6.5 open schemes 2.3 restricted schemes

Transcription

1 2018 MEMBER GUIDE

2 2016 Medical Scheme Industry Snapshot This snapshot is based on the 2016/2017 CMS Annual Report and ANNEXURES OPEN 60 RESTRICTED 3.99 million members 8.88 million beneficiaries Family size of % increase in lives covered OPEN 60 RESTRICTED > Average benefi ciary age of 32.5 years 52.9% Female benefi ciaries 82 Medical Schemes (146 in 2001) Increase of 0.2 years from % Male benefi ciaries 2017: 331 Registered benefi t options (47 EDOs) 2016: 323 Registered benefi t options (42 EDOs) AVERAGE NUMBER OF BENEFIT OPTIONS: 6.5 open schemes 2.3 restricted schemes Risk conts Risk claims R148 BILLION 8.71% 7.26% 15 year annual increase 2016 increase R136 BILLION 9.41% 8.05% 9.7% increase in hospital claims costs INDUSTRY SOLVENCY: 10.07% of claims paid from Medical Savings Accounts 31.6% 28.6% open schemes 35.8% restricted schemes PRESCRIBED MINIMUM BENEFITS: 54% of total risk claims R73.1 BILLION PMB Benefi ts package: 2016: R680 per benefi ciary per month 2015: R632 per benefi ciary per month ADMINISTRATION COSTS R14.1 BILLION 8.5% NET HEALTHCARE RESULT R2.39 BILLION DEFICIT 17/22 OPEN SCHEMES WITH NET HEALTHCARE DEFICITS

3 From your lips to our ears we have listened to your needs and have undertaken a considerable revision to your Member Guide We trust it will be of value to you and your family. We thank the stakeholder contribution to this Guide, including the Council for Medical Schemes (CMS). We wish you good health and pray for greater peace and love in Neil A. Nair, Principal Officer DISCLAIMER: This Member Guide is prepared and distributed for purposes of providing you with essential information to help you select the best benefit option for you and your family. It is not a full guide to the Scheme Rules and Benefits and does not supersede the Scheme Rules. All contributions and benefit options presented in the 2018 Member Guide are subject to the approval by the Council for Medical Schemes. Kindly familiarise yourself with your chosen benefit option and note where pre-authorisations, motivations and or letters of referral are required to access benefits.

4 CONTENTS GLOSSARY OF TERMS USED IN THIS GUIDE 1 HOW TO CHOOSE YOUR MEDICAL SCHEME FOR Advice on choosing a medical scheme or benefi t option 2 Advice for current medical scheme members 3 WHAT IS A MEDICAL SCHEME? 3 But what does this mean? 3 How the Act protects members of medical schemes 3 WHAT IS AN ADMINISTRATOR? 4 What are administrators? 4 What do administrators do exactly? 4 Self-administered medical schemes 4 MEDICAL SCHEMES VS MEDICAL INSURANCE? 4 WHAT SHOULD YOU ASK YOUR DOCTOR OR SERVICE PROVIDER 5 BEFORE TREATMENT? What is involuntary use of a non-dsp? 6 How does treatment at DSPs work? 6 THE COMPLAINTS PROCESS 7 Who can complain to the Registrar s Office? 7 Who can you complain about? 7 Time limits for dealing with complaints 8 The Registrar s Ruling and appeal to Council 8 The Section 50 Appeal s process 8 How to avoid complaints 9 HOSPITAL NETWORKS 10 Eastern Cape 10 Free State 10 Gauteng 10 Kwa-Zulu Natal (*Note: Melomed Richards Bay is an exclusive Scheme DSP) 11 Limpopo 12 Mpumalanga 12 North West 12 Northern Cape 12 Western Cape (*Note: The Scheme has an exclusive contract with the Melomed group of 12 hospitals in and surroundings, up to a 40 km radius). SAMWUMED MEMBER GUIDE 2018

5 CONTENTS PHARMACY NETWORKS 12 Eastern Cape 12 Free State 14 Gauteng 15 Kwa-Zulu Natal 21 Limpopo 24 Mpumalanga 25 North West 26 Western Cape 27 REASONS WHY WE ARE THE BEST MEDICAL AID FOR YOU 31 BENEFITS CAN BE GROUPED INTO TWO CATEGORIES 32 PREVENTATIVE CARE BENEFITS AND EARLY DETECTION 33 ENTITLEMENT TO BENEFITS 34 CHANGING OF BENEFITS, LIMITS (INCLUDING OVERALL ANNUAL LIMITS), AND 34 MEMBERSHIP CATEGORIES PRESCRIBED MINIMUM BENEFITS ( PMB ) 36 GENERAL BENEFITS AND LIMITS 36 Prescribed Minimum Benefi ts 36 Limitation and Restriction of Benefi ts BENEFITS AND CONTRIBUTIONS 39 Option A 40 Option B 46 MATERNITY BENEFITS 52 ADDITIONAL VALUE 52 SAMWUMED Primary Healthcare Benefi t Programme 52 Chronic Medicine Benefi ts 53 Care 53 MONTHLY CONTRIBUTIONS 54 Defi nitions 54 WHAT DOCUMENTS DO I NEED TO BECOME A MEMBER? 55 MEMBERSHIP MANAGEMENT 56 SAMWUMED s Premiums and Membership Department is responsible for all aspects of 56 membership and the collection of contributions Movement between Schemes during the year is not allowed 56 SAMWUMED MEMBER GUIDE 2018

6 CONTENTS Registering dependants 57 Child dependants 57 Birth of a child 57 Adult Dependants 57 EXCLUSIONS 58 QUICK GUIDE: INFORMATION ON ACCESSING YOUR BENEFITS EFFICIENTLY 58 Getting authorisation for your hospital stay 58 Why is pre-authorisation necessary? 58 When do you need to contact us for pre-authorisation? 59 How do I pre-authorise? 59 What if I'm diagnosed with Cancer? 59 What happens in an emergency? 59 What is a PMB? 60 Access and care 60 Checking available benefi ts 61 Obtaining pre-authorisation from the call centre 61 Benefi ts that require motivation and/or referral letters 61 What is covered under the medication benefi t? 61 How to register and obtain medication for a chronic condition 61 HIV MANAGEMENT PROGRAMME 62 How and when to use the SAMWUMED Primary Healthcare Programme Benefi t 62 How to replace lost membership cards 63 Submission of claims 63 Payment of accounts 66 How our claims processing works 67 FAQ'S: FREQUENTLY ASKED QUESTIONS 68 TALK TO SAMWUMED TODAY 69 SAMWUMED MEMBER GUIDE 2018

7 GLOSSARY OF TERMS USED IN THIS GUIDE: BENEFIT LIMIT: The maximum amount that the member or dependant is entitled to for a specifi c benefi t category, taking into account the Scheme Rules and Scheme Tariff paid for goods, services or appliances. CO-PAYMENT: The part of the account that a member pays in situations where the benefi t does not cover the relevant health service, or when the provider charges fees that are higher than the Scheme Tariff. DEPENDANT: A spouse or partner, child or parent who is dependent on the member for care and support. PBPA: Per Benefi ciary Per Annum DESIGNATED SERVICE PROVIDER (DSP): The service provider that the Scheme has chosen to provide certain medical care for PMBs. EXCLUSIONS: Any treatment, medications, appliances or similar that are not covered in terms of the Rules of the Scheme. FORMULARY: A list of medicines. ICD-10 CODE: The International Classifi cation of Diseases (ICD) 10. A system that organises diseases and the complications connected to these diseases according to specifi c categories. MEDICAL SCHEMES ACT: The law that governs all medical schemes in South Africa. OVERALL ANNUAL LIMIT (OAL): The limit that every member and their dependants cannot exceed during each benefi t year. PRE-AUTHORISATION: The prior approval of scheduled surgeries and procedures. Whenever hospitalisation is required (ER, triage, that already exists at the time a member or their dependant joins the Scheme. scans and casualty ward) this must be confi rmed with the Scheme and Managed Care. Please also not that there are certain day-to-day benefi ts that require pre-authorisation. PRE-EXISTING MEDICAL CONDITION: A medical condition or illness. PRESCRIBED MINIMUM BENEFITS (PMBs): A list of conditions, specifi ed in the Medical Schemes Act 131 of 1998, for which all members are entitled to treatment. CHANGE IS COMING SAMWUMED MEMBER GUIDE

8 PRESCRIBED CYCLES: The number of times a member is allowed to access certain benefi ts during a specifi c benefi t year(s). PREFERRED PROVIDER: A provider that the Scheme has negotiated favourable rates with and that can be used as an alternative to a DSP in the event of an emergency. A Preferred Provider may also be used if a DSP is not within reasonable travelling distance or does not offer the treatment or services required. PRO-RATED BENEFITS: Benefi ts allocated to a member based on the number of contributions they have paid. This applies to members who join after March of the benefi t year. SCHEME TARIFF: The rate according to which the Scheme pays for claims. SUB-LIMIT: Forms part of a broader benefi t category. WAITING PERIOD: A period during which members will not be covered even though they are paying contributions. HOW TO CHOOSE YOUR MEDICAL SCHEME FOR 2018 Provided with the kind permission of the Council for Medical Schemes (CMS) It is important to choose the right medical scheme not only based on price but by doing research to ensure that the scheme meets your needs and those of your family. It is also best to change your benefi t option at the beginning of the year, if needed, in order to get full benefi ts. ADVICE ON CHOOSING A MEDICAL SCHEME OR BENEFIT OPTION Ensure that the scheme you are considering is duly registered in terms of the Medical Schemes Act 131 of The names, addresses and telephone numbers of all registered schemes are published on the website of the Council for Medical Schemes at Identify a few schemes and request information about their benefi ts, contributions, limitations and exclusions. Compare this information provided to see which one meets your needs. Besides the healthcare benefi ts also fi nd out what the schemes reserves (solvency ratio) are, and non-healthcare expenditure, such as administration costs, to ensure they are in good fi nancial health. Understand what prescribed minimum benefi ts (PMBs) are and under what circumstances the chosen scheme provides such cover for you. Here you can look at designated service providers and their proximity to you as well as other networks that provide benefi ts to members. 2 SAMWUMED MEMBER GUIDE 2018

9 ADVICE FOR CURRENT MEDICAL SCHEME MEMBERS If you are already a member of a scheme, read all the material such as options to change plans. Ensure that you understand how the benefi t options operate and select according to your healthcare needs and what you can afford. The registered rules of medical schemes fully disclose detailed information regarding the relevant benefi ts and contributions. It is essential that you obtain the rules of the scheme or a summary thereof to verify all relevant information to enable you to make an informed choice. Some people choose to make use of an agent or broker (intermediary). Remember it is not compulsory to use a broker, but if you do ensure that he/she has been accredited by the CMS and that your selection of a scheme is based on informed consent. WHAT IS A MEDICAL SCHEME? Medical Schemes are not for profi t organisations. [The] business of a medical scheme means the business of undertaking liability in return for a premium or contribution: a) to make provision for the obtaining of any relevant health service; b) to grant assistance in defraying expenditure incurred in connection with the rendering of any relevant health service; and c) where applicable, to render a relevant health service, either by the medical scheme itself, or by any supplier or group of suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical scheme. BUT WHAT DOES THIS MEAN? Point (a) in the defi nition means that medical schemes must provide healthcare benefi ts, including a prescribed package of minimum benefi ts for healthcare needs. The uncertainty attached to your health poses a number of risks for your medical scheme; the most obvious risk to you is the loss of health itself. This is why medical scheme members buy benefi t packages based on their need for healthcare and why medical schemes are structured in a way that makes them fi nancially sustainable in the long run. Point (b) in the defi nition means that monetary contributions are paid in exchange for healthcare benefi ts. Members of medical schemes have the obligation to pay a relevant contribution which entitles them to access a defi ned benefi ts package. Members are encouraged to read up on their rights and responsibilities when accessing benefi ts, specifi cally the prescribed minimum benefi ts or PMBs. Point (c) in the defi nition means that medical schemes are allowed to contract with service providers for the provision of comprehensive benefi ts, including out-of-hospital benefi ts and PMBs. HOW THE ACT PROTECTS MEMBERS OF MEDICAL SCHEMES The defi nition of the business of a medical scheme, as in the Medical Schemes Act 131 of 1998, was always meant to guide medical schemes on the type of services required to be provided to members in order to operate as a registered medical scheme. SAMWUMED MEMBER GUIDE

10 WHAT IS AN ADMINISTRATOR? WHAT ARE ADMINISTRATORS? Medical scheme administrators are privately owned companies with the skills, infrastructure, and capacity to render a full range of administration services to schemes in compliance with prevailing legislation. They are accredited by the Council for Medical Schemes (CMS) in terms of the Medical Schemes Act if they meet the certain criteria. Most medical schemes outsource many of their functions to administrators. WHAT DO ADMINISTRATORS DO EXACTLY? Administrators perform a variety of administration functions as per their written contracts and service level agreements with schemes. They utilise comprehensive and integrated information technology systems capable of performing all administration, fi nancial, and management functions. Medical scheme administrators maintain member records. Their systems can drill down to detailed information on an individual member. It is the administrator who processes your application for membership and also suspends and terminates it. Administrators collect the monthly member contributions and manage their allocation and reconciling. They ensure that outstanding amounts are collected. SELF-ADMINISTERED MEDICAL SCHEMES Some medical schemes do not use administrators. A self-administered scheme undertakes all administration functions with its own resources decisions. Self-administered schemes do not need to be accredited, but they must comply with the same administration standards and are subject to the same on-site evaluation of compliance as third-party administrators. MEDICAL SCHEMES VS MEDICAL INSURANCE? Medical schemes are not for profi t organisations which operate like trust funds. Short and long-term insurers providing health insurance products are commercially driven for-profi t companies. Medical schemes belong to their members, while health insurance companies are owned by shareholders. Medical schemes espouse unique principles which can only be found in the Medical Schemes Act. These principles are (i) open enrolment, (ii) community rating, and (iii) a set of prescribed minimum benefi ts, commonly called PMBs. Open enrolment means that anyone can join a medical scheme and that if you apply for membership, the scheme of your choice cannot turn you away. Community rating means that all members of a medical scheme pay the same monthly contribution for the same benefi ts. PMBs ensure that members are fully protected against unforeseen and potentially catastrophic health events. These principles do not apply to health insurance products. 4 SAMWUMED MEMBER GUIDE 2018

11 Anyone can buy a short- or long-term health insurance policy, but the premium you pay will usually depend on the insurer s assessment of your state of health. Older individuals, or individuals with pre-existing health conditions, will pay more for health insurance cover. At the extreme, health insurance companies may refuse to cover you if they consider that there is too high a risk that you are likely to claim. WHAT SHOULD YOU ASK YOUR DOCTOR OR SERVICE PROVIDER BEFORE TREATMENT? Is this a Prescribed Minimum Benefi t? Is this my medical scheme s Designated Service Provider? Do I need authorisation from my medical scheme? Do you charge at my medical scheme s tariff? DURING: Is there a co-payment or levy? AFTER: Is this medication on my medical scheme s formulary list? Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable. PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of: any emergency medical condition; a limited set of 270 medical conditions; and 25 chronic conditions defi ned in the Chronic Diseases List (CDL). Medical schemes must pay in full, without a co-payment or the use of deductibles, for the diagnosis, treatment and care costs of the Prescribed Minimum Benefi t conditions. The medical scheme cannot use your medical savings account to pay for Prescribed Minimum Benefi ts. Each option offered by a medical scheme must make provision for the Prescribed Minimum Benefi ts, including hospital plan options. A designated service provider or DSP is a healthcare provider (doctor, pharmacist, hospital etc.) who is appointed by your medical scheme to treat or care for prescribed minimum benefi t (PMB) conditions of their members. State healthcare facilities can be DSPs too but before they can be listed as such in the rules of your medical scheme, your scheme must make sure that you and its other benefi ciaries can reach these facilities with reasonable ease and that the required treatment, medication, and care are both available and accessible. SAMWUMED MEMBER GUIDE

12 WHAT IS INVOLUNTARY USE OF A NON-DSP? If circumstances force you to obtain a service from a non-dsp (i.e. involuntarily), and it s a PMB condition, your scheme must pay for the costs of your treatment, diagnosis, and care in full. These are the reasons why you may need to obtain treatment from a non-dsp involuntarily: the required service or treatment is not readily available from your scheme s DSP or it will be provided with unreasonable delay; an emergency occurs under circumstances or at a location that prevents you from obtaining PMB treatment from a DSP; or there is no DSP within reasonable proximity to your ordinary place of business or personal residence HOW DOES TREATMENT AT DSPs WORK? Your scheme can insist that you go to a DSP as soon as your PMB condition is diagnosed, in which case they cover the costs from the start. When your condition is identifi ed as a PMB after diagnosis, your scheme must pay for the tests and treatment in full retrospectively. Treatment for a PMB condition at a DSP is covered in full by the medical scheme. A co-payment is the amount of money or portion of the account that your scheme may request you to fund from your own pocket. This could be either a percentage of the fee or the difference between the tariff of your scheme s chosen DSP and the amount charged by the provider (non-dsp) you went to. The co-payment amount must be specifi ed in the scheme rules. Waiting periods and late joiner penalties may be imposed under certain strictly limited circumstances. These conditions must comply with the Medical Schemes Act. On admission to membership a scheme may impose a: 3 month general waiting period 12 months condition-specifi c waiting periods (CSWP) for pre-existing conditions Waiting period on PMBs Late Joiner Penalty Except in cases where: Termination of membership due to employment or employer changing schemes A child born to a member Change between benefi t options A medicine formulary is a list of medications that the scheme is willing to fund for the treatment of PMB conditions. Feel free to ask your scheme for the formulary list for your specifi c benefi t option and discuss the available medicines with your doctor. If you choose to use medicine not listed on the formulary, the scheme is allowed to charge you a co-payment. But there are specifi c circumstances where schemes cannot enforce a co-payment and must make provision for appropriate exceptions or substitutions, including where the formulary medicine has proven ineffective or would cause you harm or an adverse reaction. The Regulations to the Medical Schemes Act provide for specifi c principles that medical schemes may use to manage the fi nancial risk associated with PMBs. These principles include designated service providers, managed care protocols and formularies. 6 SAMWUMED MEMBER GUIDE 2018

