Medical schemes administered by Universal Healthcare

For more information about any of our medical schemes, please follow the links to:

AECI Medical Scheme AECI 
» About Us                      » Contact Us
» Member Login
The Building & Construction Industry Medical Aid Fund (BCIMA) THE BUILDING & CONSTRUCTION INDUSTRY MEDICAL AID FUND (BCIMA)
» About Us                      » Contact Us
CompCare Wellness Medical Scheme
COMPCARE WELLNESS MEDICAL SCHEME
» About Us                      » Contact Us
» Member Login
gems medical scheme GOVERNMENT EMPLOYEES MEDICAL SCHEME 
» Home
Makoti Medical Scheme MAKOTI MEDICAL SCHEME (Previously Good Hope Medical Aid Society)
» About Us                      » Contact Us
Massmart medical scheme MASSMART HEALTH PLAN
» Home
Old Mutual Medical Scheme OLD MUTUAL STAFF MEDICAL AID FUND 
» Home                      » Services Offered
Grintek Electronics Medical Aid Scheme SAAB GRINTEK ELECTRONICS MEDICAL AID SCHEME
» About Us                      » Contact Us
» Member Login
Tiger Brands Medical Scheme
TIGER BRANDS MEDICAL SCHEME
» About Us                      » Contact Us
» Member Login
Transmed Medical Scheme TRANSMED 
» About Us                      » Contact Us
» Member Login
Umvuzo Medical Scheme UMVUZO HEALTH 
» About Us                      » Contact Us
» Member Login
Witbank Coalfields Medical Aid Scheme WITBANK COALFIELDS MEDICAL AID SCHEME 
» Home                      » Contact Us

SAMWUMED Progress Under Curatorship

Dear Valued Service Provider,

SAMWUMED REMAINS OPEN FOR BUSINESS

As we approach the end of another year, we would like to thank you for your cooperation and support throughout 2018, and wish you and your management team a prosperous 2019.

We would like to also take this opportunity to reaffirm that SAMWUMED Remains Open for Business, despite being placed under Curatorship since May this year.

I thought it would be important to note that Curatorship is an intervention put in place by the Council of Medical Schemes (CMS), wherein a Scheme’s existing senior leadership, for instance, the Principal Officer (PO) and the Board of Trustees are removed and replaced by an interim person known as a Curator. The primary reason for such an intervention generally is to protect Members’ interests and ensure the Scheme’s long term sustainability.

In the case of SAMWUMED, the Council for Medical Schemes (CMS) recommended and successfully applied for Curatorship of the Scheme, mainly due to non-compliance of the Scheme’s Board of Trustees to their governance rules. It is anticipated that the Scheme will remain under Curatorship for a period of about 12 months, depending on the resolution of matters that necessitated the application for Curatorship in the first instance.

As an important stakeholder, we would like to assure you that SAMWUMED remains fully operational and is being expertly managed on a day to day basis by the staff under the leadership of the Curator.

In addition, the Scheme is financially healthy, and is still one of the Three Most Sustainable Medical Schemes in South Africa,as rated by the Alexander Forbes Sustainability Index Report, in 2016 and 2017 respectively.

For your assurance, we can affirm that the Scheme will have about R108 million at year end of 2018; and this is at a time when most schemes are making losses.

We remain as committed as ever to our more than 80 000 lives that we cover who are spread throughout South Africa. To this extent we reiterate that our 2019 benefits have been significantly improved for the benefit of our members. We continue to diligently process and pay our members’ claims on a bi-weekly basis.

We shall endeavour to keep you abreast with future plans and developments within the Scheme in the New Year through various means, including formal communication such as this one, SMS’s and through our Sales Teams.

Once again we wish you as our Service Providers and your families the best for the holidays and a prosperous 2019.


Should you have any queries, please do not hesitate to contact us.

Kind regards,

Joe Seoloane

Curator

SAMWUMED

Medical Schemes Adminstered by DRC Dental Risk Company

 

2019 Dental Tariffs

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2019 TFG Medical Aid Scheme Changes

Changes to TFG Medical Aid Scheme in 2019

 

The names of the TFG Medical Aid Scheme Benefit Plans, will be changing with effect 1 January 2019.

 

To ensure that the healthcare providers and members of TFG Medical Aid Scheme experience a

seamless transition when claiming, please take note of the information in the letter.

 

The TFG Medical Aid Scheme plans changes

 

·      Plan A will be called  TFG Health

·      Plan B will be called  TFG Health Plus

 

Identifying TFG Medical Aid Scheme members

 

Discovery Health will issue new membership cards with the new plan names to members on the

TFG Health Benefit Plan. See the example below:


 

 


Submitting claims to Discovery Health

The channels and processes of submitting claims will not change, Healthcare providers should

continue submitting claims as normal.

 

Authorisations carried over from 2018 into 2019

 

To ensure no break in service is experienced, Discovery Health will automatically transfer

authorisations for all the plans that have already been approved.


 

 

 We hope this information will make the transition as smooth as possible. If you have any questions,

please send an email to electronic@discovery.co.za

 

 

Regards

 

 

Brought to you by: medical aid claims software

Bonitas tiered reimbursement consultation codes effective 1 November 2013

As part of a pilot project Bonitas has introduced tiered consultation codes The codes below are in-house Medscheme codes and we request that you load these codes into your billing systems to allow the provider practice’s to use them when billing for a consultation for all Bonitas patients (except for BonCap).

