BACKGROUND
The Swaziland Medical Aid Fund (Swazimed) is a Section 21 company (registered as a noneprofit making open-scheme) which was formed in 1980. Membership cards are accepted by all local service providers (Hospitals, Doctors and most Pharmacies) and widely accepted in South Africa. The scheme is self-administered since January 2017, there is no change in acceptance of cards and benefits access.
MEMBERSHIP CARD
Swazimed membership card has a Member’s One-(1) Number-For-Life. This means that the members’ medical aid number will never change even if the member changes options but it will reflect the new option of the member on the system. (1 membership number for life).
PAYMENTS TO SERVICE PROVIDERS
Service Providers (Hospitals, Doctors and Pharmacies) who submit their claims through EDI are paid direct to their bank accounts (EFT) in a seven (7) day payment-run and service providers submitting claims manually are paid through their bank accounts (EFT) seven (7) day payment-run.
REFUNDS TO MEMBERS
Members claiming their no/low claim bonuses or claiming refunds for cash paid accounts, an EFT payment will be paid through EFT for members who submitted their banking details. Swazimed offers nine benefit options and each individual should choose an option according to his/her health care needs. For all the options benefits are paid at 100% scale of benefits with adequate annual limits.
OPTIONAL SAVINGS
All Swazimed Benefit Plans offer an optional savings to cater for all charge above the Swazimed Price List (SPL) and also used for other costs above consultation and medicine limits.
Members are not restricted on their optional savings but encouraged to save from E300 for high benefit and from E100 for all other options, plus any amount in the denominations of E100 on monthly basis.
All these costs must be within the member’s savings.
NB: These savings are only paid cash on
termination of membership.
– Claims can be submitted using the following:
(Claim within 4 months)
– If you already paid the account, attach your receipt on the claims invoice and write “paid” on the claim
-Make sure all documents sent to Swazimed show your membership number.
-Check that your claim shows:
Your name and initials; your medical aid number; the treatment date; name of patient (as indicated on the membership card and not a nickname); date of birth; amount charged and the tariff code where applicable.
All valid claims received by Swazimed will be processed within 2 to 4 weeks.
A claims Transaction Statement will be sent to you if Swazimed has processed an account during that month. This statement will indicate all payments made to you or on your behalf.
