Affordable medical aid cover JOIN NOW

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 completed form to the following email: membership@medschemeswaziland.com

All quoted amounts are in Emalangeni
CONTRIBUTIONS
Employer Groups M0 M1 M2 M3 M4 M5 PARENT
1 – 20 members 2 673 3 764 4 203 4 418 4 521 4 814 1 367
21 – 499 members 2 540 3 577 3 992 4 198 4 296 4 573 1 298
500+ members 2 407 3 389 3 782 3 976 4 070 4 332 1 230
Principal member Adult dependant Child dependant (Max 3) Parent
Private members
<60 years 2 732 1 367 684 3 414
>=60 years 8 194 4 098 2 049 4 098
Medscheme Eswatini 2021 Comprehensive Plan

OVERALL ANNUAL LIMIT (OAL)

2 500 000 per beneficiary

NO / LOW CLAIM BONUS

Yes
30% of contributions minus all claims

TRAVEL BENEFIT TO SOUTH AFRICAN HOSPITALS

Pre-authorised travelling costs for referrals to South African acute care hospitals if residing more than 150km from hospital.
100% of Cost
Travelling expenses 1 200 per family per annum
Accommodation expenses 500 per night, limited to 2 nights per family per annum

LOYALTY PROGRAMME

As per benefit schedule

FUNERAL POLICY

Member/Spouse
Dependant: 16+ years
Dependant: 6 – 15 years
Dependant: 0 – 5 years
20 000
20 000
10 000
5 000
Please be advised that the maximum entry age for the funeral benefit is 60 and the benefit will terminate when you reach the age of 60.

WELLNESS BENEFITS

Limited to 1 GP consultation per beneficiary per annum.
1 GP consultation per beneficiary per annum covering:
  • GP consultation fee
  • Blood pressure
  • Cholesterol
  • Blood glucose
  • Papsmear for female beneficiaries
  • Prostate test for male beneficiaries
  • BMI
  • Osteoporosis screening
  • Mammogram for female beneficiaries
  • Flu vaccine
  • Pneumococcal vaccine

ALCOHOLISM AND DRUG DEPENDENCY (Substance abuse)

100% NPL / NHRPL (SA)
1 940 per family

ALTERNATIVE HEALTHCARE PRACTITIONERS & PARAMEDICAL SERVICES

(Audiology, Biokinetics, Chiropractors (including X-Rays), Dieticians, Genetic Councelling, Hearing Aid Acousticians, Homeopathy, Naturopathy (Including medicines), Occupational Therapy, Orthoptics, Physiotherapy, Podiatry & Speech Therapy) 100% NPL / NHRPL (SA)
5 460 per family

AMBULANCE SERVICES (Emergency only)

100% NPL / NHRPL (SA)
15 170 per family

APPLIANCES – MEDICAL AND SURGICAL

100% NPL / NHRPL (SA)

Wheelchairs – within above limit
Hearing Aids – within above limit
12 230 per family
7 080 per family
7 290 per family

BLOOD AND BLOOD PRODUCTS

100% Cost

CONSULTATIONS AND VISITS (General Practitioners, Specialists & Nurse Practitioners)

Rooms or Home 100% NPL / NHRPL (SA)
6 350 M0
7 240 M1
8 450 M2+
In Hospital 100% NPL / NHRPL (SA)

DENTISTRY

Advanced Dentistry/Oral Surgery
(Inlays, Crowns, Bridges, Study Models, Metal Base, Oral medicines by:
Orthodontists, Periodontists, Prosthodontists and Dental Technicians)
100% NPL / NHRPL (SA)
5 250 M0
8 970 M1
12 440 M2+
5 250 per beneficiary
Basic/Ordinary & Restorative
(Including Plastic Dentures, Dental Technicians & Dental Therapist)
Joint limit with Advanced Dentistry
100% NPL / NHRPL (SA)
2 150 M0
3 930 M1
5 560 M2+
2 150 per beneficiary
Osseointegrated Implants
(Including hospitalisation, Dental Practitioner, Anaesthetist)
Joint limit with Advanced Dentistry
100% NPL / NHRPL (SA)
Maxillo Facial Surgery 100% NPL / NHRPL (SA)

