Benefits/ Operations
In cases of emergency which hospitals can I go to?
In case of a medical emergency, a member can go to any nearest private hospital to receive medical attention and receive treatment.
As a new member, how soon will I be able to use my benefits after registering as a member of the Scheme?
If you were registered in another medical scheme in the past 90 days for at least 2 years, benefits will be activated from the joining date as soon as your application is successful. Secondly, if you join the scheme with no previous medical scheme membership, the waiting period is one month from the joining date and 12 months for pre-existing conditions.
Can an individual belong to more than one medical scheme at the same time?
No. It is illegal to belong to more than one medical scheme at a time. Members must ensure that their membership on a former medical scheme is cancelled before undertaking membership with a new medical scheme.
What is a designated service provider (DSP)?
A healthcare provider or group of providers that the Scheme has chosen to provide certain medical care for Prescribed Minimum Benefits.
Membership
Can I add my boyfriend on my medical aid?
Yes, you can add your girlfriend or boyfriend as your life partner. To add your partner as a member we would need a copy of their ID document, and a written affidavit confirming relation to you the main member.
Can I add my siblings to my medical aid membership?
No, siblings do not qualify as dependents. Only your spouse, your girlfriend or boyfriend as your life partner, children, grandchild, parent, and grandparent do qualify.
Must I give notice to scheme if I wish to terminate membership?
Yes, SAMWUMED requires a notice period of one (1) calendar month. Contributions must still be paid in full, until the last effective date of membership.
Can I go to the doctor without a membership card?
Yes, to see a doctor one can present an ID Document, Membership Certificate, or download your SAMWUMED App.
What can I do if I suspect that someone is using my card without my consent?
If you suspect any fraudulent activity in your card, contact Qhubeka Forensic services on 082 450 9539/ email on fraudreport@qforensic.co.za
Premiums
What is the Scheme Tariff?
The rate at which the Scheme pays for health services to service providers on behalf of members. It is based on the National Reference Price List published by the Department of Health.
If the Municipality I work for fails to pay will my medical aid be suspended?
Yes, if we do not receive any contributions your membership will be suspended.
Must my employer subsidise my contributions to the medical scheme?
No, subsidies are conditions of employment, and the Act does not address such conditions.
