1 Umvuzo HEALTH STANDARD 1. STANDARD. 2018. HEALTH . GUIDE . 2 Umvuzo HEALTH STANDARD. WELCOME TO. Umvuzo 's STANDARD OPTION. Your comprehensive healthcare solution. THE REASONS TO CHOOSE Umvuzo . We 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 do. IN A RECENT INDEPENDENT BRAND AUDIT OUR MEMBERS HAD THE FOLLOWING TO SAY ABOUT US: We go the extra mile We are member focussed We are co-operative Value in benefits We listen We are affordable We are flexible We are very inclusive We give access We are quick to process claims YOUR PRIMARY BENEFITS. NO PRE-AUTHORISATION REQUIRED UNIVERSAL HEALTH ONLY. GENERAL PRACTITIONER VISITS OPTOMETRY. > Unlimited but managed > 1 eye test per beneficiary per year * After the 10th visit in a 12 month period the member must choose one > 1 set of spectacles per beneficiary every 2 years GP for better management *Selection from a specified range of frames and lenses *Sunglasses and contact lenses are not covered INVESTIGATIONS.
2 > X-rays MEDICATION (FORMULARY). > Mammogram (including ultrasound) > Scripted: acute unlimited > Pathology > Scripted: chronic unlimited > Maternal ultrasound (limited to 2 per pregnancy) (subject to 26 CDL PMB conditions as well as selective Hormone Replacement Therapy (HRT) and Disease DENTAL CARE Management Programme registration). > 1 consultation per beneficiary per year > Unscripted: over the counter medication up to R270. > 1 follow-up per beneficiary per year per beneficiary per year, limited to 3 events, maximum > Cleaning, fluoride treatment, scaling, polishing of R90 per event > Fillings > Oral X-rays > Emergency root canal > Wisdom teeth extraction (in the dentists' rooms). >1 set of dentures per dependant older than 21. every 2 years KINDLY NOTE. After the 10th visit in a 12 month period the member must choose ONE GP for better management.
3 IMPORTANT NOTES. Penalties will apply if authorisation is obtained after treatment. The claim may not be paid if pre-authorisation is not obtained. The Scheme rules supersede the information on this brochure. Umvuzo ABBREVIATION DICTIONARY. GP - General Practitioner DSP - Designated Service Provider CDL - Chronic Disease List PMB - Prescribed Minimum Benefits Umvuzo HEALTH STANDARD 3. YOUR SECONDARY BENEFITS DISEASE MANAGEMENT. PRE-AUTHORISATION REQUIRED SCHEME RATES APPLY. ACTIVE DISEASE MANAGEMENT PROGRAMMES. > Our Active Disease Management Programmes enable us SPECIALIST VISITS to plan and coordinate the healthcare of members living >7. visits per family per year with chronic medical conditions, in order to give them the *Must be referred by the GP and be clinically necessary best possible outcomes.
4 AFTER-HOURS VISITS All 26 Chronic Disease List (CDL) are covered as part of > 5 visits per family per year Prescribed Minimum Benefits (PMB). MEDICATION (FORMULARY) Registration on these Disease Management Programmes is > Scripted: acute unlimited necessary to access full benefits: >S cripted: chronic unlimited (subject to 26 CDL PMB and > HIV/Aids > Hypertension 6 additional Disease Management > Oncology > Hyperlipidaemia Programme registration) > Diabetes (high cholesterol). * Medication prescribed by the specialist will be covered according to > Musculoskeletal > Asthma/COPD/. treatment guidelines > Renal Bronchiectasis APPLIANCES (crutches/support/slings) A total treatment plan for each member includes: > R9 120 per family per year Confidentiality Ongoing member support and education Individualised treatment plan TERMINAL AND WOUND CARE Ongoing counselling and HEALTH monitoring > R8 000 per family per year All Prescribed Minimum Benefits are covered according to Scheme rules, protocols and formularies.
5 EMERGENCY MEDICAL SERVICES. > Netcare 911. > Emergency transport >1 medicine bag per family How to register *Upon joining > 1 medicine bag refill per year STEP 1. Consult your GP to confirm the diagnosis and obtain the following: SUPPLEMENTARY BENEFITS Completed chronic application form >R. 3 020 per family per year Prescription Occupational Therapy Supporting documents (blood results) for chronic Dieticians medication registration Speech Therapy Physiotherapy STEP 2. Fax or email the application form, supporting documents and prescription to Universal Healthcare. Fax: 0862 108 743. KINDLY NOTE Email: All specialist visits must be referred by the Universal STEP 3. contracted GP and pre-authorised through the Universal Healthcare will fax, email or contact the member/. Umvuzo call centre.
6 Practice with the authorisation letter confirming that the Each follow up visit must also be pre-authorised. condition is registered. YOUR HOSPITAL BENEFITS. PRE-AUTHORISATION REQUIRED SCHEME RATES APPLY SCHEME USES ALL HOSPITAL GROUPS. GENERAL BLOOD TRANSFUSION. > Consultations (GP and specialists) > 100% covered > Treatment > Surgical procedures SCANS (IN & OUT OF HOSPITAL). > Non-surgical procedures > 2 scans per family per year > Anaesthesia RT scan MRI scan ACCOMMODATION CAT scan > General ward > ICU and/or high care (limited to 12 days per beneficiary DISCHARGE MEDICATION. per year) > 7 days' supply OVERALL PROSTHESES. > R50 220 overall per family per year The following sub-limits are applicable: Vascular R27 650. Joint replacement R30 940. Functional R9 120. Major musculoskeletal R18 500.
7 WHAT IS THE MONTHLY COST? PER MAIN MEMBER: R1 PER ADULT DEPENDANT: R1 PER CHILD DEPENDANT: CONTRIBUTIONS: FULL DEAL. SINGLE MEMBER. R1 DUAL PARENT FAMILY. R3 R3 R4 R5 SINGLE PARENT FAMILY. R2 R2 R3 R4 IMPORTANT CONTACT INFORMATION PLEASE HAVE ONE OF THE FOLLOWING HANDY WHEN YOU CALL. Umvuzo HEALTH . Alenti Office Park, Building D, 457 Witherite Road, Umvuzo HEALTH membership number The Willows, Pretoria, 0040 Surname PO Box 1463, Faerie Glen, 0043 South African ID number Passport number (if you are from a neighbouring country). Call Centre and Authorisations: 0861 083 084. Administrative and non-emergency medical services are attended to Please Call Me: 082 416 9898 during business hours from: MONDAYS TO THURSDAYS. T: +27 (0) 12 845 0000 08:00 16:30. F: +27 (0) 86 670 0242 FRIDAYS.
8 E: 08:00 16:00. COUNCIL FOR MEDICAL SCHEMES. Call: 0861 123 267. HOW DO I GET A PRE AUTHORISATION NUMBER? E-mail: s Call us on 0861 083 084. E-mail: Website: We will access your medical history immediately and assist you with obtaining any information you may need Find us on Facebook Umvuzo HEALTH