13 THE COMPLAINTS PROCESS WHO CAN COMPLAIN TO THE REGISTRAR S OFFICE? Any benefi ciary or any person who is aggrieved with the conduct of a medical scheme can submit a complaint. It is however very important to note that a prospective complainant should always fi rst seek to resolve complaints through the complaints mechanisms in place at the respective medical scheme before approaching the Council for assistance. You can contact your scheme by phone or writing to the Principal Officer of the scheme, giving her/him full details of your complaint. If you are not satisfi ed with the response from your Principal Officer, you can ask the matter to be referred to the Disputes Committee of your scheme. If you are not satisfi ed with the decision of the Disputes Committee, you can appeal against the decision within 3 months of the date of the decision to the Council. The appeal should be in the form of an affidavit directed to the Council. Complaints can be submitted by any reasonable means such as a letter, fax, or in person at our Offices from Mondays to Fridays during 08:00 17:00. The complaint form is available on Your complaints should be in writing, detailing the following: Full names, membership number, benefi t option, contact details and full details of the complaint with any documents or information that substantiates the complaint. The Council for Medical Scheme s Complaints Adjudication Unit also provides telephonic advice and personal consultations, when necessary. WHO CAN YOU COMPLAIN ABOUT? The Council for Medical Schemes governs the medical schemes industry and therefore your complaint should be related to your medical scheme. If your complaint is related to any other aspect of the health industry, please visit the relevant websites: For complaints against Health Professionals (doctors) and allied health professional such as physiotherapists, occupational therapists etc. or call For complaints against Private s or call For complaints against Nurses or call For complaints against Brokers or call For complaints in respect of other health insurance products (short term insurance ombudsman) or call or (long term insurance ombudsman) or call SAMWUMED MEMBER GUIDE

14 TIME LIMITS FOR DEALING WITH COMPLAINTS Our aim is to provide a transparent, equitable, accessible, expeditious as well as a reasonable and procedurally fair dispute resolution process. The Registrar s Office will send a written acknowledgement of a complaint within 3 working days of its receipt, providing the name, reference number and contact details of the person who will be dealing with a complaint. In terms of Section 47 of the Medical Schemes Act 131 of 1998 a written complaint received in relation to any matter provided for in this Act will be referred to the medical scheme. The medical scheme is obliged to provide a written response to the Registrar s Office within 30 days. The Registrar s Office shall within 4 days of receiving the complaint from the administrator, analyse the complaint and refer a complaint to a medical scheme for comments. Upon receipt of the response from the medical scheme, the Registrar s Office will analyse the response in order to make a decision or ruling. Decisions/rulings will be made within 120 working days of the date of referral of a complaint and communicated to the parties. THE REGISTRAR S RULING AND APPEAL TO COUNCIL Section 48 of the Act makes provision for any party who is aggrieved with the decision of the Registrar to appeal such a decision. This appeal is at no cost to either of the parties. An appeal must be submitted within three months and should be in the form of an affidavit directed to the Council. The operation of the decision shall be suspended pending review of the matter by the Council s Appeals Committee. The secretariat of the Appeals Committee will inform all parties involved of the date and time of the hearing. This notice should be provided no less than 14 days before the date of the hearing. The parties may appear before the Committee and tender evidence or submit written arguments or explanations in person or through a representative. The Appeals Committee may after the hearing confi rm or vary the decision concerned or rescind it and give another decision they deem to be just. THE SECTION 50 APPEAL S PROCESS Any party that is aggrieved with the decision of the Appeals Committee may appeal to the Appeal Board. The aggrieved party has 60 days within which to appeal the decision and must submit written arguments or explanation of the grounds of his or her appeal. The Appeal Board shall determine the date, time and venue for the hearing and all parties will be notifi ed in writing. The Appeal Board shall be heard in public unless the chairperson decides otherwise. The Appeal Board shall have the powers which the High Court has to summon witnesses, to cause an oath or affirmation to be administered by them, to examine them, and to call for the production of books, documents and objects. The decisions of the Appeal Board are in writing and a copy thereof shall be furnished to parties. The prescribed fee of R is payable for Section 50 Appeals. 8 SAMWUMED MEMBER GUIDE 2018

15 How to avoid complaints Make sure you have read and understood your scheme rules. Study your benefi t guide and familiarise yourself with the benefi t option you have chosen. Read all correspondence from your scheme, e.g. newsletters and statements. Make sure your contributions are paid in full and on time each month. Remember: Avoid complaints by informing yourself! The Council for Medical Schemes (CMS) protects and informs the public about their medical scheme rights and obligations, ensuring that complaints raised are handled appropriately and speedily. SAMWUMED MEMBER GUIDE

16 HOSPITAL NETWORKS Disclaimer: The hospital networks is subject to change. The changes may occur as a result of the ongoing network review processes during the year. EASTERN CAPE Group Life FREE STATE Group Life Beacon Bay Pasteur - dedicated to acute rehab Beacon Bay North Life East London Private East London Life Isivivana Private Life Mercantile Life Queenstown Private Queenstown Life St Dominic's East London Life St George's Life St James East London Life St Mary's Private Mthatha NHN Crossmed Mthatha Private Mthatha NHN East London Eye East London Netcare Netcare Cuyler Netcare Netcare Greenacres Netcare Port Alfred Port Alfred Netcare Settlers Private Eastern Cape Bloemfontein Life Rosepark Clinic Bloemfontein Mediclinic Mediclinic Blomfontein Bloemfontein Mediclinic Mediclinic Hoogland Bloemfontein NHN Horizon Eye Care Centre (Bloemfontein Eye Centre) Bloemfontein NHN Jane Keyser Clinic Bloemfontein NHN Riemland Clinic Bloemfontein NHN St Helena Welkom Netcare Netcare Kroon Bloemfontein Netcare Netcare St Augustine's Bloemfontein Netcare Netcare Vaalpark Bloemfontein Netcare Pelonomi Bloemfontein Netcare Universitas Bloemfontein 10 GAUTENG Group Life Bedford Gardens Life Brenthurst Clinic Life Carstenhof Clinic Life Dalview Clinic Life Eugene Marais Life Faerie Glen Life Genesis Clinic Life Groenkloof (Old name: Little Company of Mary Life Riverfi eld Lodge Life Robinson Private Life Roseacres Clinic Life Springs Parkland Clinic Life Suikerbosrand Clinic Life The Glynnwood Life Wilgeheuwel Mediclinic Mediclinic Gynaecological Mediclinic Mediclinic Heart Mediclinic Mediclinic Medforum Mediclinic Mediclinic Morningside Mediclinic Mediclinic Muelmed Mediclinic Mediclinic Sandton Mediclinic Mediclinic Vereeniging Mediclinic Mediclinic Wits Donald Gordon NHN Fochville NHN NHN NHN NHN Lenmed Daxina Medical Clinic Lenmed Health Ahmed Kathrada Private Lenmed Randfontein Private Lenmed Zamokuhle Private NHN Louis Pasteur Private NHN Medfem Clinic Sandton NHN Midvaal Private NHN Optimed Eye and Laser Clinic NHN Eye Institute NHN Sunshine NHN The Fountain Private aka Leslie Williams Private SAMWUMED MEMBER GUIDE 2018

17 GAUTENG (CONTINUED) Group NHN Urolocare NHN Zuid-Afrikaans Hospitaal Netcare Lakeview Netcare Netcare Akasia Netcare Netcare Bell Street Krugersdorp Netcare Netcare Bougainville Private Netcare Netcare Clinton Netcare Netcare Femina Netcare Netcare Garden City Netcare Netcare Jakaranda Netcare Netcare Krugersdorp Netcare Netcare Linksfi eld Netcare Netcare Linkwood Netcare Netcare Linmed Netcare Netcare Milpark Netcare Netcare Montana Netcare Netcare Moot Algemene Hospitaal Netcare Netcare Mulbarton Netcare Netcare N17 Netcare Netcare Olivedale Netcare Netcare Optiklin Eye Netcare Netcare Park Lane Clinic Netcare Netcare Pinehaven Netcare Netcare East Netcare Netcare Rand Netcare Netcare Rehabilitation Netcare Netcare Rosebank Netcare Netcare Sunninghill Netcare Netcare Sunward Park Netcare Netcare Union Netcare Netcare Unitas Netcare Netcare Waterfall City KWA-ZULU NATAL (Note: Melomed Richards Bay is an exclusive Scheme DSP) Group Life Chatsmed Garden Durban Life Empangeni Garden Clinic Durban Life Entabeni - acute incorporating Life St Josephs psychiatric unit Durban Life Life Hilton Private Pietermaritzburg Life Mount Edgecombe Phoenix NHN Daymed Private Life New Kensington Clinic-Rehab Durban Life The Crompton Durban Life Westville Durban Mediclinic Mediclinic Newscastle Durban Mediclinic Mediclinic Pietermaritzburg Pietermaritzburg Mediclinic Mediclinic Potschefstroom Durban Mediclinic Mediclinic Victoria Durban Pietermaritzburg NHN Ethekwini and Heart Centre Durban NHN Gateway Private Durban NHN Hibiscus Private Port Shepstone NHN Hillcrest Private Durban NHN Lenmed La Verna Durban NHN Lenmed Shifa Durban NHN Matatiele Private Durban NHN Mooimed Potschefstroom NHN Nongoma Private Durban Netcare Kokstad Durban Netcare Netcare Alberlito Durban Netcare Netcare Kingsway Durban Netcare Netcare Margate Durban Netcare Netcare Parklands Durban Netcare Netcare St Anne's Pietermaritzburg Melomed Melomed Richards Bay Netcare Netcare Umhlanga Umhlanga SAMWUMED MEMBER GUIDE

18 LIMPOPO NORTHERN CAPE Group Mediclinic Mediclinic Emfuleni Polokwane Mediclinic Mediclinic Lephalale Polokwane Mediclinic Mediclinic Limpopo Limpopo Mediclinic Mediclinic Thabazimbi Limpopo NHN Quality Care Private Polokwane NHN St Vincent's Polokwane Netcare Netcare Pholoso Polokwane MPUMALANGA Group Life Comso Mpumalanga Life a Midmed Middelburg Life Piet Retief Nelspruit Mediclinic Mediclinic Barberton Nelspruit Mediclinic Mediclinic Ermelo Nelspruit Mediclinic Mediclinic Highveld Nelspruit Mediclinic Mediclinic Nelspruit Nelspruit Mediclinic Mediclinic Secunda Nelspruit Mediclinic Mediclinic Welkom Nelspruit NHN Emalahleni Private (Pty) Ltd Nelspruit NHN Kiaat Private Nelspruit NHN Lowveld Nelspruit NHN Nelspruit Surgiclinic Nelspruit NHN Zoutpansberg Private Nelspruit NORTH WEST Group Life Anncron Clinic Klerksdorp Life La Femme Clinic Rustenburg Life Peglerae Rustenburg Mediclinic Mediclinic Brits Brits Mediclinic Mediclinic Legae Mabopane NHN Rustenburg Medicare Rustenburg NHN Sunningdale Klerksdorp NHN Vryburg Private Vryburg Netcare Netcare Ferncrest Rustenburg Group Mediclinic Mediclinic Kimberley (Gariep) Kimberley Mediclinic Mediclinic Upington Upington NHN NHN NHN Lenmed Kathu Royal and Heart Centre Wilmed Park Private Northern Cape Kimberley Klerksdorp WESTERN CAPE (*Note: The Scheme has an exclusive contract with the Melomed group of hospitals in and surroundings, up to a 40 km radius) Group Life Bayview Private MosselBay Life Knysna Private Knysna Mediclinic Mediclinic Geneva George Mediclinic Mediclinic George George Mediclinic Mediclinic Klein Karoo Oudtshoorn NHN Melomed Bellville Medical Centre NHN NHN Melomed Gatesville Medical Centre Melomed Mitchells Plain Medical Centre NHN Melomed Tokai PHARMACY NETWORKS Disclaimer: The pharmacy networks is subject to change. The changes may occur as a result of the ongoing network review processes during the year. EASTERN CAPE Clicks Pharmacy - Vincent Park Clicks Pharmacy - Walker Drive Clicks Pharmacy - Greenacres John Forbes Pharmacy Klinicare Lorraine Pharmacy Klinicare Bluewater Bay Pharmacy Clicks Pharmacy - Walmer Park Clicks Pharmacy - Grahamstown Clicks Pharmacy - Sunridge Village East London East London Grahamstown 12 SAMWUMED MEMBER GUIDE 2018

19 EASTERN CAPE (CONTINUED) EASTERN CAPE (CONTINUED) Clicks Pharmacy - King William's Town Clicks Pharmacy - Cleary Park Greenways Family Pharmacy Clicks Pharmacy - Beacon Bay Medi-Rite Pharmacy - King William`s Town Ibhayi East London Klinicare Despatch Pharmacy Medi-Rite Pharmacy - Vincent Clicks Pharmacy - Moffet Retail Park Klinicare Blooms Pharmacy Klinicare Gelvandale Pharmacy (N N Pharmaceutical Pty Ltd) Despatch East London P Ochse Pharmacy Cradock Clicks Pharmacy - Humewood Medi-Rite Pharmacy - Bethelsdorp Ibhayi Dis-Chem Jeffreys Bay Pharmacy Jeffreys Bay Vincent Family Pharmacy East London Medi-Rite Pharmacy - Greenacres Amathole Valley Pharmacy Medi-Rite Pharmacy - Uitenhage Clicks Pharmacy - Uitenhage Amayeza Ethu Pharmacy Medi-Rite Pharmacy - Moffat On Main Clicks Pharmacy - Graaff Reinet Netcare Port Alfred Private Pharmacy King William`s Town Uitenhage Uitenhage Mdantsane Graaff-Reinet Port Alfred Medi-Rite Pharmacy - Butterworth Medi-Rite Pharmacy - Queenstown Medi-Rite Pharmacy - New Brighton Clicks Pharmacy - Nonesi Mall New Brighton Pharmacy Clicks Pharmacy - Despatch Clicks Pharmacy - New Brighton Klinicare Kings Court Pharmacy Butterworth Queenstown Queenstown Despatch Clicks Pharmacy - Fountains Mall Jeffreys Bay Clicks Pharmacy - Pier 14 Clicks Pharmacy - Port Alfred Port Alfred Mpilontle Pharmacy Lady Frere Baymed Pharmacy Jeffreys Bay Medi-Rite Pharmacy - Mthatha Mthatha Clicks Pharmacy - Kabega Park Clicks Pharmacy - B T Ngebs Mall Mthatha Policlinic Pharmacy - Jeffrey's Bay Jeffreys Bay Clicks Pharmacy - Baywest Clicks Pharmacy - Gonubie East London Umendo Pharmacy Sterkspruit Medi-Rite Pharmacy - Amalinda East London Clicks Pharmacy - Mthatha Mthatha Medi-Rite Pharmacy - King Williams Town Netcare Settler's Pharmacy Dis-Chem Hemingways Mall Pharmacy Clicks Pharmacy - Hemmingways Clicks Pharmacy - 6th Avenue Walmer Klinicare Belmore Pharmacy King William`s Town Grahamstown East London East London Dis-Chem Baywest Mall Pharmacy Clicks Pharmacy - Kamma Crossing Clicks Pharmacy - Gillwell Clicks Pharmacy - Mdantsane Eldre Apteek Clicks Pharmacy - East London (Netcare East London Dispensary) East London Mdantsane Aliwal North East London Protea Pharmacy - Sidwell Clicks Pharmacy - Westering Provincial Westbourne Pharmacy Watersons Pharmacy Cradock Clicks Pharmacy - Mthatha Plaza Mthatha Berea Pharmacy East London Medi-Rite Pharmacy - Kwanobuhle Kwa Nobuhle Bonnie Doon Pharmacy East London Clicks Pharmacy - Penford Uitenhage Greenfi elds Pharmacy East London Dis-Chem Cape Road Pharmacy Linton Grange Pharmacy Dis-Chem Walmer Park Pharmacy The Medicine Chest Mbizana Pharmacy Bizana Rink Street Pharmacy Ooskaap Pharmacy Humansdorp Troppers Pharmacy Clicks Pharmacy - Oxford Street East London Klinicare Mosel Pharmacy Uitenhage SAMWUMED MEMBER GUIDE

20 EASTERN CAPE (CONTINUED) FREE STATE (CONTINUED) Arcade Pharmacy - Humansdorp Humansdorp Clicks Pharmacy - Bloemfontein C B D Bloemfontein Hendricks Pharmacy Clicks Pharmacy - Summerstrand Klinipharm Pharmacy Schuin Villa Apteek & Medisyne Depot Korsten Pharmacy Klinicare Pharmacy - Uitenhage King William`s Town Uitenhage Clicks Pharmacy - Mimosa Mall Clicks Pharmacy - Welkom Clicks Pharmacy - Bethlehem Edenburg Pharmacy Wesselsbron Apteek Netcare Pelonomi Private Pharmacy Bloemfontein Welkom Bethlehem Edenburg Wesselsbron Bloemfontein Netcare Greenacres Dispensary Mangaung Pharmacy Mangaung Klinimed Pharmacy Dis-Chem Bloemfontein Pharmacy Bloemfontein Clicks Pharmacy - Buffelsfontein Road (Netcare Walmer Dispensary) Clicks Pharmacy - Westering Clicks Pharmacy - East London (Netcare East London Dispensary) East London Clicks Pharmacy - Sasolburg Medirex Pharmacy Medi-Rite Pharmacy - Welkom Masupatsela Pharmacy Sasolburg Bloemfontein Welkom Welkom Clicks Pharmacy - East London (Netcare East London Dispensary) Netcare Cuyler Pharmacy Harrison's Pharmacy East London Uitenhage King William`s Town Medi-Rite Pharmacy - Heidedal Heidedal Pharmacy Medi-Rite Pharmacy - Sentraal Langenhovenpark Pharmacy Bloemfontein Bloemfontein Bloemfontein Bloemfontein Dorans Pharmacy Aliwal North Dis-Chem Loch Logan Pharmacy Bloemfontein Klinicare Mill Park Pharmacy Klinicare Oval Pharmacy Mountweg Pharmacy Clicks Pharmacy - Kroonstad (Cross Street) Clicks Pharmacy - Kroonstad (Cnr Van Zyl & North Street) Kroonstad Kroonstad FREE STATE Medi-Rite Pharmacy - Kroonstad Jurg Van Der Westhuizen Pharmacy Kroonstad Frankfort Clicks Pharmacy - Goldfi elds Mall Welkom Clicks Pharmacy - Bayswater Bloemfontein Clicks Pharmacy - Harrismith Harrismith Clicks Pharmacy - Fleurdal Bloemfontein Medi-Rite Pharmacy - Goldfi elds Welkom Clicks Pharmacy - Fichardtpark Bloemfontein Clicks Pharmacy - Dihlabeng Bethlehem Central Park Pharmacy Bloemfontein U Pharmacy - Riebeeckstad Welkom Clicks Pharmacy - Loch Logan Bloemfontein Clicks Pharmacy - Ficksburg Ficksburg Vrystaat Pharmacy Bloemfontein Redicare Pharmacy Bloemfontein Netcare Universitas Pharmacy Bloemfontein Dis-Chem Langenhovenpark Pharmacy Bloemfontein Medi-Rite Pharmacy - Bloemfontein Bloemfontein Clicks Pharmacy - Woodland Hills Bloemfontein Bothaville Pharmacy Bothaville Rockville Alpha Pharmacy Mangaung Medi-Rite Pharmacy - Westdene Bloemfontein Clicks Pharmacy - Boitumelo Junction Welkom Kroonstad Pharmacy Kroonstad Clicks Pharmacy - Botshabelo Botshabelo Clicks Pharmacy - Dynarc Walk Bloemfontein The Towers Pharmacy Bloemfontein Medi-Chem Westdene Pharmacy Bloemfontein Lengau Alpha Pharmacy Bloemfontein Medi-Chem Pharmacy - Universitas Bloemfontein Clicks Pharmacy - Heidedal Bloemfontein Medi-Chem Rosepark Pharmacy Bloemfontein Bloemfontein Pharmacy Bloemfontein 14 SAMWUMED MEMBER GUIDE 2018

