles a Medicine Exclusion List (MEL) which excludes payment of certain medicines from the Acute/Routine benefit. Items may appear on the MEL list for various reasons which may include amoungst others:

  • Medicines not proven to have relevant clinical value
  • Medicines more expensive compared to equally effective and safe cheaper alternatives
  • Medicines prone to abuse
  • Some expensive chronic medicines that require authorisation
  • Some combination products, where it is more appropriate to use single ingredient products etc.

Funeral Policy

All members of the scheme are automatically covered for the Swazimed funeral policy which is insured through the Eswatini Royal Insurance Corporation. The members and their registered dependants in the event of death are covered;

Member/Spouse/Parents - E15000.00

Child: 14-21 years -E15000.00

           1 - 13 years - E7500.00

            0 - 1 year - E3750.00

 

No/Low Claim Refunds

Members who have completed a twelve-month membership (calender year; January - December) are entitled to a percentage of their contributions which is claimed before the end of March of the following year. Only High benefit, Standard benefit, Medium benefit and Savings plan members are entitled to these claims. Members are encouraged to write claims letters to Swazimed for tax purposes thus there is no automatic payments of bonuses.

Wellness Benefits

ServiceClinical Criteria for Access
Consultation with general practionerLimited to one long consultation per year. During this consultation, the DR will assess blood pressure, body mass index and glucose.
Pneumococial VaccineFor all beneficiaries aged 65 years and older
Pap SmearFor all female beneficiaries aged 45years and older, limted to one test every two years
Total CholestorolFor all beneficiaries aged 45 years and older,limited to one test every two years
PSAFor all male beneficiaries aged 45 years and older, limited to one test every two years
Colo-rectal Screening (faecal occult blood)For all male beneficiaries aged 50 years and older, every year
DensiotomyFor all male beneficiaries aged 50 years and older
MammogrammFor all female beneficiaries aged 50 to 74 years
Flue VaccineFor all beneficiaries aged 6 years and older