Benefits

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

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.

In addition to MPL, SwaziMed 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 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)

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.

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

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.