21 FREE STATE (CONTINUED) GAUTENG (CONTINUED) E R Meyer Pharmacy Odendaalsrus Clicks Pharmacy - Eastgate (Bruma) Germiston Avenue Pharmacy Virginia Empilweni Pharmacy Soweto Oranje Pharmacy Virginia Clicks Pharmacy - Campus Square Virginia Pharmacy Virginia Clicks Pharmacy - Town Square Roodepoort Harrismith Apteek En Medisyne Depot Harrismith Clicks Pharmacy - Clearwater Mall Roodepoort Flamingo Pharmacy Welkom Eldoraigne Village Pharmacy Centurion Senekal Pharmacy Senekal Netcare Clinton Pharmacy Alberton Netcare Parys Pharmacy Parys Wilgers Apteek Riverside Pharmacy - Sasolburg Sasolburg Dis-Chem Olympus Pharmacy Medi Bloem Pharmacy Bloemfontein Dis-Chem Lynnwood Road Pharmacy Netcare Kroon Pharmacy Kroonstad Dis-Chem Benmore Gardens Pharmacy Sandton Pharmacross Pharmacy - Bloemfontein Bloemfontein Dahya's Pharmacy Randburg C Kroon Apteek Spitskop Pharmacy Wilge Apteek Netcare Vaalpark Pharmacy The Village Pharmacy Botshabelo Pharmacy GAUTENG Viljoenskroon Bloemfontein Frankfort Sasolburg Marquard Botshabelo Clicks Pharmacy - Saxby (Netcare Saxby Pharmacy) Netcare Olivedale Pharmacy Clicks Pharmacy - Fourways Gardens Duxmed Pharmacy Dis-Chem Cresta Pharmacy Ferngate Pharmacy Pick N Pay Pharmacy - Faerie Glen Centurion Randburg Sandton Lenasia South Randburg Randburg Netcare Mulbarton Pharmacy Sunward Park Pharmacy Netcare Akasia Pharmacy Pharma Valu - Queenswood Clicks Pharmacy - Ontdekkers Park Roodepoort (Netcare Roodepoort Dispensary) Dis-Chem Roodepoort Pharmacy Clicks Pharmacy - Montana Crossing Doornpoort Pharmacy & Medicine Depot Arrie Nel Pharmacy & Medisyne Depot Netcare Bougainville Private Pharmacy Dis-Chem Centurion Pharmacy Clicks Pharmacy - Village View Clicks Pharmacy - Rosebank Clicks Pharmacy - Menlyn Retail Park Clicks Pharmacy - Midrand Dis-Chem Northgate Pharmacy Dis-Chem Parkmeadows Pharmacy Boksburg Akasia Roodepoort Roodepoort Centurion Germiston Midrand Randburg Park Central Pharmacy Rant-En-Dal Pharmacy Clicks Pharmacy - Cresta Centre Pick N Pay Pharmacy - Bedworth Dis-Chem Montana North Pharmacy Clicks Pharmacy - Northgate Sacks Pharmacy Farrar Care Pharmacy Blairgowrie Pharmacy Medi-Rite Pharmacy - Kempton Park Medi-Rite Pharmacy - Roodepoort Pick N Pay Pharmacy - Boksburg Menlo Park Pharmacy Medi-Rite Pharmacy - Centurion Medi-Rite Pharmacy - Menlyn Medi-Rite Pharmacy - Vanderbijlpark Pick N Pay Pharmacy - Norwood Dis-Chem Norwood Gardens Pharmacy Clicks Pharmacy - Silverwater Crossing Medi-Rite Pharmacy - Eastgate Krugersdorp Randburg Vereeniging Randburg Krugersdorp Benoni Randburg Kempton Park Roodepoort Boksburg Centurion Vanderbijlpark Germiston SAMWUMED MEMBER GUIDE

22 GAUTENG (CONTINUED) GAUTENG (CONTINUED) Medi-Rite Pharmacy - Edenvale Edenvale Clicks Pharmacy - Vaal Mall Vanderbijlpark Medi-Rite Pharmacy - Sandton Sandton Clicks Pharmacy - Lambton Germiston Dis-Chem Boksburg North Pharmacy Boksburg Clicks Pharmacy - Jabulani Mall Soweto Clicks Pharmacy - Featherbrook Roodepoort Medi-Rite Pharmacy - Mayville Medi-Rite Pharmacy - Fourways Sandton Medi-Rite Pharmacy - Parklands Boksburg Clicks Pharmacy - Edenmeadow Edenvale Clicks Pharmacy - Menlyn Clicks Pharmacy - Springs Clicks Pharmacy - Killarney Mall Medi-Rite Pharmacy - Montana Clicks Pharmacy - Sandton City Clicks Pharmacy - Mall@reds Clicks Pharmacy - Festival Mall Brooklyn Pharmacy Clicks Pharmacy - Alberton Clicks Pharmacy - Carnival Mall Pick N Pay Pharmacy - Steeledale Clicks Pharmacy - Lakeside Mall Clicks Pharmacy - Lonehill Clicks Pharmacy - Sanridge Square Clicks Pharmacy - Brooklyn Mall Medi-Rite Pharmacy - Westgate Medi-Rite Pharmacy - Marks Park Clicks Pharmacy - Midway Mews Wonderpark Pharmacy Clicks Pharmacy - Jacaranda Centre Olivewood Pharmacy Barclay Square Pharmacy Clicks Pharmacy - Trade Route Mall Springs Sandton Centurion Kempton Park Alberton Brakpan South Benoni Sandton Midrand Roodepoort Vereeniging Midrand Akasia Lenasia South Clicks Pharmacy - Columbine Square Pick N Pay Pharmacy - Centurion Pick N Pay Pharmacy - Montana Joburg City Pharmacy Clicks Pharmacy - Southdowns Clicks Pharmacy - Bellairs Clicks Pharmacy - East Rand Mall Clicks Pharmacy - Greenstone Mall Kungwini Pharmacy Pick N Pay Pharmacy - Greenstone Clicks Pharmacy - Cedar Road Dis-Chem Hazeldean Pharmacy Dis-Chem Athol Oaklands Pharmacy Dis-Chem Farramere Pharmacy Clicks Pharmacy - Maponya Mall Medi-Rite Pharmacy - Arcon Park Medi-Rite Pharmacy - Quagga Pick N Pay Pharmacy - Soweto Clicks Pharmacy - Fourways Mall Clicks Pharmacy - Key West Clicks Pharmacy - the Glen South Centurion Centurion Randburg Boksburg Lethabong Bronkhorstspruit Lethabong Sandton Benoni Pimville Vereeniging Soweto Sandton Krugersdorp South Dis-Chem Carlswald (Midrand) Pharmacy Dis-Chem Greenstone Mall Pharmacy Dis-Chem Strubens Valley Pharmacy Midrand Lethabong Roodepoort Medi-Rite Pharmacy - Glenvista Clicks Pharmacy - Southgate South South Clicks Pharmacy - Wonderpark Akasia Dis-Chem Woodmead Pharmacy Sandton Medi-Rite Pharmacy - Ontdekkers Roodepoort Clicks Pharmacy - Bedford Centre Germiston Gallo Manor Pharmacy Sandton Pick 'n Pay Pharmacy - Woodmead Sandton Dis-Chem Vaal Mall Pharmacy Vanderbijlpark Clicks Pharmacy - Kolonade Clicks Pharmacy - Eco Boulevard Centurion Clicks Pharmacy - Meyerton Meyerton Medi-Rite Pharmacy - Balfour Park Medi-Rite Pharmacy - Gezina Clicks Pharmacy - Silverlakes Clicks Pharmacy - Hatfi eld Plaza Clicks Pharmacy - Riverside Boulevard Vanderbijlpark Clicks Pharmacy - Randfontein Randfontein 16 SAMWUMED MEMBER GUIDE 2018

23 GAUTENG (CONTINUED) GAUTENG (CONTINUED) Clicks Pharmacy - Carletonville Clicks Pharmacy - Fedsure Forum Clicks Pharmacy - Hyde Park Clicks Pharmacy - Carlton Centre Clicks Pharmacy - Norkem Mall Clicks Pharmacy - Northvaal Arcade Dis-Chem Wonderboom Pharmacy Clicks Pharmacy - Rivonia Dis-Chem Raslouw Pharmacy Clicks Pharmacy - the Zone Medi-Rite Pharmacy - Lenasia Medi-Rite Pharmacy - Moreleta Park Clicks Pharmacy - Quagga Centre Clicks Pharmacy - Brackenhurst Clicks Pharmacy - Sunninghill Medi-Rite Pharmacy - Raslouw Clicks Pharmacy - Sunnypark Carletonville Sandton Kempton Park Sandton Centurion Lenasia Alberton Sandton Centurion Clicks Pharmacy - Bronkhorstspruit Clicks Pharmacy - Fourways Crossing Clicks Pharmacy - Northmead Square Medi-Rite Pharmacy - Jan Smuts Clicks Pharmacy - the Angelo - Nigel Clicks Pharmacy - Lynridge Mall Medi-Rite Pharmacy - Randburg Medi-Rite Pharmacy - Grey Owl Medi-Rite Pharmacy - Horizon View Medi-Rite Pharmacy - Bartlett Irene Pharmacy Clicks Pharmacy - the Village@moreleta Clicks Pharmacy - Northpark Clicks Pharmacy - Lyttleton Clicks Pharmacy - the Grove Clicks Pharmacy - Comaro View Bronkhorstspruit Sandton Benoni Kempton Park Nigel Randburg Olifantsfontein Roodepoort Boksburg Centurion Centurion South Clicks Pharmacy - Atlasville Boksburg Clicks Pharmacy - Olivedale Randburg Clicks Pharmacy - Gezina Clicks Pharmacy - Valley Centre Randburg Clicks Pharmacy - Brightwater Commons Randburg Dis-Chem Krugersdorp Pharmacy Krugersdorp Clicks Pharmacy - Glenvista Greenways Lambton Pharmacy Clicks Pharmacy - Percegold Clicks Pharmacy - Bryanston South Germiston Sandton Dis-Chem Brooklyn Mall Pharmacy Clicks Pharmacy - Losberg Medi-Rite Pharmacy - Braam Fisher Dis-Chem Woodlands Boulevard Pharmacy Fochville Randburg Clicks Pharmacy - Woodbridge Mall Kempton Park Clicks Pharmacy - Waverley Medi-Rite Pharmacy - Atteridgeville Pick N Pay Pharmacy - Hurlingham Sandton Clicks Pharmacy - Rand City Mall (2nd Avenue) Clicks Pharmacy - Randburg Clicks Pharmacy - Southdale Alberton Randburg South Dis-Chem Clearwater Mall Pharmacy Khanyisa Sosh Pharmacy Clicks Pharmacy - Selcourt Towers Medi-Rite Pharmacy - Daspoort Roodepoort Soshanguve Springs Clicks Pharmacy - Parkrand Boksburg Medi-Rite Pharmacy - Dobsonville Soweto Clicks Pharmacy - River Square Vereeniging Waterkloof Corner Pharmacy Clicks Pharmacy - Broadacres Sandton Medi-Rite Pharmacy - Chris Hani Crossing Vosloorus Medi-Rite Pharmacy - Palm Springs Springs Medi-Rite Pharmacy - Brakpan Brakpan Medi-Rite Pharmacy - Jabulani Soweto Medi-Rite Pharmacy - Benoni Lake Benoni Medi-Rite Pharmacy - Greenstone Lethabong Dis-Chem Verdi Pharmacy Randburg Clicks Pharmacy - Wonderboom Clicks Pharmacy - Heathway Square Randburg Van Heerden Pharmacy - Parkview Clicks Pharmacy - Lemon Tree Alberton Dis-Chem the Glen Pharmacy South Clicks Pharmacy - Appletons Village Randburg SAMWUMED MEMBER GUIDE

24 GAUTENG (CONTINUED) GAUTENG (CONTINUED) Clicks Pharmacy - Chris Hani Crossing Vosloorus Van Heerden Pharmacy - Herfsblaar Clicks Pharmacy - Tembisa Tembisa Medi-Rite Pharmacy - Randfontein Randfontein Clicks Pharmacy - Horizon - Roodepoort Clicks Pharmacy - Honey Ridge Firstcare Courier Pharmacy Clicks Pharmacy - Eldo Square Clicks Pharmacy - Melrose Arch Clicks Pharmacy - Farrarmere Dis-Chem Three Rivers Pharmacy Dis-Chem Victory Park Pharmacy Dis-Chem Carnival Mall Pharmacy Medi-Rite Pharmacy - Golden Walk Dis-Chem Direct Oncology Pharmacy Clicks Pharmacy - Jubilee Mall Roodepoort Randburg Krugersdorp Centurion Benoni Vereeniging Randburg Brakpan Germiston Midrand Hammanskraal Clicks Pharmacy - Diepkloof Square Albemarle Pharmacy Clicks Pharmacy - Protea Glen Dis-Chem Festival Mall Pharmacy Medi-Rite Pharmacy - Riverview Clicks Pharmacy - Cradlestone Mall Dis-Chem Cradlestone Pharmacy Dis-Chem Rosebank Pharmacy Dis-Chem Wonderpark Pharmacy Clicks Pharmacy - Mamelodi Crossing Clicks Pharmacy - Norwood Mall Clicks Pharmacy - Parkview Clicks Pharmacy - Cosmo City Diepkloof Germiston Soweto Kempton Park Krugersdorp Krugersdorp Roodepoort Akasia Randburg Clicks Pharmacy - Centurion Lifestyle Centre Dis-Chem Glenfair Pharmacy Centurion Clicks Pharmacy - Mabopane Pick N Pay Pharmacy - Randfontein (Helikonpark Pharmacy) Mabopane Randfontein Netcare Waterfall City Pharmacy Midrand Clicks Pharmacy - Forest Hill Centurion Medi-Rite Pharmacy - Carnival City Brakpan Clicks Pharmacy - Balfour Park Oakdene Pharmacy Medi-Rite Pharmacy - Southgate South South Clicks Pharmacy - Soshanguve Crossing Clicks Pharmacy - Eyethu Orange Farm Lennymed Pharmacy Soshanguve Orange Farm Westonaria Medi-Rite Pharmacy - Northcliff Corner Randburg Medi-Rite Pharmacy - North Dis-Chem Nicolway Pharmacy Sandton Dis-Chem Park Station Pharmacy Medi-Rite Pharmacy - Three Rivers Clicks Pharmacy - Birchleigh North Clicks Pharmacy - Elspark Vereeniging Kempton Park Germiston Dis-Chem Southgate Mall Pharmacy Dis-Chem Heidelberg Mall Pharmacy South Heidelberg - GP Clicks Pharmacy - Meyersdal Alberton Dis-Chem Glen Acres Pharmacy Kempton Park Medi-Rite Pharmacy - Silver Lakes Spar - Willow Way Medi-Rite Pharmacy - Protea Glen Mall Soweto Dis-Chem Vanderbijlpark Pharmacy Vanderbijlpark Clicks Pharmacy - Flora Centre Pick N Pay Pharmacy - the Falls Clicks Pharmacy - Protea Gardens Pick N Pay Pharmacy - Brentwood Park Clicks Pharmacy - Tsakane Clicks Pharmacy - Cavendish Glen Dis-Chem Westgate Pharmacy Clicks Pharmacy - Crowthorne Pick N Pay Pharmacy - Lonehill Roodepoort Roodepoort Soweto Benoni Brakpan Kempton Park Roodepoort Midrand Sandton Clicks Pharmacy - Heidelberg Mall Clicks Pharmacy - Newtown Junction Dis-Chem Jean Avenue Pharmacy Dis-Chem Bedford Square Pharmacy Clicks Pharmacy - Mark Park Clicks Pharmacy - Dainfern Square U Pharmacy - Nevada Dis-Chem Direct Courier Pharmacy Dis-Chem Killarney Mall Pharmacy Heidelberg - GP Centurion Germiston Vereeniging Sandton Alberton Midrand 18 SAMWUMED MEMBER GUIDE 2018