HOSPITALISATION

In-patient
(Accommodation – General Ward, Theatre Fees, Medicines, Materials & Equipment)
100% NPL / NHRPL (SA)
TTO’s 500 per admission
Out-patient
(Facility fee, consultation and medicine)
100% NPL / NHRPL (SA)
Inpatient General Practitioner Consultations 100% NPL / NHRPL (SA)
1 360 M0
1 730 M1
2 040 M2+
Alternatives to Hospitalisation
(Step down nursing Facilities, Private Nursing, Frail Care, Hospice & Physical rehabilitation in hospital)
100% NPL / NHRPL (SA)
17 480 per family

IMMUNE DEFICIENCY (related to HIV/AIDS)

(Services, Materials, Medicines)
Limited to acute medicine and consultation benefit
100% NPL / NHRPL (SA)

MEDICINES & INJECTION MATERIAL

Chronic Medicines
Only cover for: asthma, allergic rhinitis, epilepsy, GORD, hypertension, diabetes (Type 1&2), hyperlipidaemia.
100% Cost
3 510 M0
6 510 M1
8 870 M2+
Acute Medicines 100% Cost
4 620 M0
9 030 M1
12 750 M2+
Pharmacy Advised Therapy (OTC)
Within acute medicine limit
Schedule 0, 1 and 2 only
100% Cost
1 150 M0
2 150 M1
3 090 M2+
220 per script
Contraceptives (oral)
Within acute medicine limit
100% Cost
100 per script

MENTAL HEALTH (In and out of hospital)

100% NPL / NHRPL (SA)
15 170 per family

NON-SURGICAL PROCEDURES AND TESTS

In Hospital
Out of Hospital (Sleep Studies is paid only when authorised by the Fund)
100% NPL / NHRPL (SA)
100% NPL / NHRPL (SA)

OPTOMETRY

Frames, Lenses, Readers
One in 2 year claiming period
100% NPL / SAOA
3 880 M0
5 880 M1
6 400 M2+
3 880 per beneficiary
Eye Examinations 100% NPL / NHRPL (SA)
One per beneficiary per year
Refractive Surgery
(Radial Keratotomy/ Excimer Laser)
100% NPL / NHRPL (SA)
2 940 per family

ORGAN TRANSPLANTS

100% NPL / NHRPL (SA)
For pathology & radiology the separate benefit limits apply 186 000 per family

ONCOLOGY

Radiotherapy and Chemotherapy
(Including medicine, radiology and pathology.)
100% NPL / NHRPL (SA)
278 000 per family
Bracytherapy
(Within oncology limit above)
100% NPL / NHRPL (SA)
44 600 per family

PATHOLOGY AND MEDICAL TECHNOLOGY

In Hospital 100% NPL / NHRPL (SA)
41 600 per family
Out of Hospital 100% NPL / NHRPL (SA)
6 140 per family

PHYSIOTHERAPY AND BIOKINETICS

In Hospital
(Only applicable when there is a referring doctor)
100% NPL / NHRPL (SA)
2 310 M0
4 560 M1
6 820 M2+
Out of Hospital Subject to Paramedical Services Benefit limit

PREGNANCY/CONFINEMENT

Hospitalisation
(Accomodation, Theatre Fees, Labouir Ward Fees, Drugs, Dressings, Medicines and Materials.)
Physio will only be applicable to post caesarean cases during hospital stay.
Abnormal vaginal delivery will be considered for physiotherapy on application and authorisation.
100% NPL / NHRPL (SA)
33 100 per family
Global fee for delivery
Within Maternity limit above
100% NPL / NHRPL (SA)
6 450 per family
Services (Consultations, Visits & Scans)
Ante-natal consults are from the Consultation benefit and Scans from Radiology benefit and scans are limited to two.
100% NPL / NHRPL (SA)
4 x post natal midwife consultations per pregnancy

PROSTHESIS

100% Cost
Internal (e.g. Knee & Hip Replacements, etc.) – surgically implanted 57 200 per family
External (Includes External Fixators) 100% cost
37 000 per family

RENAL DIALYSIS

Acute & Chronic – for Pathology & Radiology the separate benefit limits apply. 100% NPL / NHRPL (SA)
101 000 per family

RADIOLOGY & RADIOGRAPHY

In Hospital
General and Specialised (including CT Scans, MRI Scans, etc)
100% NPL / NHRPL (SA)
24 500 per family
Out of Hospital
Within Radiology limit above
100% NPL / NHRPL (SA)
3 990 per family
PET Scan and PET-CT Scans
Bone Densitometry
Within Radiology limit above

1 per family per annum
1 per family per annum

SURGICAL PROCEDURES

100% NPL / NHRPL (SA)

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

DOWNLOAD PDF JOIN NOW

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

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