Dear Valued SAMWUMED Member,
SAMWUMED has three main goals for you, our member:
- To ensure that you have enough medical aid benefits to access affordable and excellent care.
- To help you to stay health.
- Ensure that your contribution increases remain affordable.
SAMWUMED, like most South African medical schemes, has had to increase your member contributions to pay for the increasing costs of healthcare and to remain financially stable. The costliest healthcare claims are for Specialist consultations and hospitalization. To assist with managing these costs, SAMWUMED has contracted a General Practitioner (GP) Network that will not charge you co-payments, provided you have not used all your annual benefits. SAMWUMED has also contracted a Hospital Network that charges Scheme rates and is also contracting a Specialist Network for 2024.
To provide you with the best possible care and make your benefits last longer, SAMWUMED requires you to nominate a GP. Having a Nominated GP enables better coordination of care and less wastage as one doctor would know all your medical conditions, medicines, and test results. Your Nominated GP would share this information with Specialists so that your benefits are not depleted due to repeated tests. If you or your dependents live in one area and work in another, you can each nominate two GPs, one Primary Nominated GP, who you would consult most often, and another Secondary Nominated GP.
SAMWUMED also requires you to consult with your Nominated GP, before seeing a specialist or going to hospital. As GPs charge lower rates than Specialists for consultations, this will further assist with making your annual benefits last longer.
You can avoid co-payments if you nominate a GP who is on the SAMWUMED GP Network or by asking your existing GP to join the SAMWUMED GP Network. You can view the list of GPs who are currently on SAMWUMED GP Network on our website www.samwumed.org.
Please note that, from 1 July 2024, SAMWUMED will only fund two consultations per beneficiary per benefit year for a GP that you have not nominated. Once you have used your two out of area visits, SAMWUMED will not provide additional funding for claims submitted by a GP that you have not nominated. Thus it is important that you nominate your two preferred GPs.
In cases where you have a medical emergency you are still encouraged to access the closest medical facility to ensure you immediately get the care you need.
If you require any additional information regarding GP nomination, the SAMWUMED GP Network or coordination of care, please feel free to contact our call centre on 0860 104 117.
Yours in good health,
SAMWUMED