25 GAUTENG (CONTINUED) GAUTENG (CONTINUED) Dis-Chem Dainfern Square Pharmacy Sandton Medicare Pharmacy - Grosvenor Sandton Clicks Pharmacy - Sancardia Linksfi eld Park Clinic Pharmacy Dis-Chem Mall of the South Pharmacy Clicks Pharmacy - Mall of the South South South Clicks Pharmacy - Rynfi eld Square Clicks Pharmacy - Springs Mall Dawn Park Pharmacy Benoni Springs Boksburg Dis-Chem Sunninghill Pharmacy Sandton Dis-Chem Springs Mall Pharmacy Springs Pick N Pay Pharmacy - Glen Balad Kempton Park Clicks Pharmacy - Alex Mall Alexandra Spar - Evaton Sebokeng Docmed Pharmacy Vanderbijlpark Clicks Pharmacy - Golden Walk Germiston Dis-Chem Rynfi eld Terrace Pharmacy Benoni U Pharmacy - Vorna Valley Midrand Clicks Pharmacy - Irene Village Mall Centurion Clicks Pharmacy - Waterfall Corner Midrand Dis-Chem Randfontein Pharmacy Randfontein Clicks Pharmacy - Blue Hills Stix Morewa Memorial Pharmacy U Pharmacy - Waverley Clicks Pharmacy - Wingtip Clicks Pharmacy - Northmead Mall Dis-Chem Direct Oncology Pharmacy Clicks Pharmacy - Olympus Village Midrand Benoni Midrand Dis-Chem Jubilee Mall Pharmacy Kilburn Pharmacy Clicks Pharmacy - Kyalami Corner Clicks Pharmacy - Middestad Clicks Pharmacy - Katlehong Clicks Pharmacy - Ontdekkers Park Roodepoort (Netcare Roodepoort Dispensary) Hammanskraal Roodepoort Midrand Katlehong Roodepoort Dis-Chem Mall of Africa Pharmacy Medi-Rite Pharmacy - Mall of Africa Clicks Pharmacy - Mall of Africa Clicks Pharmacy - Carletonville Mall Midrand Midrand Midrand Carletonville Clicks Pharmacy - the Berg (Netcare Schoongezicht Pharmacy) Clicks Pharmacy - Carlswald Clicks Pharmacy - Constantia (Netcare Constantia Pharmacy) Randburg Midrand Clicks Pharmacy - Oakfi elds Clicks Pharmacy - Thabong Clicks Direct Medicines Benoni Sebokeng Randburg Clicks Pharmacy - Nimrod Park (Netcare Monument Dispensary) Clicks Pharmacy - Kembirch (Netcare Kembirch Dispensary) Kempton Park Kempton Park Clicks Pharmacy - Equestria Dis-Chem Newmarket Mall Pharmacy Northriding Pharmacy Alberton Randburg Clicks Pharmacy - North (Netcare North Dispensary) Clicks Pharmacy - Saxby (Netcare Saxby Pharmacy) Centurion Dis-Chem Menlyn Park Pharmacy Clicks Pharmacy - Sinoville Dis-Chem Maponya Mall Pharmacy Dis-Chem Greenvalley Pharmacy Soweto Lethabong Clicks Pharmacy - Silverton Street (Netcare Silverton Dispensary) Dis-Chem Valley View Pharmacy The Local Choice Pharmacy - Village Centre Krugersdorp Winternest Pharmacy Kelly Road Pharmacy Spar - Clubview (Ashmed Pharmacy) Akasia Randburg Centurion The Local Choice Pharmacy - Village Centre Dis-Chem Soshanguve Pharmacy Dis-Chem Meadowdale Mall Pharmacy Soshanguve Germiston Dorite Spar - Jean Avenue Centurion Clicks Pharmacy - Germiston Germiston Clicks Pharmacy - Daveyton Mall Benoni Clicks Pharmacy - Benoni Benoni Clicks Pharmacy - Menlyn Maine Atlyn Pharmacy Nelson Mandela Children's - Pharmacy SAMWUMED MEMBER GUIDE

26 GAUTENG (CONTINUED) GAUTENG (CONTINUED) Clicks Pharmacy - West (Netcare West Dispensary) Clicks Pharmacy - Vereeniging (Netcare Vereeniging Pharmacy) Vereeniging Medi-Park Apteek Ferryvale Pharmacy De Wiekusweg Apteek Kempton Park Nigel Kempton Park Clicks Pharmacy - Edenvale Edenvale Moreletapark Apteek Clicks Pharmacy - Boksburg (Netcare Boksburg Dispensary) Clicks Pharmacy - Sophia Town (Netcare Sophiatown Pharmacy) Clicks Pharmacy - Rabie Street Clicks Pharmacy - Krugersdorp Clicks Pharmacy - Dalpark Clicks Pharmacy - Selection Park Dis-Chem Melville Pharmacy Dis-Chem Morningside Pharmacy Dis-Chem 55 Pharmacy Dis-Chem Gandhi Square Pharmacy Benns Pharmacy Ackermans Apteek Heidelberg Apteek Boksburg Randburg Krugersdorp Brakpan Springs Sandton Centurion Brakpan Germiston Heidelberg - GP Jacqueline Pharmacy Dis-Chem Randridge Medicine Centre Pharmacy Mega Apteek & Medisyne Depot Station Pharmacy - Mayfair Adlams Pharmacy Oberholzer Netcare Krugersdorp Pharmacy Netcare Unitas Pharmacy Clicks Pharmacy - Woodlands Boulevard Netcare Jakaranda Pharmacy Serene Apteek Panorama Pharmacy Pharma Valu - Die Hoek Netcare Garden City Pharmacy Baker Street Pharmacy Alberton Randburg Vereeniging Carletonville Krugersdorp Centurion Centurion Edenvale El Corro Link Pharmacy Randburg Kagiso Pharmacy Krugersdorp Dis-Chem Mondeor Pharmacy South Dr S K Matseke Memorial Pharmacy Diepkloof Rosebank Clinic Pharmacy Dis-Chem the Mall Pharmacy Sandton Milpark Dispensary Rox Pharmacy Adlams Pharmacy - Carletonville Carletonville Bronkhorstspruit Dispensary Clicks Pharmacy - Centurion Centre (Hyper-Pharm Centurion) Bronkhorstspruit Centurion Vanderwalt Pharmacy Meyerton Henda Pharmacy Nigel Apteek Eastwood Park Pharmacy Kramer's Pharmacy Randgate Pharmacy Alpha Petersfi eld Pharmacy Strubenvale Pharmacy Netcare Rand Clinic Dispensary Cullinan Pharmacy Nigel Randfontein Springs Springs Cullinan Van Heerden Apteek & Medisyne Depot - Hamilton Netcare Sunninghill Pharmacy Netcare Linmed Pharmacy Colony Pharmacy Netcare Linksfi eld Park Retail Pharmacy Netcare Bell St Pharmacy Clicks Pharmacy - Boksburg (Netcare Boksburg Dispensary) Sandton Benoni Randburg Krugersdorp Boksburg Netcare Park Lane Pharmacy Clicks Pharmacy - Edenvale Edenvale Clicks Pharmacy - Doringkloof Tileba Apteek Harmelia Apteek Centurion Akasia Germiston Clicks Pharmacy - Kembirch (Netcare Kembirch Dispensary) Clicks Pharmacy - Gezina (Netcare Gezina Dispensary) Kempton Park Bronberrik Pharmacy Netcare Union Pharmacy Centurion Alberton Clicks Pharmacy - Gezina (Netcare Gezina Dispensary) 20 SAMWUMED MEMBER GUIDE 2018

27 GAUTENG (CONTINUED) GAUTENG (CONTINUED) Clicks Pharmacy - Rabie Street Clicks Pharmacy - Silverton Street (Netcare Silverton Dispensary) Arrie Nel Montana Pharmacy Clicks Pharmacy - the Berg (Netcare Schoongezicht Pharmacy) Clinix Botshelong - Empilweni Private Pharmacy Clicks Pharmacy - Watermeyer Clicks Pharmacy - North (Netcare North Dispensary) Clicks Pharmacy - Vereeniging (Netcare Vereeniging Pharmacy) Van Heerden Lynriff Apteek Clicks Pharmacy - Selection Park Clinix Tshepo-Themba Private Pharmacy Clicks Pharmacy - Germiston Clicks Pharmacy - Krugersdorp Clicks Pharmacy - Constantia (Netcare Constantia Pharmacy) Hanrimed Medisyne Depot Van Heerden Glen Village Pharmacy Netcare Femina Pharmacy Clicks Pharmacy - West (Netcare West Dispensary) Clicks Pharmacy - Sophia Town (Netcare Sophiatown Pharmacy) Clicks Pharmacy - Benoni Clicks Pharmacy - Nimrod Park (Netcare Monument Dispensary) Netcare East Pharmacy Veganview Dispensary Lily Pharmacy Clicks Pharmacy - Atterbury Clinix Naledi-Nkanyezi Private Pharmacy Dis-Chem Bracken Gardens Pharmacy Eldo Park Pharmacy - Wierda Park Oak Avenue Pharmacy (Oaklaan-Germiston Apteek) Muntu Medicine Depot Clicks Pharmacy - Noordheuwel Netcare Montana Private Pharmacy Pharmacentre - Kyalami Randburg Randburg Vosloorus Vereeniging Springs Soweto Germiston Krugersdorp Brakpan Benoni Kempton Park Edenvale Germiston Sebokeng Alberton Centurion Boksburg Boksburg Krugersdorp Midrand Dis-Chem East Rand Pharmacy Netcare N17 Pharmacy Clicks Pharmacy - Mayville Clicks Pharmacy - Westgate (Ontdekkers Road) Clicks Pharmacy - Cornwall View Dis-Chem Rynfi eld Terrace Pharmacy Falls Apteek En Medisyne Depot Netcare Moot General Pharmacy S Buys Park Pharmacy KWA-ZULU NATAL Newlands City Pharmacy & Medicine Depot Hayfi elds Pharmacy Clicks Pharmacy - La Lucia Durdoc Clinic Pharmacy Hasmed Pharmacy Netcare Margate Pharmacy Glenwood Village Pharmacy Medi-Rite Pharmacy - Chatsworth Clicks Pharmacy - Liberty Midlands Mall Clicks Pharmacy - Gateway Medi-Rite Pharmacy - Gateway Medi-Rite Pharmacy - Pavilion Clicks Pharmacy - Shelly Beach Clicks Pharmacy - Pavilion Clicks Pharmacy - Pinetown Shepmed Pharmacy Clicks Pharmacy - Richards Bay Dis-Chem Glen Lucia Pharmacy Medi-Rite Pharmacy - Richards Bay Pick N Pay Pharmacy - Durban North Just Health Pharmacy Clicks Pharmacy - Kensington Square Springmed Pharmacy Clicks Pharmacy - Westville Mall Clicks Pharmacy - Hayfi elds Boksburg Springs Roodepoort Benoni Benoni Carletonville Newlands West Pietermaritzburg La Lucia Durban Phoenix Margate Berea Chatsworth Pietermaritzburg Umhlanga Umhlanga Westville Margate Westville Pinetown Pinetown Richards Bay La Lucia Richards Bay Durban North Durban Durban North Durban Durban Pietermaritzburg SAMWUMED MEMBER GUIDE

28 KWA-ZULU NATAL (CONTINUED) KWA-ZULU NATAL (CONTINUED) Clicks Pharmacy - Amajuba Mall Newcastle People's Choice Pharmacy Kokstad Netcare Alberlito - Pharmacy Dolphin Coast Dis-Chem Richards Bay Pharmacy Richards Bay Dis-Chem Hillcrest Pharmacy Hillcrest Clicks Pharmacy - Southway Mall Durban South Medi-Rite Pharmacy - Shallcross Queensburgh Clicks Pharmacy - Ladysmith Ladysmith Clicks Pharmacy - Ballito Lifestyle Dolphin Coast Link Hills Pharmacy Waterfall Medi-Rite Pharmacy - Shelley Beach Dis-Chem Westville Pharmacy D-Med Pharmacy Umhlanga Medical Centre Pharmacy Clicks Pharmacy - Montclair Port Shepstone Westville Durban Umhlanga Durban South Clicks Pharmacy - Musgrave Clicks Pharmacy - Queensburgh Eastbury Pharmacy Clicks Pharmacy - Margate Medi-Rite Pharmacy - Edendale Mall Berea Durban Phoenix Margate Pietermaritzburg Clicks Pharmacy - Scottburgh Clicks Pharmacy - Empangeni Clicks Pharmacy - Windermere Scottburgh/ Umzinto North Empangeni Berea Westville Dolphin Coast Clicks Pharmacy - Westville Village Clicks Pharmacy - Umhlali Dis-Chem Liberty Midlands Mall Pharmacy Pietermaritzburg Endumeni Pharmacy Medi-Rite Pharmacy - Boardwalk Clicks Pharmacy - the Bluff Clicks Pharmacy - Game City Medi-Rite Pharmacy - Bluff Pick N Pay Hypermarket Pharmacy - South Coast Medi-Rite Pharmacy - Newcastle Milmed Pharmacy Clicks Pharmacy - Chatsworth Clicks Pharmacy - Westguard Clicks Pharmacy - the Workshop Clicks Pharmacy - South Coast Mall Cosmed Pharmacy Clicks Pharmacy - the Galleria Amanzimtoti Dundee Richards Bay Bluff Durban Bluff Amanzimtoti Newcastle Durban Chatsworth Durban Durban Margate Margate Amanzimtoti Clicks Pharmacy - Cascades Clicks Pharmacy - Westwood Clicks Pharmacy - Reservoir Hills Clicks Pharmacy - Meer En See Medi-Rite Pharmacy - Cascades Medi-Rite Pharmacy - Castle Rock Clicks Pharmacy - Newcastle Mall Waterloo Pharmacy Clicks Pharmacy - Lillies Quarter Clicks Pharmacy - Edendale Clicks Pharmacy - Scottsville Mall Clicks Pharmacy - Bridge City Pick N Pay Pharmacy - Pavillion Pietermaritzburg Westville Durban Richards Bay Pietermaritzburg Newcastle Newcastle Blackburn Hillcrest Pietermaritzburg Pietermaritzburg KwaMashu Westville Dis-Chem Amanzimtoti Pharmacy Medi-Rite Pharmacy - Galleria Medi-Rite Pharmacy - Margate Clicks Pharmacy - Kokstad Medi-Rite Pharmacy - Bridge City Dis-Chem Ballito Junction Regional Mall Pharmacy Clicks Pharmacy - Pietermaritzburg Clicks Pharmacy - Victoria The Dundee Trading Pharmacy Amanzimtoti Amanzimtoti Margate Kokstad Iqadi Dolphin Coast Pietermaritzburg Pietermaritzburg Dundee Clicks Pharmacy - the Crescent - Umhlanga Clicks Pharmacy - Howick Clicks Pharmacy - Stanger Dis-Chem Overport Pharmacy Umtshezi Pharmacy Clicks Pharmacy - Vryheid T L C Umdloti Pharmacy Newkwa Pharmacy Dis-Chem the Pavilion Pharmacy Umhlanga Howick KwaDukuza Durban Estcourt Vryheid Umdloti Newlands West Westville 22 SAMWUMED MEMBER GUIDE 2018

29 KWA-ZULU NATAL (CONTINUED) KWA-ZULU NATAL (CONTINUED) Clicks Pharmacy - Kloof Clicks Pharmacy - Amazimtoti (Seadoone Mall) Kloof Amanzimtoti Clicks Pharmacy - Hayfi elds Mall Skinmed Pharmacy Pietermaritzburg Durban Clicks Pharmacy - Phoenix Plaza Dis-Chem Watercrest Mall Pharmacy Isandlwana Pharmacy Clicks Pharmacy - Brookside Mall Medi-Rite Pharmacy - Brookside Mall Clicks Pharmacy - Pongola Clicks Pharmacy - Kwamnyandu Clicks Pharmacy - Watercrest Mall Clicks Pharmacy - Dundee Phoenix Waterfall Vryheid Pietermaritzburg Pietermaritzburg Pongola Umlazi Waterfall Dundee Clicks Pharmacy - the Bluff Lighthouse Road Clicks Pharmacy - Meller Road Mdlovane Pharmacy Dis-Chem Cornubia Pharmacy Clicks Pharmacy - Cornubia Dis-Chem Newcastle Pharmacy Medi-Rite Pharmacy - Cornubia Ladysmith Pharmacy Bluff Pinetown Greytown Mount Edgecombe Mount Edgecombe Newcastle Mount Edgecombe Ladysmith Clicks Pharmacy - Ulundi Caremed Pharmacy Crystal Pharmacy - Kokstad Ulundi Pietermaritzburg Kokstad Spar Ramsgate Aquarius Pharmacy Medicare Pharmacy - Verulam Margate Port Shepstone Verulam Spar - Port Edward Port Edward Randeree's Pharmacy Durban Durban North Pharmacy Umhlanga Maxwell Centre Pharmacy Durban Dis-Chem the Bluff Pharmacy Bluff Linmed Pharmacy Tongaat Spar - Bridge City Clicks Pharmacy - Smith Street Clicks Pharmacy - Mtubatuba Dis-Chem Pinecrest Pharmacy Clicks Pharmacy - Kingsburgh Hilton Health Pharmacy Main Pharmacy - Hill Street Mpop-Med Pharmacy Spar - Winkle Clicks Pharmacy - Umlazi Mega City KwaMashu Durban Mtubatuba Pinetown Amanzimtoti Hilton Pinetown Umhlabuyalingana Rural Kingsburgh Umlazi Delta Pharmacy Netcare Kingsway Pharmacy Scott Street Day & Nite Pharmacy Naveen's Pharmacy Remedia Pharmacy Netcare Parklands Pharmacy Whitehouse Mall Pharmacy Netcare St Augustine's - Dispensary Pietermaritzburg Amanzimtoti Scottburgh/ Umzinto North Newcastle Vryheid Durban Port Shepstone Berea Ekuphileni Pharmacy Newcastle Parkgate Pharmacy & Medicine Depot Phoenix Medi-Rite Pharmacy - Mangusi Hluhluwe Motalas Pharmacy Durban Ahmed Al-Kadi Private Pharmacy Durban Stanger Pharmacy KwaDukuza Nature's Health Pharmacy Clicks Pharmacy - Ballito Junction Regional Mall Chatsworth Dolphin Coast Netcare St Anne's Pharmacy Stonebridge Pharmacy & Medicine Depot Pietermaritzburg Phoenix Dis-Chem Southcoast Mall Pharmacy Clicks Pharmacy - Berea Centre Clicks Pharmacy - Conabor Street Clicks Pharmacy - Hillcrest Corner Margate Berea Durban Hillcrest Medpharm Pharmacy Pointmed Pharmacy Clicks Pharmacy - the Bluff Lighthouse Road Pietermaritzburg Durban Bluff SAMWUMED MEMBER GUIDE

