Did you know?
Swaziland Medical Aid Fund pays the rates set out annually by the Board of Swazimed. These rates are known as Swazimed Price List (SPL).
Doctors and other medical service providers who charge Swazimed Price List submit accounts directly the fund. These doctors are then paid by the fund according to the fund’s rules.
SAMA Rates
Some providers are ‘’contracted out’’ and charge fees higher than Swazimed Price List. These are known as SAMA Rates (South African Medical Association) and are also referred to as ‘’private fees’’.
Medical accounts charged at SAMA rates are sent directly from the supplier to the member for payment. However, should you attach a receipt of payment to your account, you will be refunded with the Swazimed rates. However, you are still responsible for paying the supplier the difference between SPL and the amount charged.
Pharmacy Advised Therapy
You don’t always have to go to a doctor to get medicine. Your registered pharmacist can sell you medication over the counter (OTC).
For example a mild sore throat, cold, a mild cough or anything similar, ask your pharmacist to dispense medicine and clearly write ‘’PAT’’ on your claim.
The cost of this claim is deducted from your normal Acute (Routine) Medical Benefit. You don’t have to pay for this out of your pocket.
Intensive Care Unit (ICU) & High Care
For Swaziland to pay for ICU and High Care facility, the Private Hospital must comply with the following:
- Register with the Medical and Dental Council of Swaziland
- Register with Board of Health Care Funders in SA
- Evaluated and approved by the Health Service Accreditation of Southern Africa (COHSASA)
- Signed memorandum of understanding with Swazimed which sets terms and conditions of operating an ICU including list of required specialists i.e. neuro-surgeon, anaesthesiologist, cardio thoracic surgeon, neurologist, paediatrician etc.
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 |
|---|---|
| Pap Smear | For all beneficiaries aged 21 years & older. |
| Total Cholesterol | For all beneficiaries aged 40 years & older |
| PSA | For all male beneficiaries aged 45 years & older, limited to one test every two years |
| Colo-rectal Screening (faecal occult blood) | For all beneficiaries aged 50 years & older, every year |
| Consultation with general practitioner | All beneficiaries aged 21 and older. During this consultation, the DR will assess blood pressure, body mass index and glucose |
Management of Fraud and Abuse
Fraud continues to be a major concern to most medical aid companies and schemes lose millions of Emalangeni as a result of paying fraudulent claims. As you know, the greater the losses through fraud, the higher your contributions are to help cover this loss. Swazimed has measures in place to detect and manage fraud and abuse of benefits. You can help to combat fraud by anonymously contacting our Fraud Hotline if you are aware of any practitioner or patient abusing the system.
Fraud Telephone No.: 2404 0339
Aid for AIDS
For many people HIV/AIDS is a frightening disease, but today there are treatments that are keeping many people living with HIV, healthy and productive.
Action and Information
The first step is to find out whether you have been infected with HIV and what you can do to stay healthy to protect yourself and your loved ones. Medicine can attack the virus while vitamins, good nutrition and exercise can play a critical role in keeping your body strong and healthy. Starting the treatment at the right time improves quality of life and decreases the risk of serious infections or other complications. Our AID for AIDS programme can help you access benefits to assist you with the management of HIV/AIDS.
Your condition will stay confidential
AIDS is a sensitive matter and every effort is made to keep your condition confidential. The staff members at our AID for AIDS unit have all signed confidentiality agreements and work in a separate area away from the medical scheme. They use separate telephone, fax and private mailbag facilities. Patients must use these facilities to maintain confidentiality.
We can help you to manage your condition
Your medical scheme has a benefit amount specifically for HIV/AIDS related medicine. This benefit amount is used to pay for medicine to attack the virus, vaccination to protect you against illnesses such at TB and flu and vitamins to boost your immune system.
You must register on our AID for AIDS programme
If your test shows you are HIV-positive , your doctor must register you with AID for AIDS as soon as possible to make use of this benefit.
You are not covered within the first 3 months of joining the fund.
After you have registered
After registration, a highly qualified medical team will examine your details and if necessary, discuss cost effective and appropriate treatment with your doctor.
Once treatment has been agreed upon, you and your doctor will be sent a detailed treatment plan, which explains the approved medicines as well as the regular tests that needs to be done to ensure that the drugs are working correctly and safely.
What the AID for AIDS programme offers you?
AID for AIDS is a complete HIV disease management programme that offers both members and beneficiaries:
- Medicine to treat HIV (including drugs to prevent mother-to-child transmission and infection after rape or needle stick injury) at the most appropriate time.
- Treatment to prevent opportunistic infections like certain serious pneumonias and TB
- Regular monitoring of disease progression and response to therapy.
- Ongoing patient support for providers.
- Help in finding a registered counsellor for emotional support.