Affordable medical aid cover

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  1. Download the application form below.
  2. Complete both sides of this application form to avoid a delay in registration.
  3. Send the completed form to the following email: membership@medschemeswaziland.com
All quoted amounts are in Emalangeni
Inpatient Benefits
INPATIENT BENEFITS COMPREHENSIVE FLEXIBLE PLAN
Overall Annual Limit (OAL) 2 500 000 per beneficiary per annum 750 000 per beneficiary per annum
Travelling Expenses 1 200 per family per annum 900 per annum
Accommodation expenses 500 per night, limited to 2 nights per
family per annum
375 per night, limited to 2 nights per
family per annum
Blood and blood products 100% of ORHE tariff and Subject to
Overall IP Limit
100% of ORHE tariff and Subject to
Overall IP Limit
Consultations and Visits – (General
Practitioners, Specialist and Nurse
Practitioners)
100% of ORHE tariff and Subject to
Overall IP Limit
100% of ORHE tariff and Subject to
Overall IP Limit
Maxillofacial Surgeon 100% of ORHE tariff and Subject to
Overall IP Limit
100% of ORHE tariff and Subject to
Overall IP Limit
Hospitalisation
In-Patient

(Accommodation – General ward, Theatre fees,
medicines, Material and Equipment)
100% of ORHE tariff and Subject to
Overall IP Limit
100% of ORHE tariff and Subject to
Overall IP Limit
TTO's 7 days 7 days
Alternative to Hospitalisation
(Step Down nursing facilities, Private nursing,
Frail care, Hospice and Physical Rehabilitation
17 480 per family 17 480 per family
Mental Health (in and out of Hospital) 15 170 per family 9 290 per family
Non-Surgical Procedures 100% of ORHE tariff and Subject to
Overall IP Limit
100% of ORHE tariff and Subject to
Overall IP Limit
Organ Transplant (for pathology and
Radiology the separate benefit limits apply)
186 000 per family 152 000 per family
Oncology
Radiotherapy & Chemotherapy
(including
medicine, radiology, and pathology)
278 000 per family 207 000 per family
Brachytherapy
(within oncology limit above)
44 600 per family 44 600 per family
Pathology & Medical Technology 41 600 per family 20 700 per family
Physiotherapy and Biokinetics 2 310 M0
4 560 M1
6 820 M2+
780 M0
1 520 M1
2 410 M2+
Pregnancy/Confinement    
Hospitalisation (Accommodation, theatre
fees, Labour ward fees, drugs, dressings,
medicines, and materials) Physio will only
apply to post caesarean cases during hospital
stay. Abnormal Vaginal delivery will be
considered for physiotherapy on application &
authorisation
33 100 per family 31 300 per family
Global fee for delivery
within Maternity limit above
6 450 per family 6 140 per family
Prosthesis
Internal
External
57 200 per family
37 000 per family
26 800 per family
No Benefit
Renal Dialysis
Acute & Chronic – pathology and Radiology the
separate benefit limits apply
101 000 per family 69 000 per family
Radiology & Radiography
In Hospital

(general & specialised – including CT scans,
MRI Scans etc)
24 500 per family 16 200 per family
PET Scan and PET-CT scan
Bone densitometry within Radiology limit
1 per family per annum 1 per family per annum
Surgical Procedures 100% of ORHE tariff and Subject to
Overall IP Limit
100% of ORHE tariff and Subject to
Overall IP Limit
Emergency Room Benefit 3 000 per beneficiary per Annum 2 000 per beneficiary per Annum
Ambulance Service (Emergency only) 15 170 per family 12 120 per family
Appliances – Medical and Surgical 12 230 per family 5 000 per beneficiary per annum

 