30 KWA-ZULU NATAL (CONTINUED) LIMPOPO (CONTINUED) Clicks Pharmacy - Conabor Street Clicks Pharmacy - Hayfi elds Mall Clicks Pharmacy - Meller Road The Bay - Pharmacy Murray Square Pharmacy & Medicine Depot Netcare Umhlanga - Pharmacy Rinaldo Pharmacy Medfi eld Pharmacy LIMPOPO Clicks Pharmacy - Polokwane 2 Mokopane Pharmacy - Potgietersrus Van Heerden Pharmacy - Tzaneen Thulamela Pharmacy Van Heerden Pharmacy - Thabazimbi Peacemed Pharmacy Clicks Pharmacy - Polokwane C B D Clicks Pharmacy - Cycad Medi-Rite Pharmacy - Polokwane Masingita Pharmacy Clicks Pharmacy - Tzaneen Clicks Pharmacy - Phalaborwa Van Heerden Pharmacy - Nylstroom 2 Clicks Pharmacy - Savannah Centre Ladanna Pharmacy Clicks Pharmacy - Thornhill T J Healthcare Pharmacy Dis-Chem Savannah Mall Pharmacy Dis-Chem Platinum Park Pharmacy Clicks Pharmacy - Mall of the North Medi-Rite Pharmacy - Mall of the North Dis-Chem Mall of the North Pharmacy Pick N Pay Pharmacy - Mall of the North Clicks Pharmacy - Ellisras Clicks Pharmacy - Louis Trichardt Nyeleti Pharmacy Clicks Pharmacy - Tubatse Crossing 24 Durban Pietermaritzburg Pinetown Richards Bay Pinetown Umhlanga Durban North Durban Polokwane Mokopane Tzaneen Thohoyandou Thabazimbi Tzaneen Polokwane Polokwane Polokwane Giyani Tzaneen Phalaborwa Modimolle Polokwane Polokwane Polokwane Thohoyandou Polokwane Polokwane Polokwane Polokwane Polokwane Polokwane Lephalale Louis Trichardt Greater Tzaneen Rural Burgersfort Bophelomed Pharmacy Tsusanang Pharmacy Clicks Pharmacy - Mokopane Ripfumelo Pharmacy Parks-Med Pharmacy Mutakalo Pharmacy Lombard Pharmacy Sebola Pharmacy Clicks Pharmacy - Musina Mall Clicks Pharmacy - Groblersdal ity Pharmacy Clicks Pharmacy - Thavhani Mall Mogolaneng Pharmacy Weldon's Apteek Potgietersrus Pharmacy Muldok Pharmacy Watts Apteek Van Heerden Apteek & Medisyne Depot Head Office (Warmbaths) Van Heerden Pharmacy - Nylstroom Groblersdal Pharmacy Sanbonani Pharmacy Medline Pharmacy The Local Choice Pharmacy - Polokwane Cure-O-Pharm Pharmacy Modimolle Clicks Pharmacy - Modi Mall Clicks Pharmacy - Mall@lebo (Lebowakgomo) Spar City Centre Clicks Pharmacy - Thaba Mall Clinix Phalaborwa Private Pharmacy Clicks Pharmacy - Lephalale Mall Tzaneen Pharmacy Modjadji Pharmacy - Duiwelskloof Lepele-Nkumpi Rural Polokwane Thabazimbi Phalaborwa Lephalale Tzaneen Modjadjiskloof Lepele-Nkumpi Rural Burgersfort Mokopane Greater Tzaneen Rural Polokwane Thohoyandou Tzaneen Bela-Bela Musina Groblersdal Louis Trichardt Thohoyandou Polokwane Louis Trichardt Mokopane Mokopane Mokopane Bela-Bela Modimolle Groblersdal Groblersdal Bela-Bela Polokwane Polokwane SAMWUMED MEMBER GUIDE 2018

31 MPUMALANGA MPUMALANGA (CONTINUED) Clicks Pharmacy - Highland Mews Witbank Ext 16 Clicks Pharmacy - Saveways Witbank Van Heerden Pharmacy - Sonpark - Sonheuwel Nelspruit Van Heerden Pharmacy - Nelspruit Sonheuwel Medico Medisyne Depot Secunda Medi-Rite Pharmacy - Nelspruit Nelspruit Clicks Pharmacy - Midwater Centre Aerorand Protea Medi-Wise Pharmacy Secunda Greylingstad Pharmacy Balfour Clicks Pharmacy - Standerton Standerton Clicks Pharmacy - Highveld Mall Witbank Clicks Pharmacy - Riverside Mall Nelspruit Clicks Pharmacy - Middelburg Middelburg Van Heerden Pharmacy - Sabie Sabie Cosmos Pharmacy Bethal Laeveld Pharmacy White River Clicks Pharmacy - Hazyview Hazyview Medi-Rite Pharmacy - Ermelo Ermelo Medi-Rite Pharmacy - Bell Street Nelspruit Dis-Chem Nelspruit Pharmacy Nelspruit Medi-Rite Pharmacy - Klipfontein Klipfontein Clicks Pharmacy - Delmas Delmas Mopani Pharmacy - Ilanga Mall Nelspruit Dis-Chem Witbank Pharmacy Witbank Russells Pharmacy Nelspruit Rixile Pharmacy Bushbuckridge Clicks Pharmacy - Ermelo Ermelo Clicks Pharmacy - Ilanga Mall Nelspruit Medi-Rite Pharmacy - Lydenburg Lydenburg Zamantungwa Pharmacy - Amersfoort Amersfoort Pick N Pay Pharmacy - Middelburg Middelburg Clicks Pharmacy - Middelburg Mall Middelburg Medi-Rite Pharmacy - Middelburg Mall Middelburg Clicks Pharmacy - Ben Fleur Witbank Mopani Pharmacy - White River White River Vigilcare Pharmacy - Mhluzi Mhluzi Ext 4 Dis-Chem Secunda Pharmacy Secunda Clicks Pharmacy - Secunda Regional Mall Secunda U Pharmacy - Kriel Kriel Dis-Chem Middelburg Mall Pharmacy Mpumelelo Pharmacy U Pharmacy - Emalahleni U Pharmacy - Transvalia Clicks Pharmacy - Barberton Clicks Pharmacy - Emba Medi-Rite Pharmacy - Secunda Clicks Pharmacy - K G Mall Clicks Pharmacy - Malelane Ingwe Centre Clicks Pharmacy - Mfula Clicks Pharmacy - Nelspruit (Netcare Nelspruit Pharmacy) Clicks Pharmacy - Tonga Mall Clicks Pharmacy - Phola Park M G Eksteen Apteek Van Biljon Apteek Kark Apteek Leading Pharmacy Melrow Pharmacy Bhyat Pharmacy Evander Pharmacy Eastdene Pharmacy Hazyview Apteek Komati Pharmacy Tasbet Park Apteek Clicks Pharmacy - Nelspruit (Netcare Nelspruit Pharmacy) Rivermall Pharmacy NORTH WEST Blackmode Pharmacy Clicks Pharmacy - Mafi keng Clicks Pharmacy - Wilkoppies Clicks Pharmacy - Potchefstroom Clicks Plus Pharmacy - Waterfall Mall Klerksdorp Pharmacy Ifafi Pharmacy Clicks Pharmacy - Klerksdorp Krishna Medi Pharmacy Taljaard Aptekers Middelburg Witbank Witbank Secunda Barberton Embalenhle Secunda Emalahleni Malelane Piet Retief Nelspruit Tonga Kwamhlanga Barberton Belfast Bethal Delmas Ermelo Ermelo Evander Middelburg Hazyview Komatipoort Emalahleni Nelspruit Nelspruit Rustenburg Mmabatho Klerksdorp Potchefstroom Rustenburg Klerksdorp Hartbeespoort Klerksdorp Brits Coligny SAMWUMED MEMBER GUIDE

32 NORTH WEST (CONTINUED) NORTH WEST (CONTINUED) Giggs Pharmacy Rustenburg Clicks Pharmacy - Matlosana Mall Klerksdorp Wilge-Park Pharmacy Potchefstroom Molemo Good Health Pharmacy Mmabatho Schoemansville Pharmacy Hartbeespoort Valumed Sun City Pharmacy Rustenburg Kampus Apteek Potchefstroom Clicks Pharmacy - Boitekong Rustenburg Tuscany Pharmacy Rustenburg Clicks Pharmacy - Thabo Mbeki Rustenburg Medi-Rite Pharmacy - Klerksdorp Klerksdorp Clicks Pharmacy - Lombard Street Potchefstroom Molemo Pharmacy Mmabatho Bloemhof Apteek Bloemhof Dis-Chem Rustenburg Pharmacy Rustenburg Saambou Pharmacy Klerksdorp Clicks Pharmacy - Thabo Mbeki Rustenburg Springbok Apteek - Klerksdorp Klerksdorp Biblio Plaza Pharmacy Rustenburg Atomic Pharmacy Orkney Ridder Street Pharmacy Rustenburg Orkney Pharmacy Orkney Clicks Pharmacy - Brits Brits Mooi River Pharmacy Potchefstroom Clicks Pharmacy - Mooi River Potchefstroom Nissen's Pharmacy Rustenburg Mesemed Pharmacy Ventersdorp Deka Apteek Stilfontein Medi-Rite Pharmacy - Mooirivier Potchefstroom Andre Pharmacy Rustenburg Clicks Pharmacy - Rustenburg Rustenburg Chris Gibson Pharmacy Rustenburg Medi-Rite Pharmacy - Hartebeespoort Hartbeespoort Waldorf Pharmacy & Medicine Depot Klerksdorp Clicks Pharmacy - Vryburg Vryburg Nel 3 Pharmacy Brits Clicks Pharmacy - Hartebeespoortdam Hartbeespoort Van Rensburg Pharmacy & Med Depot Brits Clicks Pharmacy - Zeerust Zeerust Vryburg Apteek Vryburg Clicks Pharmacy - Mafi keng Crossing Mooinooi Apteek Dis-Chem Potchefstroom Pharmacy Wollies Pharmacy Hartbeesfontein Pharmacy Clicks Pharmacy - Lombard Street Wilmed Park Pharmacy Netcare Ferncrest Pharmacy Mmabatho Mooinooi Potchefstroom Wolmaransstad Hartbeesfontein Potchefstroom Klerksdorp Tlhabane Medi-Rite Pharmacy - Waterberg Rustenburg Spar - Lautzlaan Klerksdorp Clicks Pharmacy - Brits Mall Brits Nel 2 Apteek Brits Brits Mall Pharmacy Brits Oryx Pharmacy Upington Medi-Rite Pharmacy - Brits Mall Brits Zest Pharmacy Kimberley Dis-Chem Klerksdorp Pharmacy Klerksdorp Clicks Pharmacy - Kimberley Kimberley Ibiza Pharmacy Rustenburg Clicks Pharmacy - Diamond Pavillion Kimberley Nu Horizon Pharmacy Cc Rustenburg Kathu Pharmacy Kathu Clicks Pharmacy - Lichtenburg Lichtenburg Medi-Rite Pharmacy - Kimberley Kimberley Medi-Rite Pharmacy - Taung Taung Medi-Rite Pharmacy - Diamond Pavilion Kimberley Dis-Chem Hartbeespoort Pharmacy Hartbeespoort Clicks Pharmacy - Upington Upington Medi-Rite Pharmacy - Platinum Junction Rustenburg Clicks Pharmacy - North Cape Mall Kimberley Minty's Pharmacy Klerksdorp Clicks Pharmacy - Kathu Kathu Clicks Pharmacy - Lichtenburg Mall Lichtenburg Clicks Pharmacy - Springbok Springbok Clicks Pharmacy - Moruleng Mall Rustenburg Medi-Rite Pharmacy - Upington Upington Clinix Itokolle-Victoria Private Dispensary Mmabatho Dis-Chem Kimberley Pharmacy Kimberley 26 SAMWUMED MEMBER GUIDE 2018

33 NORTH WEST (CONTINUED) WESTERN CAPE (CONTINUED) Palmae Pharmacy Kuruman Medi-Rite Pharmacy - Atlantis Clicks Pharmacy - Hartswater Hartswater Medi-Rite Pharmacy - Cape Gate Clicks Pharmacy - Kalahari Mall Upington Clicks Pharmacy - V & A Waterfront Ons Apteek Aggeneys Clicks Pharmacy - Intercare Tyger Valley Clicks Pharmacy - Kuruman Mall Kuruman Medi-Rite Pharmacy - Table View Medi-Rite Pharmacy - Kuruman Kuruman Pick n Pay Pharmacy-Ottery Clicks Pharmacy- Kameeldoorn Kathu Clicks Pharmacy - Cape Gate Clicks Pharmacy - Stone Street (Netcare Kimberley Clicks Pharmacy - Tygervalley Kimberley Pharmacy) Clicks Pharmacy - Somerset Mall Richmond Pharmacy Kimberley Clicks Pharmacy - Kenilworth Centre Assembley Pharmacy Kimberley Medi-Rite Pharmacy - Blue Route (Tokai) Port Nolloth Pharmacy Port Nolloth Dis-Chem Paarl Mall Pharmacy Paarl Clicks Pharmacy - Stone Street (Netcare Kimberley Kimberley Pharmacy) Dis-Chem Tygervalley - Willowbridge Pharmacy WESTERN CAPE Dis-Chem Claremont Pharmacy Clicks Pharmacy - Garden Route Mall George Clicks Pharmacy - Promenade Medi-Rite Pharmacy - Somerset West Somerset Clicks Pharmacy - N1 City Symphony Pharmacy Essential Health Pharmacy - Arcade Clicks Pharmacy - Glengariff Clicks Pharmacy - Paarl Mall King George Pharmacy George Clicks Pharmacy - Mountain Mill Worcester Clicks Pharmacy (Table View) Netcare Table view Pharmacy Clicks Pharmacy - Parow Centre Parow East Clicks Pharmacy - Stellenbosch (Eikestad Mall) Stellenbosch Clicks Pharmacy - Langeberg Mall Mossel Bay Caledon Pharmacy Caledon Clicks Pharmacy - Vangate Mall Mini-Kem Pharmacy Goodwood Clicks Pharmacy - Knysna Knysna Clicks Pharmacy - Edgemead Pick N Pay Pharmacy - Brackenfell Netcare Kuils River - Pharmacy Medi-Rite Pharmacy - Sea Point Parow Family Pharmacy Waterstone Pharmacy Clicks Pharmacy - Parklands Intercare Clicks Pharmacy - Rondebosch Clicks Pharmacy - Melkbos Netcare Blaauwberg Pharmacy Esack's Pharmacy Clicks Pharmacy - Hermanus Hermanus Medi-Rite Pharmacy - Parow Pick N Pay Pharmacy - Plattekloof Dis-Chem Somerset Mall Pharmacy Clicks Pharmacy - Westcoast Village Nu-Crane Pharmacy - Mitchell's Plain Essential Health Pharmacy - Protea Heights Medi-Rite Pharmacy - N1 City Clicks Pharmacy - Ceres Ceres Riverside Pharmacy - George George Pick N Pay Pharmacy - Table View Fairbairn Pharmacy Worcester Medi-Rite Pharmacy - Paarl Paarl Clicks Pharmacy - Blue Route Medi-Rite Pharmacy - Mountain Mill Clicks Pharmacy - Canal Walk Medi-Rite Pharmacy - Khayelitsha Clicks Pharmacy - Golden Acre Clicks Pharmacy - Waterstone Village SAMWUMED MEMBER GUIDE

34 WESTERN CAPE (CONTINUED) WESTERN CAPE (CONTINUED) Clicks Pharmacy - Southgate Medi-Rite Pharmacy - Weltevreden Mitchell's Plain Clicks Pharmacy - Cobble Walk Clicks Pharmacy - Oudtshoorn Clicks Pharmacy - Paarl Pick N Pay Pharmacy - Claremont Medi-Rite Pharmacy - Eerste Rivier Medi-Rite Pharmacy - Kenilworth Essential Health Pharmacy - Kuils River Clicks Pharmacy - Langebaan Clicks Pharmacy - Zevenwacht Clicks Pharmacy - Soneike Clicks Pharmacy - Burg Street Medi-Rite Pharmacy - Bothasig Akmed Pharmacy Medi-Rite Pharmacy - Witteklip Franschhoek Pharmacy Gansbaai Pharmacy Clicks Pharmacy - Graanendal Clicks Pharmacy - Robertson Clicks Pharmacy - Constantia Clicks Pharmacy-Malmesbury Medi-Rite Pharmacy - Blue Downs Clicks Pharmacy - Weskus Mall Clicks Pharmacy - Fairbridge Mall Clicks Pharmacy - Sable Square Clicks Pharmacy - Adelphi Centre Medi-Rite Pharmacy - Middestad Medi-Rite Pharmacy - Gugulethu Clicks Pharmacy - Pinelands (Howard Centre) Clicks Pharmacy - Central Square Pinelands Medi-Rite Pharmacy - Heiderand Medi-Rite Pharmacy - De Grendel Medi-Rite Pharmacy - Vineyard Medi-Rite Pharmacy - Bishop Lavis Clicks Pharmacy - Hout Bay Clicks Pharmacy - Wellington Clicks Pharmacy - Gardens Centre Medi-Rite Pharmacy - Bredasdorp 28 Oudtshoorn Paarl Langebaan Vredenburg Franschoek Gansibaai Robertson Malmesbury Vredenburg Mossel Bay Wellington Bredasdorp George Dis-Chem George Pharmacy Golden Acre Pharmacy Clicks Pharmacy - Durbanville Clicks Pharmacy - Bellville (Teddington St) Clicks Pharmacy - George C.B.D. Clicks Pharmacy - Beaufort West Medi-Rite Pharmacy - Berg River Clicks Pharmacy - Cavendish Connect Clicks Pharmacy - Gugulethu Square Medi-Rite Pharmacy - Hermanus Citrusdal Pharmacy Clicks Pharmacy - Stellenbosch Square Pick N Pay Pharmacy - Somerset Mall Dis-Chem Bayside Pharmacy Clicks Pharmacy - Regent Road Langebaan Pharmacy Clicks Pharmacy - Mossel Bay Mall Medi-Rite Pharmacy - Vasco Clicks Pharmacy - Westgate Mall (Mitchells Plain) Kwanonqaba Pharmacy Medi-Rite Pharmacy - Durbanville Pick N Pay Pharmacy - Promenade Chemcare Pharmacy Clicks Pharmacy - Plettenberg Bay Medi-Rite Pharmacy - Philippi Clicks Pharmacy - Ashers Clicks Pharmacy - Adderley Street Pick N Pay Pharmacy - George Medi-Rite Pharmacy - Lansdowne Corner Atlantis Pharmacy Stellenbosch Square Pharmacy Clicks Pharmacy - Capricorn Square Dis-Chem Blue Route Pharmacy Medi-Rite Pharmacy - Mh Parklands Clicks Pharmacy - Franschoek Clicks Pharmacy - Flamingo Square Clicks Pharmacy - Swellendam Eikestad Mall Pharmacy Medi-Rite Pharmacy - Broadway George Beaufort West Paarl Hermanus Citrusdal Stellenbosch Langebaan Mossel Bay Mossel Bay Plettenberg Bay George Stellenbosch Franschhoek Swellendam Stellenbosch Bredasdorp SAMWUMED MEMBER GUIDE 2018

