SAMWUMED Annual General Meeting held on 9 September 2022 Q&A

A member from Ekurhuleni registered on the online platform, welcomed the Report delivered by the Principal Officer. He, however raised concern with respect to General Practitioners (GPs) who refused to treat members as they were under the erroneous belief that members had depleted their benefits.  Upon checking for themselves, members often discovered that they still had benefits in place.  He reported that when he had contacted the scheme about this, he was informed that the problem could have been due to the system migration that was underway.  He raised concern that members were never advised about the migration, and he also raised concern that members were still subject to a co-payment even when they used a network hospital.

The Scheme acknowledges the frustration of the affected members in this regard and is doing everything it can to ensure that these matters are being addressed by the Scheme as a matter of urgency so as to not negative affect our members. The Scheme apologies for any inconvenience caused.

At Selby Hall 2 venue two members submitted comments. Member 1, requested that communications sent to members should be in other languages and not only in English.  He also raised concern that there were rumours that the scheme was going to change its name.  The second member, Ms. F du Ploy reported that when she went to the pharmacy, they declined to fill her script.  Upon enquiry they informed her that their reluctance was based on the fact that the scheme was not going to pay them. She wanted to know how the scheme addressed such scenarios.

The member’s comment on the Scheme publishing communication in other South African languages was noted and will be considered for other platforms as far as reasonably possible. On the front line, Sales Reps and Call Centre Agents, the Scheme has made provision for all 11 South African languages to assist our members. On the name change of the Scheme that is false information. The Scheme has made no submission to change its name. Regarding paying of claims, the members need to advise the pharmacies that the Scheme has two payment cycles, and if a member has benefits available and service providers submitting according to correct ICD 10 codes, there is no reason for the members’ claims not to be honoured (paid) by the Scheme.

At Belmont Square a member sought clarity on the registration of additional beneficiaries. He submitted that members did not previously pay for this. He requested that when changes such as these are made, members must be properly advised of these and any other changes and this must be done timeously.  A second member was concerned by the slow growth in membership.  He sought details on what the scheme was doing to address this.

The member’s comment was noted in regard to additional beneficiaries. This would be reviewed by the Scheme for the next benefit year. Communication in regard to the change was sent in 2018. In terms of growth, the Scheme and many other medical schemes do at times experience slow growth, particularly during challenging economic climate. The Scheme has compiled a turn around strategy that is being implemented from this Freedom of Association, including more visibility on various media, and improving its service points to increase ambassadors from existing member to help the Scheme grow.

In Nigel a member was of the view that the radiology benefit was insufficient. Another member requested the scheme to investigate why pharmacies were always off-line. 

Issues relating to Benefits get reviewed on an annual basis. Where majority of members highlight such, the Scheme engages with actuaries to ensure there is a balance in benefits and contribution paid by members. The Pharmacies being off-line was a temporary issue that was dealt with by the Scheme with its Pharmacy Benefit Management (PBM) service provider, which at the time affected all the schemes under their stable. The issue has since subsided.

In Boksburg a member requested the scheme increase its optometry benefits. Another member raised concern that there weren’t enough network hospitals in the East Rand.  She also requested a review of the chronic benefits as she was always subjected to a co-payment. The member also sought clarity and assistance with the application for a nebuliser for her son. 

These issues would be dealt with at Bencom on an annual basis, to ensure existing members get the best for their money or contributions.

At Tshwane House a member complained that the Call Centre did not promptly respond to calls. It was reported that in 2021 a doctor tried to call the call centre on behalf of the member but call centre did not respond.  The doctor subsequently wrote a letter of demand when the scheme failed to pay the claim. The Scheme has addressed all issues of call centre delays. This was prominent during the lockdown period (2020 -2021 period), where a lot of Call Centre Staff worked from home, and issues of connectivity were a real challenge. Since then, the Call Centre has been revamped with a new Call Solution that separates the service provider line from the members’ line, as well as there being web chat and a mobile app for queries as a means to ensure there are no waiting lines for members/providers who call in. The call answer rate is currently at 98%.

In Alberton, a member enquired why the scheme did not pay Lancet for blood drawn while in hospital.

The matter was an isolated incident and would be looked into by the Scheme as blood tests in hospital and out are paid by the Scheme subject to members’ available benefits.

All additional questions were noted and will be updated on this page as they come.