SAMWUMED has partnered with Preferred Provider Negotiators (PPN), for enhanced optometry services and the administration of optical benefits.
PPN will administer all optical claims, irrespective of service date, and benefits, on behalf of the Scheme, effective 1 August 2024.
SAMWUMED members on both Option A and Option B qualify for optical cover. The revised optical benefits, effective 1 August 2024, are as follows:
Please note:
- Option A beneficiaries are covered for eye tests, frames, and clear spectacle lenses, every 24 months. No contact lens benefit is available on Option A.
- Option B beneficiaries are covered for eye tests, frames, clear spectacle lenses or contact lenses, every 24 months. Both spectacle lenses and contact lenses cannot be claimed during the 24-month period. Benefits apply to either/or not both.
- The two-year (24 months) benefit cycle applies to frames, lenses and contact lenses on the anniversary date on both options.
- Members are encouraged to make use of a PPN Network Provider, as you are guaranteed to receive an improved frame/lens enhancement benefit compared to a non-PPN Network Provider. Cash payments do not qualify for the frame/lens enhancement benefit.
- Make sure your optical provider fully explains any potential co-payments.
THE OPTICAL BENEFIT IS SUBJECT TO THE FOLLOWING RULES
- No single vision Rx < 0.50 Diopter will be paid or considered for payment.
- No bifocal/varifocal adds for less than 1 Diopter will be paid or considered for payment.
- Bifocal/Varifocal lenses for adults under the age of 40 years old must be motivated.
- No varifocals to children under age 18 years will be paid or considered for payment with the exception of post cataract surgery. Bifocals are to be considered for children under the age of 18 years on motivation only.
- No contact lenses for children under the age of 16 years unless motivated.
- Motivations are required for composite consultations performed on children under the age of 5 years old.
- Vertical prism > 1 Diopter should be motivated
- All claims are subject to the Validate IT lab order controls and fraud prevention measures.
How to make contact with PPN
The PPN interaction solutions and web interfaces make it possible for members and providers to obtain information 24 hours a day. By using the self-help solution, you are able to confirm your optical benefit, check your claim status and find the nearest PPN Network provider 24/7!
Alternatively, to speak to an agent, please contact the PPN Contact Centre on 041 065 0650, Monday – Friday, between 08h00 and 16h30, and select option 3.
Claims Submissions
Please note that effective 1 August 2024, all claims regardless of the date of service, should be sent to PPN for processing.
You are able to submit your optical claim, via the PPN Website at www.ppn.co.za, or alternatively, you can email it to claims@ppn.co.za, for processing.
Should you require any additional information/clarity, please do not hesitate to contact our PPN Contact Centre on 041 065 0650 or email us at info@ppn.co.za.
We look forward to your cooperation and support during this transitional period.
Kind regards
PPN Management in partnership with SAMWUMED.