35 WESTERN CAPE (CONTINUED) WESTERN CAPE (CONTINUED) Essential Health Pharmacy - Bredasdorp Clicks Pharmacy - Bredasdorp Medi-Rite Plus Pharmacy - Big Bay George Clicks Pharmacy - Prospur Clicks Pharmacy - George 2 (Pick N Pay) Mossel Bay Clicks Pharmacy - Clock Tower Mossel Bay Pharmacy Plax Chemist Medi-Rite Pharmacy - Parow Park Clicks Pharmacy - Cinnamon Square Clicks Pharmacy - the Paddocks Clicks Pharmacy - Rosmead Avenue (Netcare Kenilworth Pharmacy) Clicks Pharmacy - Table View (Netcare Table View Pharmacy) Dis-Chem Sea Point Pharmacy Clicks Pharmacy - Caledon Clicks Pharmacy - Glengarry Caledon Clicks Pharmacy - Tokai (Netcare Tokai Dispensary) Clicks Pharmacy - Kipling Street (Netcare Langeberg Pharmacy) Worcester Clicks Pharmacy - Welgemoed Clicks Pharmacy - Worcester Hermanus Melopharm Pharmacy Clicks Pharmacy - Whale Coast Clicks Pharmacy - Pinehurst Pick N Pay Pharmacy - Table Bay Clicks Pharmacy - Lansdowne Vredendal Clicks Pharmacy - Erica Square Clicks Pharmacy - Vredendal Worcester Clicks Pharmacy - Table Bay Mall Dis-Chem Worcester Pharmacy Dis-Chem Table Bay Mall Pharmacy Sandbaai Essential Health Pharmacy - Claremont Dis-Chem Hermanus Pharmacy Clicks Pharmacy - Vergelegen Culemborg Pharmacy Clicks Pharmacy - Strand Square Vitacare Unikem Pharmacy - Rylands Dis-Chem Zevenwacht Mall Pharmacy Sunset Pharmacy Dis-Chem Central Park Pharmacy Wynberg Pharmacy George Pharma-Kem Pharmacy - Strand Protea Pharmacy George Webb and Savoy Pharmacy Ress & Van Zyl Pharmacy Dis-Chem Noordhoek Pharmacy Monument Pharmacy Robertson Dis-Chem Panorama Oncology Pharmacy George Robertsons Pharmacy Wellington Medi-Rite Pharmacy - Eden Meander Bergrivier Pharmacy Worcester Chemcare Pharmacy - Church Way Homes Pharmacy Worcester Clicks Pharmacy - Atlantis QuΘnets Pharmacy Dis-Chem Cape Gate Pharmacy Essential Health Pharmacy - Brackenfell Vredenburg Medi-Rite Pharmacy - Helderberg Mall Paarl Weskem Apteek Clanwilliam Clicks Pharmacy - Laborie Paarl Sederkem Pharmacy Worcester Melopharm Tokai Pharmacy Durban Street Pharmacy - Worcester Malmesbury Rivetts Pharmacy Geard Apteek Clicks Pharmacy - 2 Long Street Mossel Bay Essential Health Pharmacy - Helderzicht Paarl Dis-Chem Mosselbaai Mall Pharmacy Drakenstein Apteek Sedgefi eld Spar - Uitzicht Sedgefi eld Pharmacy Porterville Medi-Rite Pharmacy - Langa Porterville Alpha Pharmacy Dis-Chem Liberty Promenade Pharmacy Nu-Kem Pharmacy Clicks Pharmacy - the Sanctuary Wellington Medicare Pharmacy - Retreat Clicks Pharmacy - Welgelee Plein Bredasdorp Kem-Park Pharmacy Robertson SAMWUMED MEMBER GUIDE

36 WESTERN CAPE (CONTINUED) WESTERN CAPE (CONTINUED) Wynland Pharmacy Rondebosch East Pharmacy Netcare Christiaan Barnard Memorial Pharmacy Plett Medicine Depot Eikendal Pharmacy Medical Centre Pharmacy Cylnor Pharmacy Narotam Pharmacy Broad Road Pharmacy Plettenberg Bay George Worcester Clicks Pharmacy - Bayside Centre Medi-Rite Pharmacy - Brackenfell Medi-Health Pharmacy - Stellenbosch Medigate Pharmacy Medley Pharmacy DIis-Chem Ballito Lifestyle Pharmacy Clicks Pharmacy Delft Mall Stellenbosch Steenberg Pharmacy Hypermed Pharmacy Wavecrest Pharmacy Westgate Pharmacy Onrus Onrus Pharmacy Khayelitsha Pharmacy Netcare N1 City Dispensary Mediplein Pharmacy Incorporated Stellenbosch Die Boord Apteek Bel - Kem Pharmacy Station Pharmacy Southern Suburbs Pharmacy Mossel Bay Spar - Mosskem Athlone Pharmacy Lite-Kem Pharmacy Clicks Pharmacy - Parow (Netcare Parow Dispensary) Clicks Pharmacy - Parow (Netcare Parow Dispensary) Clicks Pharmacy - Rosmead Avenue (Netcare Kenilworth Pharmacy) Vitacare Pharmacy - Rondebosch Still Bay Fynbos Pharmacy Clicks Pharmacy - Tokai (Netcare Tokai Dispensary) Ariefa's Pharmacy Clicks Pharmacy - Kipling Street (Netcare Langeberg Pharmacy) Koeberg Pharmacy Essential Health Pharmacy - Strand Paarl Gys Smit Pharmacy Kemtique Pharmacy David Bloom Pharmacy Chavda's Pharmacy 30 SAMWUMED MEMBER GUIDE 2018

37 REASONS WHY WE ARE THE BEST MEDICAL AID FOR YOU 1 MONTH WAITING PERIOD We have reduced the general waiting period from 3 months to 1. LOWEST CONTRIBUTION INCREASES IN THE INDUSTRY Our contribution increases are about the lowest in the industry. Whilst we have reviewed the Overall Annual and Limits our analysis indicates that this may only adversely affect approximately 3% of members. The average claim spend of an average family remains at approximately R so in simple logic a million rands worth of benefi t is not generally going to be consumed by the average family except being used to woo and impress members. The only incentive this creates is for opportunistic service providers. In the event that a member does require high level care for PMB conditions THERE ARE NOT LIMITS. ACCESS TO PRIVATE HOSPITALS* Our hospital contracts have been reviewed to include PMB level of care in private hospitals, subject to terms and conditions. NO SAVINGS ACCOUNTS We do NOT subscribe to Savings Accounts this ensures that members are NOT double billed. WE ARE ABLE TO PROVIDE PERSONALISED SERVICES We have our own marketing infrastructure this means that we are able to provide personalised services on an exclusive and consistent basis. We have our own offices and are rolling out more offices around the country. NO LATE JOINER FEES You do not pay late joiner fees when you join us. WE ARE FINANCIALLY STABLE We have been independently judged as the 2 nd most sustainable medical scheme in South Africa by Alexander Forbes in In 2017 we again received this accolade as one of the top three most sustainable medical scheme in South Africa. SAMWUMED MEMBER GUIDE

38 BENEFITS CAN BE GROUPED INTO TWO CATEGORIES: BENEFITS CAN BE GROUPED INTO WE BELIEVE EVERYONE IS ENTITLED TO QUALITY HEALTHCARE DAY-TO-DAY BENEFITS that you can access outside of hospital such as doctor and specialist consultations and visits, dental procedures, medication and optical care. Each benefi t category is subject to limits as specifi ed in the Scheme Rules. These benefi ts allow you and your family to access a wide range of healthcare services. SECONDARY OR TERTIARY CARE includes hospitalisation and the treatment of Prescribed Minimum Benefi t (PMB) conditions. The hospitalisation benefi t makes provision for in-hospital admission and/or transfers to rehabilitation and step-down facilities. The Chronic Disease List (CDL) specifies medication and treatment for the 26 chronic conditions that are covered in this section of the PMBs: Addison's disease Asthma Bipolar Mood Disorder Bronchiectasis Cardiac failure Cardiomyopathy Chronic obstructive pulmonary disease Chronic renal disease Coronary artery disease Crohn's disease Diabetes insipidus Diabetes mellitus types 1 & 2 Dysrhythmias Epilepsy Glaucoma Haemophilia HIV/Aids Hyperlipidaemia Hypertension Hypothyroidism Multiple sclerosis Parkinson's disease Rheumatoid arthritis Schizophrenia Systemic lupus erythematosus Ulcerative colitis NOTE* If you have any questions please contact our Contact Centre on SAMWUMED MEMBER GUIDE 2018

39 COMPREHENSIVE PREVENTATIVE CARE BENEFITS AND EARLY DETECTION Apart from ensuring our members do not fi nd themselves in hospital, the SAMWUMED Preventative Healthcare and early detection benefi t provides members with an opportunity to take ownership of their own health. This programme will ensure together we could better manage quality health outcomes which would ultimately result in lower medical aid premiums. Our amazing Preventative Healthcare Programmes includes the following screenings: AGE Adults aged 18 years and older SCREENING TEST Blood Pressure CONDITIONS 2018 Limited to one screening Pbpa Adults Type II diabetes Limited to one screening Pbpa Adults aged 20 years and older Adults aged 18 years and older Child bearing age Over the age of 50 until the age of 75. Over the age of 50 until the age of 70. Women older than 65 years and men older than 70 years 45 years to 69 years Total Blood Cholesterol Papanicolaou (Pap) test Chlamydia screening Sexually active females or beginning at age 18. Chlamydia screen is recommended as part of this process. Teach clinical breast examination to >18 This should be done concomitantly with Pap Smear. Limited to one screening Pbpa Limited to one screening Pbpa within a 2 year cycle Limited to one screening Pbpa within a 2 year cycle Folic acid Limit to 1 per month for the fi rst 3 months of pregnancy Limit to 1 per month for the fi rst 3 months of pregnancy Faecal occult blood test Mammogram Bone density Test Screening for prostate cancer Limited to one screening Pbpa Breast Cancer Every 3 years - females over the age of 50 until the age 70 Limited to one Pbpa Limited to one screening Pbpa Limited to one screening Pb every three years until the age of 70 Limited to one Pbpa Limited to one Pbpa All Ages HIV Limited to one Pbpa All Ages Cervical cancer Limited to one Pbpa every 5 years Less than 1 month old 2 to 64 years, over 65 years old TSH screening Congenital hyperthyroidism Once-off for hyperthyroidism in new-borns Pneumococcal vaccine Limit to one vaccination per benefi ciary over 65 and benefi ciaries aged 2-64 who are at risk of serious pneumococcal disease per lifetime. One vaccination per benefi ciary per lifetime All Ages Flu Vaccine Limited to one Pbpa * Pbpa = Per benefi ciary per annum SAMWUMED MEMBER GUIDE

40 ENTITLEMENT TO BENEFITS The Scheme Tariff for 2018 will be the SAMWUMED monetary tariffs applicable in 2017 increased by CPI as published by the SARB, unless an alternative tariff has been negotiated with specifi c providers, which will not be less than the fee charged by the State. Benefi ciaries are entitled to benefi ts as shown in this Annexure B, subject to the monetary limits and implementation restrictions set out herein, to the exclusions referred to in Annexure C of the Rules, to the general limitation and restriction of benefi ts set out in Annexure D of the Rules and to the procedural and other requirements set out in the Main Rules. CHANGING OF BENEFITS, LIMITS (INCLUDING OVERALL ANNUAL LIMITS), AND MEMBERSHIP CATEGORIES The column headed Limits shows the extent to which the relevant benefi t is limited annually or sub-limited in monetary value or other terms. When that limit is reached no further benefi ts are available in the category. The column headed Benefi ts shows how the cost of a valid claim shall be determined for the purpose of reimbursing the member or the supplier and the share of such cost that the Scheme will bear. The balance of the share of costs to make up 100% thereof shall be the member s responsibility, except for Prescribed Minimum Benefi ts. The overall annual benefi t limits are as follows: OPTION LIMIT Option A Option B AMMOUNTS R 300,000 per family per annum R 500,000 per family per annum Membership categories: Member only = M0 Member plus 1 dependant = M1 Member plus 2 dependants = M2 Member plus 3 or more dependants = M3+ 34 SAMWUMED MEMBER GUIDE 2018

41 General conditions for the selection/change of a Preferred Family Practitioner (PFP) The Scheme shall pay for benefi ts in respect of out-of-hospital consultations by Family Practitioners subject to the conditions set out in the Scheme Rules. Each member, on behalf of himself or herself and his or her registered dependants, shall select a PFP by completing the Selection Form as required by the Scheme. It is permissible for dependants to select different PFP s, subject to the following provisions: Adult dependants (e.g. spouses) may select a PFP of their choice; For child dependants under the age of 16 years, a PFP will be selected by the parent registered as the principal member of the Scheme; Child dependants over the age of 16 years may select their own PFP, with the consent of the parent registered as the principal member of the Scheme; A PFP may be changed at the principal member s discretion once every six (6) months by completing a Selection/Change of Preferred Family Practitioner form. These forms are available from the Employer s Human Resources Department; Where a PFP is part of a group practice of Family Practitioners, members may visit any doctor in the group practice provided that the claim is submitted on a group practice number; When a member/benefi ciary is referred by a Family Practitioner to a specialist, the consultation for the specialist will be covered in accordance with the Scheme Rules; In the event of emergencies, the rule relating to PFP s will apply. A member/benefi ciary will be required to obtain a referral number from his PFP for a specialist consultation. The following exceptions are applicable: 1 (one) Urologist consultation/ visit for male benefi ciaries 1 (one) gynaecological consultation/ visit for female benefi ciaries Children under the age of 2 (two) years, for paediatric visits / consultations Alternative healthcare practitioners Dental practitioners, technologists and therapists Maternity benefi ts - Ante natal visits and consultations Oncologists, haematologists and credentialed medical practitioners during pre, active and/ or post active treatment periods Ophthalmologist Optometrists Pathologists Psychiatrists, psychometrists, psychologists and registered counsellors Radiologists SAMWUMED MEMBER GUIDE

42 PRESCRIBED MINIMUM BENEFIT ( PMB ) RULES EXTRACT Prescribed Minimum Benefi ts as shown in Annexure A of the General Regulations, made in terms of the Medical Schemes Act 131 of 1998, override all benefi ts and limits indicated in this Annexure. The Prescribed Minimum Benefi ts are available in conjunction with the Scheme s contracted managed health care programmes, which include the application of treatment protocols, medicine formularies, pre-authorisation and case management. These measures have been implemented to ensure appropriate and effective delivery of Prescribed Minimum Benefi ts. See Annexure D - paragraph 7 for a full explanation. GENERAL BENEFITS AND LIMITS PRESCRIBED MINIMUM BENEFITS The Scheme will pay in full, without co-payment or use of deductibles, the diagnosis, treatment and care costs of the prescribed minimum benefi ts as per Regulation 8 of the Act, in compliance to agreed tariffs. The Scheme will employ appropriate interventions aimed at improving the efficiency and effectiveness of healthcare provision, including such techniques as requirements for pre-authorisation, the application of treatment protocols, and the use of formularies. (Regulation 8(3)). Where a managed health care protocol or a formulary drug preferred by the Scheme, but excluding the PMB algorithm as defi ned in the Regulation has been ineffective or would cause harm to a benefi ciary, the Scheme will fund the cost of the appropriate substitution treatment without a penalty to the benefi ciary as required by Regulation 15H and 15I of the Act. LIMITATION AND RESTRICTION OF BENEFITS In cases of an illness of a protracted nature, the Scheme shall have the right to insist upon a member or dependant of a member consulting any particular specialist, the Scheme may nominate in consultation with the attending provider. The Scheme may require a second opinion in respect of proposed health care service(s) which may result in a claim for benefi ts and for that purpose the relevant benefi ciary shall consult a dental or medical provider nominated by the Scheme and at the cost of the Scheme. In the event that the second opinion proposes different health care service(s) to the fi rst, the Scheme may in its discretion require that the second opinion proposals be followed, unless in terms of the managed health care programme. In cases where a specialist is consulted without the recommendation of a Family Practitioner, the benefi t allowed by the Scheme may, at its discretion, be limited to the amount that would have been paid to the Family Practitioner for the same service. Unless otherwise decided by the Scheme, benefi ts in respect of medicines obtained on a prescription are limited to one month s supply (or to the nearest unbroken pack) for every such prescription or repeat thereof. If the Scheme or its managed health care programme contracted service supplier has funding guidelines or protocols in respect of covered services and supplies, benefi ciaries will only qualify for benefi ts in respect of those services and supplies with reference to the available funding guidelines and protocols with due regard to the provision of Regulation 15(H) and 15(I). 36 SAMWUMED MEMBER GUIDE 2018

43 If the Scheme does not have funding guidelines or protocols in respect of benefi ts for services and supplies referred to in Annexure B, benefi ciaries will only qualify for benefi ts in respect of those services and supplies if the Scheme or its managed health care programme contracted service supplier acknowledges them as medically necessary, and then subject to such conditions as the Scheme or its managed health care programme contracted service supplier may impose. Medically necessary refers to health services or supplies that meet all the following requirements: they are required to restore normal function of an affected limb, organ, or system; no alternative exists that has a better outcome, is more cost-effective, or has a lower risk; they are accepted by the relevant service provider as optimal and necessary for the specifi c condition, and at an appropriate level to render safe and adequate care; they are not rendered or provided for the convenience of the relevant benefi ciary or service provider; outcome studies are available and acceptable to the Scheme in respect of such services or supplies. they are not rendered or provided because of personal choice or preference of the relevant benefi ciary or service provider, while other medically appropriate, more cost-effective alternatives exist. The Scheme reserves the right not to pay for any new medical technology or, investigational procedures, interventions, new drugs or medicine as applied in clinical medicine, including new indications for existing medicines or technologies, unless the following clinical data relating to the above have been presented to and accepted by the Medical Advisory Committee and such data demonstrating their: therapeutic role in clinical medicine; cost-efficiency and affordability; value relative to existing services or supplies; role in drug therapy as established by the Schemes managed health care programme contracted service supplier. In the event that: the treatment of an extended chronic sickness condition becomes necessary; a disease or a condition (including pregnancy) requires specialised or intensive treatment; the treatment of any disease or condition becomes of a protracted nature or requires extended medicine and such treatment is given in or by a non-designated service provider or a preferred provider, the case may be evaluated in terms of the relevant managed health care programme and, having regard to the aforementioned diseases or conditions in question, the Scheme may require or advise: the transfer as arranged by the Scheme of that benefi ciary to a public hospital or other designated service provider where appropriate care is available, with due regard to Regulation 8(3)(c); the application of a limited drug formulary; both such transfer and restricted drug formulary; in order to conserve or maximise efficient utilisation of available benefi ts. SAMWUMED MEMBER GUIDE

