SWAZILAND MEDICAL AID FUND(SWAZIMED)

February 7, 2024 Editor

The Swaziland Medical Aid Fund (Swazimed) is a Section 21 company (registered as a none-profit 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).

Who can join?

Swazimed is an open-scheme which can be joined by anyone whether employed or unemployed. Group members have (1) month waiting period and three months waiting period for individuals (Direct Paying Members), terms and conditions apply.

  • Group (10 or more members)
  • Individuals (Direct Paying Members)
  • Swaziland Building Society Sipatji Accounts holders
  • Government employees (deducted from Treasury dept.)
  • Students
  • Aged Parents of active members (no age restriction)

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 charges 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.

AUTHOR

Editor