Transcription of 2018 HEALTH GUIDE - Umvuzo Health
1 1 Umvuzo HEALTH SUPREMESUPREME2018 HEALTH GUIDE2 Umvuzo HEALTH SUPREMEANNUAL FAMILY BENEFIT ALLOCATIONMAIN MEMBERADULT DEPENDANTCHILD DEPENDANTFAMILY BENEFITR9 ABBREVIATION DICTIONARYGP - General Practitioner DSP - Designated Service Provider CDL - Chronic Disease List PMB - Prescribed Minimum Bene tsMEDICATION> Scripted: acute medication as prescribed > Unscripted: over the counter medicationADDITIONAL CHRONIC MEDICATION (FORMULARY)> Scripted: 9 additional chronic conditions subject to available funds in the family bene t and Disease Management Programme registrationOVER THE COUNTER MEDICATION> Limited to R600 per bene ciary per yearORAL CONTRACEPTIVES> Limited to R140 per registered female per monthWELCOME TOUmvuzo s SUPREME comprehensive healthcare PRIMARY BENEFITSGENERAL PRACTITIONER & SPECIALIST VISITS> Consultations> Minor procedures in the doctors roomsDENTAL CARE> Consultations> Cleaning, uoride treatment, scaling, polishing> Fillings> Wisdom teeth extraction (in the dentists rooms)> DenturesOPTOMETRY> Eye test> Frames/lenses: limited to R2 650 per bene ciary every 2 years NO PRE-AUTHORISATION REQUIRED SUBJECT TO FAMILY BENEFITIMPORTANT NOTES Penalties will apply if authorisation is obtained after treatment.
2 The claim may not be paid if pre-authorisation is not obtained. The Scheme rules supersede the information on this A RECENT INDEPENDENT BRAND AUDIT OUR MEMBERS HAD THE FOLLOWING TO SAY ABOUT US: We go the extra mile We are co-operative We listen We are exible We give access We are member focussed Value in bene ts We are affordable We are very inclusive We are quick to process claimsTHE REASONS TO CHOOSE UMVUZOWe have been providing solutions for our members and their families for the past 13 years. We are passionate about people, and show this in everything that we to R1 920 per bene ciary per year, with a maximum of R160 per HEALTH SUPREMEYOUR SECONDARY BENEFITSAPPLIANCES (crutches/support/slings)> R9 250 per family per yearTERMINAL AND WOUND CARE> R10 000 per family per yearEMERGENCY medical SERVICES> Netcare 911> Emergency transport > 1 medicine bag per family *Upon joining> 1 medicine bag re ll per yearSUPPLEMENTARY BENEFITS> R4 600 per family per year Occupational Therapy Podiatry Dieticians Psychology Speech Therapy and Audiology PhysiotherapyINVESTIGATIONS (OUT OF HOSPITAL)
3 > Limited to R5 500 per family per year X-rays and blood testsPRE-AUTHORISATION REQUIRED SCHEME RATES APPLYDISEASE MANAGEMENTACTIVE DISEASE MANAGEMENT PROGRAMMES> Our Active Disease Management Programmes enable us to plan and coordinate the healthcare of members living with chronic medical conditions, in order to give them the best possible 26 Chronic Disease List (CDL) are covered as part of Prescribed Minimum Bene ts (PMB).Registration on these Disease Management Programmes is necessary to access full bene ts:> HIV/Aids> Oncology> Diabetes> Musculoskeletal> Renal> Hypertension> Hyperlipidaemia (high cholesterol)> Asthma/COPD/BronchiectasisA total treatment plan for each member includes: Con dentiality Ongoing member support and education Individualised treatment plan Ongoing counselling and HEALTH monitoringAll Prescribed Minimum Bene ts are covered according to Scheme rules, protocols and to registerSTEP 1 Consult your GP to con rm diagnosis, registration and fax/email script to Mediscor.
4 ChroniLineTM: Tel: 0860 119 553 | Fax: 0866 151 509 Email: A look-up facility is available on our website ( ) for the 2 The member, doctor/pharmacist can contact ChroniLineTM and speak to one of the pharmacists to verify whether the medicine will be authorised from the chronic bene 3 The member can fax/email their chronic prescription. Please ensure that the medical aid details and diagnosis code (ICD10 code) are stated on the further information on all our Active Disease Management Programmes, please email. Email: HOSPITAL BENEFITSPRE-AUTHORISATION REQUIRED SCHEME RATES APPLY SCHEME USES ALL HOSPITAL GROUPSGENERAL> Consultations (GP and specialists)> Treatment> Surgical procedures> Non-surgical procedures> AnaesthesiaACCOMMODATION> General ward> ICU and/or high care (limited to 12 days per bene ciary per year)OVERALL PROSTHESES> R54 500 overall per family per yearThe following sub-limits are applicable: Vascular R35 850 Joint replacement R35 700 Functional R12 650 Major musculoskeletal R21 500 BLOOD TRANSFUSION> 100% coveredSCANS (IN & OUT OF HOSPITAL)> 2 scans per family per year RT scan MRI scan CAT scanDISCHARGE MEDICATION> 7 days supplyIMPORTANT CONTACT INFORMATIONA lenti Of ce Park, Building D, 457 Witherite Road, The Willows, Pretoria, 0040PO Box 1463, Faerie Glen, 0043 Call Centre and Authorisations: 0861 083 084 Please Call Me: 082 416 9898 T: +27 (0) 12 845 0000F: +27 (0) 86 670 0242E.
5 DO I GET A PRE AUTHORISATION NUMBER? Call us on 0861 083 084 E-mail: We will access your medical history immediately and assist you with obtaining any information you may needPLEASE HAVE ONE OF THE FOLLOWING HANDY WHEN YOU CALL Umvuzo HEALTH Umvuzo HEALTH membership number Surname South African ID number Passport number (if you are from a neighbouring country)Administrative and non-emergency medical services are attended to during business hours from:MONDAYS TO THURSDAYS08:00 16:30 FRIDAYS08:00 16:00 COUNCIL FOR medical SCHEMESCall: 0861 123 267E-mail: PARENT FAMILYR2 MAIN MEMBER:R2 ADULT DEPENDANT:R1 CHILD : FULL DEALDUAL PARENT FAMILYR3 MEMBERR2 us on Facebook Umvuzo HealthWHAT IS THE MONTHLY COST?