44 In the event that a decision has been, the following conditions shall apply: in respect of Prescribed Minimum Benefi ts, no benefi t limit shall apply provided treatment is given in or by a public hospital or designated service provider. If for any reason the benefi ciary involuntarily receives treatment in or by a non-designated service provider, no co-payment applies; in respect of non-prescribed Minimum Benefi t conditions, if the Scheme or its managed health care programme contracted service supplier should determine that any annual benefi t limits, as set out in Annexure B, and available to the benefi ciary receiving such treatment, are likely to be exceeded in the course of the year, the benefi ciary may be advised to move to a public hospital or designated service provider or to accept a limited drug formulary, or both, in order to conserve available benefi ts. In such designated service provider or public facility any costs incurred over and above the limit stipulated in Annexure B (excluding Prescribed Minimum Benefi t conditions), shall be the member s responsibility. The member may elect on behalf of himself or his benefi ciary, to remain in the private hospital, or remain on the full drug formulary available, or both, in which event the Scheme shall pay up to the benefi t limit stipulated in Annexure B, whereafter the member shall be responsible for payment, direct to the private hospital, for any further treatment in such hospital, or for payment direct to the supplier for further medicine. The Scheme (or its managed health care programme contracted service supplier on behalf of the Scheme) may from time to time contract with or credential specifi c provider groups (networks) or centres of excellence as determined by the Scheme in order to ensure cost effective and appropriate care. The Scheme reserves the right not to fund or partially fund services acquired outside of these networks, provided reasonable steps are taken by the Scheme to ensure access to the network, subject to Prescribed Minimum Benefi ts. The Scheme reserves the right not to pay for procedures performed by non-recognised providers (where applicable). Certain procedures may be associated with a signifi cant learning curve and/or are not taught routinely at local universities and/or require special training and experience, including that aimed at maintenance of expertise, and/or need access to certain infrastructure for quality outcomes, where such procedures have been identifi ed by the Scheme s managed health care programme contracted service supplier. Recognised providers are those who have been acknowledged by meeting minimum training and practice criteria for the safe and effective performance of such procedures. Recognition occurs as a result of a formal application process by interested providers and adjudication of relevant information against competency guidelines by the managed health care programme contracted service supplier and/or appointed credentialing body. Criteria for formal recognition are informed by clinical evidence, clinical guidelines and/ or expert opinion. 38 SAMWUMED MEMBER GUIDE 2018

45 BENEFITS & CONTRIBUTIONS WE HAVE TWO BENEFIT PLANS, OPTION A AND OPTION B, HAVE BEEN CAREFULLY DESIGNED TO PROVIDE FOR YOUR HEALTHCARE NEEDS. SAMWUMED MEMBER GUIDE

46 A OPTIONABENEFITS ALTERNATIVE HEALTH CARE PODIATRIST HOMEOPATH NATUROPATH CHIROPRACTOR INCLUDED with GP consultations and visits. Practitioners to be registered with the Health Professions Council of SA or Allied Health Professionals Council of South Africa. PFPA = R2,000 AMBULANCE SERVICES ROAD AND AIR Designated Service Provider only. UNLIMITED FOR EMERGENCY ASSISTANCE ONLY - case managed, and protocols apply. Co-Payment rule for voluntary use of a Non-DSP. Scheme Members to be held liable for the full cost of transportation for non-medically justifiable cases. APPLIANCES MEDICAL AND SURGICAL R 2, R 3, R 4, The Scheme (or contracted managed care company on behalf of the Scheme) may from time to time contract with or pilot with or credential specific provider groups (networks) or centres of excellence order to ensure cost effective and appropriate care. Beneficiaries are entitled to benefits from contracted networks appointed as the Scheme s DSP for PMB benefits and other benefits. Subject to the submission of a clinical motivation with correct Tariff codes and costing for pre-authorisation by the Scheme. The Scheme reserves the right not to fund or partially fund services acquired outside of these networks, provided reasonable steps are taken by the Scheme to ensure access to the network, subject to Prescribed Minimum Benefits. Limits and cycles as per the Scheme s list of approved appliances apply DENTISTRY BASIC R 3, R 3, BASIC DENTISTRY INCLUDES fillings, root canal treatments, scaling & polishing, extractions, fissure sealants, R 5, dentures and repairs Subject to prescribed cycles R 6, FULL DENTURES A 3 YEAR benefit cycle applies. PARTIAL DENTURES A 2 YEAR benefit cycle applies. GP CONSULTATIONS, VISITS AND PROCEDURES ROOMS OR HOME R 3, R 4, R 5, R 6, BENEFICIARY LIMIT R 3, PER ANNUM EMERGENCY TREATMENT AND PROCEDURES SUB-LIMIT R 1, PER FAMILY PER YEAR THIS SUB-LIMIT IS INCLUDED WITH THE GP Consultations, Visits and Procedures limit. INFERTILITY ONLY PMB CONDITIONS Subject to State hospitals for Hysterosalpingogram (HSG) and Diagnostic Dilatation and Curettage (DD&C) State Protocols Apply 40 SAMWUMED MEMBER GUIDE 2018

47 CHANGE IS COMING MEDICATION PRESCRIBED, DISPENSED OR ACUTE R 1, R 2, R 3, R 5, SUB-LIMIT R 2, PER BENEFICIARY, PER YEAR Subject to Medicine Exclusion Lists. PRIMARY HEALTHCARE BENEFIT PROGRAMME Condition specific benefits, sub limits and treatment plans apply. Remind your pharmacist to include the appropriate ICD-10 diagnostic codes with all claims for this Programme. Limited to listed conditions and number of incidents per beneficiary per year as outlined below: Stomach pain, heartburn, indigestion (including reflux), 2 Acute gastroenteritis: - vomiting and diarrhoea, 2 Upper and lower respiratory tract infections, 3 Oral and topical candidiasis: - thrush/fungal or yeast infections, 2 Helminthic infestation: - worms, 2 Headache, 4 Bacterial conjunctivitis: - eye infection, 2 Urinary tract infection (acute uncomplicated cystitis), 1 Urticarial: skin rashes, insect bites and stings, 2 Treatment of wounds and/or infections of the skin/subcutaneous tissues (excl. post- operative wound care), 1 CHRONIC MEDICATION Subject to Chronic Disease List (CDL) and Chronic Formulary and protocols apply. 25% CO-PAYMENT for Chronic medication not on the Chronic Formulary 25% CO-PAYMENT for voluntarily utilisation of an out-of-network pharmacy PAT: OVER-THE- COUNTER MEDICINE LIMITED R PER FAMILY, PER YEAR SUB-LIMIT R PER DAY INCLUDED with prescribed, dispensed or acute medication limit. Subject to Medicine Exclusion Lists. MENTAL HEALTH SUBSTANCE DEPENDENCY CONSULTATIONS/VISITS AND PROCEDURES. 100% OF COST AT DSP PER FAMILY, PER YEAR Included with In- Patient benefit. Clinical motivation required for authorisation of continued consultations AFTER FIRST 20 INITIAL ASSESSMENTS. Subject to Scheme Network Limited to PMB Conditions only. HOSPITALISATION SUBSTANCE DEPENDENCY Referral from an Employee Assistance Programme (EAP) or GP required MENTAL HEALTH CONDITIONS Referral from specialist required Subject to Scheme Network PMB conditions unlimited at State s SAMWUMED MEMBER GUIDE

48 A OPTIONABENEFITS OPTICAL FRAMES/LENSES/ CONTACT LENSES R 4, PER FAMILY Subject to prescribed cycles. SUB-LIMIT R 2, PER BENEFICIARY, PER YEAR OPHTHALMOLOGIST VISIT subject to referral from Optometrist or GP Exclusions apply, including but not limited to repairs. Spectacle lenses and contact lenses cannot be obtained simultaneously. A 2 YEAR FRAMES LENSES benefit cycle applies. SPECTACLE LENSES AND CONTACT LENSES CANNOT BE OBTAINED SIMULTANEOUSLY FRAMES FRAMES R LIMIT PER BENEFICIARY FRAMES LENSES A 2 YEAR benefit cycle applies. EYE TESTS LIMITED ONE CONSULTATION PER BENEFICIARY PER ANNUM Subject to family limit LENSES WHITE LENSES: 100% of the lower cost or Optical Assistant Tariff. PHOTOCHROMIC LENSES: 100% of the lower cost or Optical Assistant Tariff up to a maximum of R 350 per pair Subject to a prescription of +0.50/-0.50 and above. FIXED OR GRADIENT TINTS UP TO 35% 100% of the lower cost or Optical Association Tariff. FRAMES LENSES A 2 YEAR benefit cycle applies. OUT-PATIENT BENEFITS CONSULTATIONS, VISITS AND PROCEDURES R 1, R 1, R 2, Subject to State Out-Patient facilities PATHOLOGY OUT-OF-HOSPITAL INCLUDED with Specialist Benefit. Subject to Scheme Network LIMITED TO PMB CONDITIONS ONLY IN-HOSPITAL R 4, PER FAMILY PER YEAR INCLUDED with In-Patient benefit LIMITED TO PMB CONDITIONS ONLY Subject to Scheme Network 42 SAMWUMED MEMBER GUIDE 2018

49 CHANGE IS COMING PHYSIOTHERAPY OUT-OF-HOSPITAL INCLUDED with Specialist Benefit. Limited to PMB Conditions only Subject to Scheme Network IN-HOSPITAL Clinical motivation required for authorisation of continued consultations after first two visits. R 1, PER FAMILY PER YEAR INCLUDED with Specialist Benefit. LIMITED TO PMB CONDITIONS ONLY Subject to Scheme Network PROSTHESES INTERNAL R 24, PER FAMILY, PER YEAR Included with In-Patient benefit. Subject to the submission of a clinical motivation and costings for pre-authorisation by the Scheme. State is the DSP for joint replacements. The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member s benefit. EXTERNAL (INCLUDING ARTIFICIAL EYES AND LIMBS) R 12, PER FAMILY, PER YEAR Subject to the submission of a clinical motivation and costings for pre-authorisation by the Scheme. The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member s benefit. RADIOLOGY RADIOGRAPHY GENERAL (IN AND OUT-OF- HOSPITAL) R 2, PER FAMILY, PER YEAR INCLUDES two ultrasounds, per pregnancy Limited to PMB Conditions only. SPECIALISED (IN AND OUT-OF- HOSPITAL) R 8, INCLUDED WITH IN-PATIENT BENEFIT Limited to PMB Protocols only. REMEDIAL THERAPY OCCUPATIONAL, SPEECH THERAPY, AUDIOLOGY & DIETICIANS SUBJECT TO R 2, PER FAMILY, PER YEAR INCLUDED with Specialist benefit for In- or Out-of-hospital treatment. Subject to GP Referral SPECIALIST CONSULTATIONS, VISITS AND PROCEDURES OUT-OF-HOSPITAL R 3, R 5, R 7, R 9, IN-HOSPITAL PER FAMILY, PER YEAR BENEFICIARY LIMIT R 4, PER YEAR INCLUDED with In-Patient benefit Subject to GP Referral SAMWUMED MEMBER GUIDE

50 A OPTIONABENEFITS HOSPITALISATION IN-PATIENT R 250, Subject to pre-authorisation. Unlimited PER FAMILY, PER YEAR benefits for PMB conditions subject to pre-authorisation at a DSP. State Facility as DSP for joint replacements, cardiac and abdominal surgery. Subject to Scheme Network Take Home medication limited to 7 days supply MATERNITY CAESAREAN SECTION R 23, PER FAMILY, PER YEAR ABORTION THREATENED R 5, PER FAMILY, PER YEAR NORMAL DELIVERY R 13, PER FAMILY, PER YEAR ABORTION INCOMPLETE R 15, PER FAMILY, PER YEAR ABORTION INEVITABLE R 15, PER FAMILY, PER YEAR ABORTION VOLUNTARY R 4, PER FAMILY, PER YEAR ALTERNATIVES TO HOSPITALISATION Private nursing, Frail care, Hospice, Step-down facility INCLUDED with In-Patient benefit BLOOD TRANSFUSION SERVICES INCLUDED with In-Patient benefit RENAL DIALYSIS INCLUDED with In-Patient benefit Subject to State s PMB ONLY ORGAN TRANSPLANT Scheme Rules and treatment plans apply PMB Conditions only Pre-Authorisation required ONCOLOGY OUT-OF-HOSPITAL Medication to be obtained from State hospitals PMB Conditions only IN-HOSPITAL Included with In-Patient benefit and subject to State hospitals. Pre-Authorisation required OUT-OF-HOSPITAL Subject to Overall Annual Limit and State hospitals. IN-HOSPITAL Included with In-Patient benefit and subject to State hospitals. OVERALL ANNUAL LIMIT - R 300, PER FAMILY, PER YEAR. 44 SAMWUMED MEMBER GUIDE 2018

51 OUR 2018 CONTRIBUTION TABLE FOR OPTION A Table below represents 100% contribution. EMPLOYEES ONLY PAY UP TO 40%. A] Contributions are paid monthly in arrears. 0% CONTRIBUTION INCREASE PRINCIPAL ADULT CHILD Income Band Contribution Contribution Contribution 100% 40% 100% 40% 100% 40% R0 - R3 500 R995 R398 R995 R398 R350 R140 R R4 500 R1 176 R470 R1 176 R470 R412 R165 R R5 500 R1 265 R506 R1 265 R506 R444 R178 ONLY 5% CONTRIBUTION INCREASE R R7 000 R1 PRINCIPAL 425 R570 R1 425 ADULT R570 R500 CHILD R200 R R8 500 R1 527 R611 R1 527 R611 R537 R215 Contribution Contribution Contribution Income R Band R % R654 40% R % R654 40% R % R231 40% R R7 000 R1 425 R570 R1 425 R570 R500 R200 R R8 500 R1 527 R611 R1 527 R611 R537 R215 R R1 636 R654 R1 636 R654 R577 R231 SAMWUMED MEMBER GUIDE

52 B OPTION BENEFITS ALTERNATIVE HEALTH CARE PODIATRIST HOMEOPATH NATUROPATH CHIROPRACTOR INCLUDED with GP and Specialist consultations and visits limit. Practitioners to be registered with the Health Professions Council of SA or Allied Health Professionals Council of South Africa. PFPA = R3,000 AMBULANCE SERVICES ROAD AND AIR Designated Service Provider only. UNLIMITED FOR EMERGENCY ASSISTANCE ONLY - case managed, and protocols apply. Co-Payment rule for voluntary use of a Non-DSP. Scheme Members to be held liable for the full cost of transportation for non-medically justifiable cases. APPLIANCES MEDICAL AND SURGICAL R 5, PER FAMILY PER YEAR Subject to the submission of a clinical motivation with correct Tariff codes and costing for pre-authorisation by the Scheme. The Scheme (or contracted managed care company on behalf of the Scheme) may from time to time contract with or pilot with or credential specific provider groups (networks) or centres of excellence or supplier groups as determined by the Scheme in order to ensure cost effective and appropriate care. Beneficiaries are entitled to benefits from contracted networks appointed as the Scheme s DSP for PMB benefits and other benefits. The Scheme reserves the right not to fund or partially fund services acquired outside of these networks, provided reasonable steps are taken by the Scheme to ensure access to the network, subject to Prescribed Minimum Benefits. Limits and cycles as per the Scheme s list of approved appliances apply DENTISTRY BASIC R 6, R 7, BASIC DENTISTRY INCLUDES fillings, root canal treatments, scaling & polishing, extractions, fissure sealants, R 8, dentures and repairs Subject to prescribed cycles R 10, FULL DENTURES PARTIAL DENTURES A 3 YEAR benefit cycle applies. A 2 YEAR benefit cycle applies. ADVANCED EXCLUSIONS Clinical motivation required for preauthorisation from Scheme. Orthodontics, crown and bridge work or any procedure that requires anaesthetics. isation costs for removal of wisdom teeth or treatment for children under the age of 7 paid from the hospitalisation benefit. Dental procedure costs paid from dentistry benefit Cosmetic dentistry such as veneers and implants is excluded GP AND SPECIALIST CONSULTATIONS AND VISITS ROOMS OR HOME R 3, R 5, R 7, R 9, BENEFICIARY LIMIT R 5, PER ANNUM Subject to Scheme networks and the appointment of a family practitioner GP AND SPECIALIST PROCEDURES AND TESTS ROOMS OR HOME R 7, PER FAMILY, PER YEAR Subject to Scheme networks and the appointment of a family practitioner 46 SAMWUMED MEMBER GUIDE 2018

53 CHANGE IS COMING INFERTILITY ONLY PMB CONDITIONS Subject to State hospitals for Hysterosalpingogram (HSG) and Diagnostic Dilatation and Curettage (DD&C) State Protocols Apply MEDICATION PRESCRIBED, DISPENSED OR ACUTE R 3, R 4, R 6, SUB-LIMIT R 4, PER BENEFICIARY, PER YEAR R 8, Subject to Medicine Exclusion Lists. PRIMARY HEALTHCARE BENEFIT PROGRAMME CHRONIC MEDICATION Condition specific benefits, sub limits and treatment plans apply. Subject to Chronic Disease List (CDL) and Chronic Formulary and protocols apply. Remind your pharmacist to include the appropriate ICD-10 diagnostic codes with all claims for this Programme. Limited to listed conditions and number of incidents per beneficiary per year as outlined below: Stomach pain, heartburn, indigestion (including reflux), 3 Acute gastroenteritis: - vomiting and diarrhoea, 3 Upper and lower respiratory tract infections, 4 Oral and topical candidiasis: - thrush/fungal or yeast infections, 3 Helminthic infestation: - worms, 2 Headache, 6 Bacterial conjunctivitis: - eye infection, 2 Urinary tract infection (acute uncomplicated cystitis), 1 Urticarial: skin rashes, insect bites and stings, 2 Treatment of wounds and/or infections of the skin/ subcutaneous tissues (excl. post- operative wound care), 2 25% CO-PAYMENT for Chronic medication not on the Chronic Formulary 25% CO-PAYMENT for voluntarily utilisation of an out-of-network pharmacy Chronic Medication for Gout, GORD, Depression and Menopause added to the chronic formulary PAT: OVER-THE- COUNTER MEDICINE LIMITED R 1, PER FAMILY, PER YEAR SUB-LIMIT R PER DAY Subject to Medicine Exclusion Lists. Included with prescribed, dispensed or acute medication limit. MENTAL HEALTH SUBSTANCE CONSULTATIONS/VISITS AND PROCEDURES. INCLUDED with In-Patient benefit Clinical motivation required for authorisation of continued consultations AFTER FIRST 20 INITIAL ASSESSMENTS. Subject to Scheme Network Limited to PMB Conditions only. HOSPITALISATION SUBSTANCE DEPENDENCY Referral from an Employee Assistance Programme (EAP) or GP required MENTAL HEALTH CONDITIONS Referral from specialist required Subject to Scheme Network PMB conditions unlimited at State s SAMWUMED MEMBER GUIDE