Outpatient Benefits
INPATIENT BENEFITS COMPREHENSIVE FLEXIBLE PLAN
Alcoholism and drug dependency 1940 per family Subject to available Savings
Alternative health care Practitioners &
Paramedical Services
(audiology, biokinetics,
chiropractors (including X-Rays), dieticians,
Genetic Counselling, hearing aid acousticians,
homeopathy, naturopathy (including
medicines), occupational therapy, Orthoptic,
physiotherapy, podiatry & speech therapy)
5460 per family Subject to available Savings
Consultations – (General Practitioners,
Specialist and Nurse Practitioners)
6 350 M0
7 240 M1
8 450 M2+
Subject to available Savings
Advanced Dentistry/Oral Surgery
(Inlays, crowns, Bridges, Study models, Metal
base, Oral medicines by: Orthodontists,
Periodontists, Prosthodontists, and dental
technicians)
5 250 M0
8 970 M1
12 440 M2+
5 250 per beneficiary
Subject to available Savings
Basic/ Ordinary & Restorative
(Including Plastic Dentures, Dental Technicians
& Dental Therapist) Joint limit with Advanced
Dentistry
2 150 M0
3 930 M1
5 560 M2+
2 150 per beneficiary
Subject to available Savings
Osseo integrated Implants
(Including hospitalisation, Dental practitioner,
Anaesthetist) Joint limit with Advanced
Dentistry
subject to clinical protocols No benefit
Immune Deficiency (related to HIV/AIDS) subject to clinical protocols subject to clinical protocols
Chronic Medication
Only cover for: asthma, allergic rhinitis,
epilepsy, GORD, Hypertension, Diabetes (Type
1 &2), hyperlipidaemia Subject to registration
3 510 M0
6 510 M1
8 870 M2+
1 150 M0
2 360 M1
2 940 M2+
Acute Medication 4 620 M0
9 030 M1
12 750 M2+
Subject to available Savings
Pharmacy Advised Therapy (OTC)
Within acute medicine limit
Schedule 0,1,2 only
1 150 M0
2 150 M1
3090 M2+
220 per script
Subject to available Savings
220 per script
Contraceptives
Within acute medication limit
100 per script Subject to available Savings
100 per script
Optometry
Frames, Lenses, Readers
One in 24 months claiming period
3 880 M0
5 580 M1
6 400 M2+
3 880 per beneficiary
Subject to available Savings
Eye Examination One per Beneficiary per year Subject to available Savings
Refractive Surgery
(Radial Keratotomy/Excimer Laser)
2 940 per family No Benefit
Pathology & Medical Technology 6 140 per family Subject to available Savings
Pregnancy/Confinement
Services (Consultants, Visits & Scans)

Ante-natal consults are from the consultation
benefit and scans are from the radiology
benefit and scans are limited to two
4 x post-natal midwife consultation per
pregnancy
4 x post-natal midwife consultation per
pregnancy Subject to available Savings
Radiology & Radiography
Out of Hospital
Within In-Hospital Radiology
3 990 per family Subject to available Savings

 

All quoted amounts are in Emalangeni
Special Benefits
SPECIAL BENEFITS COMPREHENSIVE FLEXIBLE PLAN
Wellness Program Limited to 1 GP consultation per beneficiary per annum.
1 GP consultation per beneficiary per annum covering:
GP consultation fee
Health Assessment (Blood pressure, Cholesterol, Blood glucose, BMI)
Pap smear for female beneficiaries
Prostate test for male beneficiaries
Bone Density Screen
Mammogram for female beneficiaries
Flu vaccine
Pneumococcal vaccine

 

Monthly Premium Rates
  COMPREHENSIVE FLEXIBLE PLAN
  1-20 members 21- 499
members
1-20 members 21- 499
members
Additional Contributions for
Savings for Flexible Plan
M0 2 800 2 661 1 048 996 Level 0 0
M1 3 943 3 747 1 475 1 401 Level 1 236
M2 4 403 4 182 1 646 1 564 Level 2 354
M3 4 628 4 398 1 731 1 644 Level 3 472
M4 4 736 4 501 1 771 1 683 Level 4 941
M5 5 043 4 791 1 886 1 792 Level 5 1410
Parent 1 432 1 360 1 048 996    
  COMPREHENSIVE FLEXIBLE PLAN
Private
Members
<60 years >=60 years <60 years >=60 years
Principal
Member
2 862 8 584 1 139  
Adult
Dependant
1 432 4 293 570 1 708
Child
Dependant
717 2 147 285 855
Parent 3 577 4 293 1 424 1 708

 

This Plan is subject to underwriting as per the Scheme Rules. Underwriting will be done at application stage. NPL: Medscheme Eswatini Price List NHRPL (SA): National Health Reference Price List (inside South Africa) SAOA: South African Optometrists Association

JOIN US TODAY

  1. Download the application form below.
  2. Complete both sides of this application form to avoid a delay in registration.
  3. Send the comleted form to the following email: membership@medscheme-eswatini.com/medscheme