It will not be necessary for you to communicate to the practices as Bonitas will be sending a letter positioning the pilot to the GP’s and Specialists .

 The codes below are to be used instead of tariff codes 0190/1/2/3.

 Should a doctor however decide not to use the new dummy codes below we must still accept 0190/1/2/3.The effective date for implementation to your systems and to be ready to accept is 1 November 2013.

 Bonitas will pay the scheme rate or a network rate if on the Bonitas network irrespective of which code used.

 Psychiatrists and anaesthetists are to be excluded.

Tariff Code

Description

07326

New or established patient: Office or outpatient visit requiring up to 10 minutes. This would typically involve problems of minimal severity.

07327

New or established patient: Office or outpatient visit requiring from 10 to 20 minutes. This would typically involve a problem focussed history, clinical examination and straight forward decision making for a minor problem.

07328

New or established patient: Office or outpatient visit requiring from 20 to 40 minutes. This would typically involve a detailed history, clinical examination and straight forward decision making or counselling.

07329

New or established patient: Office or outpatient visit requiring over 40 minutes. This would typically involve a comprehensive history, clinical examination and complex decision making or counselling for a complex problem.

 

*** Medinol Medical Billing Software users:

Add these codes to your Treatment file. R269. In future apply these to your Bonitas consultations instead of 0190, etc. Problems, please contact BPM.

 

Momentum Medical Aid fee increase 2019

Momentum Medical Aid fee increase 2019

Date: 20 Nov 2018

 

Momentum Health has published its fee schedule for 2019, showing how much their members can expect to pay for their various schemes in 2019.

According to the group, the average increase in contributions across its plans is 10.7% –  slightly above the industry corridor of 3% to 4% above CPI.

The group cited rising medical inflation and the April 2018 VAT hike to 15% as reason for the increase.

“The healthcare industry in South Africa is constant flux, perhaps more so at present than in recent years, given an increasingly unstable economic landscape and the proposal of new NHI regulations,” it said.

Despite the increase, Momentum said it still has one of the lowest average contributions on the market and has also avoided having to reduce benefits to achieve lower prices.

Momentum is the fourth biggest private medical aid scheme in South Africa with over 260,000 beneficiaries, behind Discovery, Bonitas and PolMed (fifth, if you include the government medical scheme, GEMS).

Here are the new prices for 2019 (principal member):

Ingwe

Plan based on monthly salary, with Hospital providers on a State, Ingwe or Any network. Chronic and day-to-day care are split between the Ingwe Primary Care Network (State or Ingwe) and the Ingwe Active Primary Care Network (Any).

PlanNetwork20182019Change (%)
Ingwe <=R700State
Ingwe
Any
R370R40710.0%
Ingwe R701 – R6 800State
Ingwe
Any
R603
R759
R986
R664
R835
R1 085
10.1%
10.0%
10.0%
Ingwe R6 801 – R9 000State
Ingwe
Any
R691
R965
R1 378
R761
R1 062
R1 517
10.1%
10.4%
10.1%
Ingwe R9 001 – R12 500State
Ingwe
Any
R806
R1 344
R1 877
R887
R1 479
R2 066
10.0%
10.0%
10.1%
Ingwe R12 501+State
Ingwe
Any
R1 393
R1 903
R2 409
R1 533
R2 094
R2 651
10.1%
10.0%
10.0%

Impact

Hospital, chronic and day-to-day care on the Impact Network.

PlanNetwork20182019Change (%)
ImpactImpact NetworkR2 025R2 22910.1%

Custom

Associated and Any hospital plans, with chronic care at State, Associated and Any provider.

PlanNetwork20182019Change (%)
Custom AssociatedState
Associated
Any
R1 366
R1 750
R1 885
R1 515
R1 944
R2 113
10.9%
11.1%
12.1%
Custom AnyState
Associated
Any
R1 743
R2 074
R2 249
R1 938
R2 304
R2 521
11.2%
11.0%
12.1%

Incentive

Associated and Any hospital plans, with chronic care at State, Associated and Any provider.

PlanNetwork20182019Change (%)
Incentive AssociatedState
Associated
Any
R1 834
R2 514
R2 737
R2 006
R2 770
R3 012
9.4%
10.2%
10.0%
Incentive AnyState
Associated
Any
R2 249
R2 737
R3 052
R2 464
R3 014
R3 406
9.6%
10.1%
11.6%

Extender

Associated and Any hospital plans, with chronic care at State, Associated and Any provider.

PlanNetwork20182019Change (%)
Extender AssociatedState
Associated
Any
R4 129
R4 715
R5 113
R4 580
R5 240
R5 684
10.9%
11.1%
11.2%
Extender AnyState
Associated
Any
R4 723
R5 232
R5 816
R5 249
R5 813
R6 464
11.1%
11.1%
11.1%

Summit

Any hospital with freedom of choice for chronic and day-to-day care.

PlanNetwork20182019Change (%)
SummitFreedom of choiceR8 342R9 26911.1%

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