54 B OPTION BENEFITS OPTICAL FRAMES/LENSES/ CONTACT LENSES R 5, PER FAMILY Subject to prescribed cycles. SUB-LIMIT R 2, PER BENEFICIARY, PER YEAR OPHTHALMOLOGIST CONSULTATION subject to referral from Optometrist or GP Exclusions apply, including but not limited to repairs. FRAMES LENSES A 2 YEAR benefit cycle applies. SPECTACLE LENSES AND CONTACT LENSES CANNOT BE OBTAINED SIMULTANEOUSLY FRAMES FRAMES R 1, LIMIT PER BENEFICIARY FRAMES LENSES A 2 YEAR benefit cycle applies LENSES WHITE LENSES: 100% of the lower cost or Optical Assistant Tariff. PHOTOCHROMIC LENSES: 100% of the lower cost or Scheme Tariff up to a maximum of R 350 per pair Subject to a prescription of +0.50/-0.50 and above. FIXED OR GRADIENT TINTS: 100% of the lower cost or Optical Association Tariff. FRAMES A 2 YEAR benefit cycle applies CONTACT LENSES Contact lenses with a prescription reading of or and above: 100% of the lower of costs or Optical Assistant Tariff up to a maximum of R 2,210 per beneficiary CONTACT LENSES A 2 YEAR benefit cycle applies EYE TESTS ONE EYE TEST PER BENEFICIARY, PER ANNUM AT OPTICAL ASSISTANT S TARIFF Subject to family limit PATHOLOGY IN-AND-OUT- OF-HOSPITAL R 8, PER FAMILY PER YEAR Subject to Scheme Network PHYSIOTHERAPY IN-AND-OUT- OF-HOSPITAL R 4, PER FAMILY PER YEAR SUB-LIMIT R 1, PER BENEFICIARY, PER YEAR Clinical motivation required for authorisation of continued consultations after first two visits. Subject to Scheme Network 48 SAMWUMED MEMBER GUIDE 2018

55 CHANGE IS COMING PROSTHESES INTERNAL R 24, PER FAMILY, PER YEAR Included with In-Patient benefit. Subject to the submission of a clinical motivation and costings for preauthorisation by the Scheme. The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member s benefit. RADIOLOGY RADIOGRAPHY EXTERNAL (INCLUDING ARTIFICIAL EYES AND LIMBS) GENERAL (IN AND OUT-OF- HOSPITAL) R 14, PER FAMILY, PER YEAR Included with In-Patient benefit. The Scheme reserves the right to purchase the appliance on behalf of the member and the purchase may be billed against the member s benefit. R 8, PER FAMILY, PER YEAR Subject to the submission of a clinical motivation and costings for preauthorisation by the Scheme. SPECIALISED (IN AND OUT-OF- HOSPITAL) R 12, PER FAMILY, PER YEAR MRI/CAT or similar Scans limited Subject to preauthorisation from the Scheme Limited to 2 scans per family per year. REMEDIAL THERAPY OCCUPATIONAL, SPEECH THERAPY, AUDIOLOGY & DIETICIANS SUB-LIMIT R 4, PER FAMILY, PER YEAR In-and-Out of Subject to GP Referral SAMWUMED MEMBER GUIDE

56 B OPTION BENEFITS HOSPITALISATION IN-PATIENT R 500, PER FAMILY, PER YEAR Subject to Scheme Network Subject to pre-authorisation and registration with Clinical Disease Management Programme for asthma, cardiovascular disease, diabetes, and cancer, where applicable. State Facility as DSP for joint replacements, cardiac and abdominal surgery. Unlimited benefits for PMB conditions subject to pre-authorisation at a DSP Take Home medication limited to 7 days supply MATERNITY CAESAREAN SECTION R 24, PER FAMILY, PER YEAR NORMAL DELIVERY R 16, PER FAMILY, PER YEAR ABORTION THREATENED R 6, PER FAMILY, PER YEAR ABORTION INCOMPLETE R 16, PER FAMILY, PER YEAR ABORTION INEVITABLE R 16, PER FAMILY, PER YEAR ABORTION VOLUNTARY R 4, PER FAMILY, PER YEAR ALTERNATIVES TO HOSPITALISATION Private nursing, Frail care, Hospice, Step-down facility INCLUDED with In-Patient benefit BLOOD TRANSFUSION SERVICES INCLUDED with In-Patient benefit RENAL DIALYSIS INCLUDED with In-Patient benefit Subject to State s PMB ONLY ORGAN TRANSPLANT Scheme Rules and treatment plans apply PMB Conditions only OUT-OF-HOSPITAL Medication to be obtained from State hospitals Pre-Authorisation required IN-HOSPITAL Included with In-Patient benefit and subject to State hospitals. ONCOLOGY Subject to pre-authorisation and registration with Disease Management Programme. OUT-OF-HOSPITAL NON-PMB SUBJECT TO R100, Subject to Overall Annual Limit and State hospitals. PMB Conditions only IN-HOSPITAL Included with In-Patient benefit and subject to State hospitals. OVERALL ANNUAL LIMIT - R 500, PER FAMILY, PER YEAR. 50 SAMWUMED MEMBER GUIDE 2018

57 OUR 2018 CONTRIBUTION TABLE FOR OPTION B Table below represents 100% contribution. EMPLOYEES ONLY PAY UP TO 40%. B] Contributions are paid monthly in arrears. ONLY 6% CONTRIBUTION INCREASE MEMBER TYPE PRINCIPAL ADULT CHILD Income Band Contribution Contribution Contribution 100% 40% 100% 40% 100% 40% R0 - R5 000 R1 694 R678 R1 694 R678 R594 R238 R R6 000 R1 893 R757 R1 893 R757 R664 R266 R R7 000 R1 930 R772 R1 930 R772 R677 R271 R R R1 970 R788 R1 970 R788 R692 R277 R R R2 076 R830 R2 076 R830 R705 R282 R R2 185 R874 R2 185 R874 R720 R288 HOW TO CALCULATE YOUR CONTRIBUTION AS PER YOUR EMPLOYMENT CONTRACT 1 Establish your 2 Sum the values 3 Multiply the total by your contribution income before deductions to in the respective columns for the percentage as per your Employment Contract establish your Principal member Income Band and beneficiaries R2185 x (40% OR 0.4) = R874 SAMWUMED MEMBER GUIDE

58 MATERNITY BENEFITS Expecting moms can access the SAMWUMED Maternity Programme to help take better care of themselves and their unborn baby by taking advantage of a wide range of maternity preventative care and early detection benefi ts. SIMPLY DIAL TO REGISTER Folic Acid At least fi rst trimester of pregnancy Limit to fi rst 3 months of pregnancy. Ultrasounds 100% of Scheme rate, limited to two ultrasounds Pbpa for maternity. Limited to two screening Pbpa. Ante Natal Consultations 8 Ante-natal consultations per maternity event Limited to 8 Ante-natal consultations per maternity. Vitamins Iron Supplements Limit to fi rst 3 months of pregnancy. HIV Screening Screen of 1 test per maternity event within 1st trimester Limited to one Pbpa. Pap Smear (6 weeks Post- Partum) Limited to one Pbpa within 6 weeks post-partum. Limited to one Pbpa. ADDITIONAL VALUE SAMWUMED PRIMARY HEALTHCARE BENEFIT PROGRAMME This unique benefit offers SAMWUMED members peace of mind should a member deplete his/her annual medicine benefit. In partnership with our pharmacy network, SAMWUMED has created a formulary (a specific list of most cost effective medicines) available over the counter for the 10 most common ailments: Stomach pain, heartburn, indigestion (including reflux), 2 Acute gastroenteritis: vomiting and diarrhoea, 2 Upper and lower respiratory tract infections, 3 Oral and topical candidiasis: thrush/fungal or yeast infections, 2 Helminthic infestation: worms, 2 Headache, 4 Bacterial conjunctivitis: eye infection, 2 Urinary tract infection (acute uncomplicated cystitis), 1 Urticarial: skin rashes, insect bites and stings, 2 Treatment of wounds and/or infections of the skin/subcutaneous tissues (excl. post- operative wound care), 1 Subject to Scheme tariffs, members can access these from an approved pharmacist without paying extra money. 52 SAMWUMED MEMBER GUIDE 2018

59 CHRONIC MEDICINE BENEFITS A chronic condition is a persistent or otherwise long-lasting illness that may be longer than three months or lifelong. SAMWUMED will cover for the diagnosis, treatment and care of 26 chronic conditions. SAMWUMED works with Medscheme to give members the best advice on the use of their chronic medication, as well as ensure that their chronic benefits are correctly allocated. You treating doctor will need to call our Managed Care Provider, Medscheme on to register for your Chronic Medication. HOSPITAL CARE When you need hospital treatment or an operation, SAMWUMED will cover you for approved medical expenses when you are in hospital. The comprehensive hospital benefit cover ensures you are taken care of should you or your loved ones land up in a hospital. We have partnered with Medscheme as our and Oncology Benefit Management Service Provider to manage your hospital care. For all hospital pre-authorisations members can call Unless an emergency, members will need to contact Medscheme no less than 5 business days before the procedure to get authorisation for their admission to hospital on ADDITIONAL VALUE SAMWUMED MEMBER GUIDE

60 MONTHLY CONTRIBUTIONS Your medical aid contribution is generally paid for from two sources: your employer s subsidy and your monthly salary. Your employer deducts contributions ns from your salary each month and pays it over to the Scheme. Contributions are calculated according to income and family size and are paid monthly in arrears. The Scheme does not have access to your salary. The Scheme will advise you in cases where incorrect contributions are received or if your employer has not paid the correct amount to the Scheme. If you join after 31 March, you will be subject to pro-rated benefits. This means that you will only be entitled to benefits according to the contributions that you have made: January - March April - June July - September October - December 100% of benefi efi t 75% of benefi efi t 50% of benefi efi t 25% of benefi efit DEFINITIONS OF THE COLUMNS OF THE CONTRIBUTION TABLES Salary column: This refl ects the monthly salary before tax or other deductions. Principal column: This column shows how much the main member, who is a local goverment employee registered with SAMWUMED, has to pay. Adult column: This column shows how much you have to pay for your adult dependants. Child column: This column shows how much you have to pay for a child dependant. SAWUMED covers children up to the age of 21, unless the child is mentally or physically disabled or is below 25 years of age and is a student registered at a recognised educational institution and proof thereof is provided. See member guide on the Scheme website for full details. 54 SAMWUMED MEMBER GUIDE 2018

61 WHAT DOCUMENTS DO I NEED TO BECOME A MEMBER? No matter which benefit option you take, SAMWUMED Medical Aid offers cover in full and as stipulated by Scheme Rules, for the diagnosis, treatment and care of an extensive range of medical conditions. GO AHEAD AND CHOOSE THE MOST SUITABLE OPTION FOR YOUR FAMILY S NEEDS IT S SIMPLE TO BECOME A MEMBER OF SAMWUMED 1 STEP Request and complete an APPLICATION FORM from our Sales & Servicing and Broker Consultants or via your HR office. 2 STEP Submit your application with photo copies of SOUTH AFRICAN IDENTITY. 3 STEP You will receive a SMS from SAMWUMED to confi rm receipt of your application. 4 STEP You will receive your SAMWUMED WELCOME PACK which includes your Membership Quick Guide and Membership Card. WHAT DOCUMENTS DO I NEED TO BECOME A MEMBER? SOUTH AFRICAN ID Book/Card, Birth Certifi cates. A SWORN AFFIDAVIT proving fi nancial dependency for children over the age of 21. LEGAL DOCUMENTS of adopted/foster children, PREVIOUS MEMBERSHIP. CERTIFICATE Confi rmation of BANKING DETAILS and SALARY SLIP NO LATE JOINING FEE PENALTIES You do not pay late joiner fees when you join us. WAITING PERIOD General waiting periods of up to one (1) month apply Condition specifi c waiting periods of up to 12 months apply For more information members may contact the Premiums Department via at premiums@samwumed.org SAMWUMED MEMBER GUIDE

62 MEMBERSHIP MANAGEMENT SAMWUMED S PREMIUMS AND MEMBERSHIP DEPARTMENT IS RESPONSIBLE FOR ALL ASPECTS OF MEMBERSHIP AND THE COLLECTION OF CONTRIBUTIONS. All local government employees have the opportunity to change their medical aid options during the Freedom of Association period (also known as the window period ) from October until the end of November each year. Members who wish to make this change must notify the Scheme in writing by submitting an Option change form via their Human Resource Department by no later than 15 December of the same year. All benefi t option changes must be confi rmed by January each year. Section 7 of the South African Local Government Bargain Council s Main Collective Agreement states that medical scheme members may make an election regarding movement from one accredited medical scheme to another accredited medical scheme on an annual basis before 01 January. MOVEMENT BETWEEN SCHEMES DURING THE YEAR IS NOT ALLOWED. Membership application and dependant registration forms make provision for the disclosure of pre-existing health conditions. Failure to provide the appropriate information to the Scheme could lead to the termination of your or your dependant s membership. Single principal members are issued with one membership card and families receive two cards. The Scheme does not charge members for replacement of lost or stolen cards. It is important that the Scheme has the correct identity numbers for members and dependants. Without it, you might not be able to use your benefi ts. Please contact the Scheme to ensure that we have your correct telephone numbers, address, and details of your dependants. If your information changes during the year, it is important to let the Scheme know by contacting ALL INFORMATION THAT YOU DISCLOSE TO THE SCHEME IS CONSIDERED CONFIDENTIAL. You should be mindful not to disclose information such as your membership number or hand over tax or membership certifi cates/cards to any third party. 56 SAMWUMED MEMBER GUIDE 2018

63 REGISTERING DEPENDANTS To register a dependant, a Dependant Registration form must be completed and submitted to the Scheme via your Human Resource Department along with the required documentation such as copies of birth certifi cates when registering children; affidavits and marriage certifi cates for spouses and partners; proof of study and/or affidavits proving dependency for dependants over the age of 21. The Dependant Registration form makes provision for the disclosure of pre-existing conditions that prospective dependants might have. Depending on the severity of the condition(s), certain waiting periods may be considered by the Scheme before dependants can claim benefi ts. Failure to disclose these pre-existing conditions could limit or exclude a dependant from claiming benefi ts, according to provision 11.5 of the Scheme Rules, which states that The Board may, in its absolute discretion, exclude from benefi ts or terminate the membership of a member or dependant whom the Board fi nds guilty of abusing the benefi ts and privileges of the Scheme by presenting false claims or making a material misrepresentation or non-disclosure of factual information or who, in the opinion of the Board, is guilty of misconduct that would either compromise the achievement of the aims and objects of the Scheme or bring the Scheme into disrepute. In such event, he or she may be required by the Board to refund to the Scheme any sum which, but for his or her abuse of the benefi ts or privileges of the Scheme, would not have been disbursed on his or her behalf. CHILD DEPENDANTS A child dependant is someone up to the age of 21 but not older than 25 years. Student dependants must be attending a recognised educational institution and be without a regular income. To register a child dependant, a birth certifi cate, identity document, or affidavit (where the child s surname is not the same as the main member s) is required. Proof of study or medical report must be submitted for child dependants who are students or mentally/ physically disabled. Grandchildren can be registered, provided that the member is responsible for their care and fi nancial support. An affidavit confi rming this dependency is required and this is subject to an annual review. BIRTH OF A CHILD Members must notify the Scheme within 30 days of the birth of a child to qualify for immediate benefi ts. The birth certifi cate must be submitted along with the Dependant Registration form. A threemonths waiting period will be imposed if the registration is not completed within this time. ADULT DEPENDANTS Adult dependants are 21 years and older and can be a spouse or partner. Spouses who are registered within 30 days of marriage will qualify for benefi ts immediately. A marriage certifi cate or affidavit must be submitted with the registration form. A three-month waiting period will be imposed if the registration is not completed within this time. Dependants over the age of 21, who are not spouses or partners, but are dependent on the main member for care and fi nancial support, can be registered as adult dependants. An affidavit proving this dependency is required. If you have any questions regarding membership, please contact our Premiums Department by dialling and pressing 2 when prompted or premiums@samwumed.org. SAMWUMED MEMBER GUIDE

64 EXCLUSIONS WHAT DOES THE SCHEME NOT PAY FOR? Exclusions: Any treatment, medications, appliances or similar that are not covered in terms of the Rules of the Scheme is regarded as an exclusion. Refer to Annexure C, Scheme Rules. QUICK GUIDE: INFORMATION ON ACCESSING YOUR BENEFITS EFFICIENTLY GETTING AUTHORISATION FOR YOUR HOSPITAL STAY A Managed Care partner has been contracted by the Scheme to ensure that you and your dependants get cost efficient, quality care in hospital. Managed Care offers you useful advice and their team of doctors and nurses will make sure that you are admitted at the appropriate facility at the correct fee. You must contact Managed Care for pre-authorisation on , at least fi ve (5) working days before a planned procedure or on the fi rst working day after an emergency hospital admission to obtain an authorisation number for your treatment. Authorisation requests for major surgery should be submitted at least thirty (30) days in advance to allow the Scheme to obtain a second opinion to ensure that you or your dependant receive appropriate treatment. It is important to note that pre-authorisation is compulsory for hospitalisation and failure to comply could result in a commensurate penalty. WHY IS PRE-AUTHORISATION NECESSARY? Pre-authorisation for hospital admissions and certain out-of-hospital care is a key component in managing your access to affordable, appropriate, safe and quality health care. Medscheme s pre-authorisation requests are adjudicated against clinical and funding guidelines as well as set criteria in recognising healthcare providers who are able to perform certain procedures. Once you are pre-approved, the healthcare provider and hospital account will then be paid according to your selected benefi t option and available benefi ts. 58 SAMWUMED MEMBER GUIDE 2018

65 WHEN DO YOU NEED TO CONTACT US FOR PRE-AUTHORISATION? Any procedure or treatment that clinically requires admission to hospital. Specialised radiology in- and out-of-hospital (MRI and CT Scans). Oncology Treatment. Renal Dialysis. Clinically appropriate home nursing, admission to a step-down facility and rehabilitation. Maternity admissions and confi nements. HOW DO I PRE-AUTHORISE? Call (at least 5 business days before the procedure is performed) and provide the following information: Membership number Patient s name, surname and date of birth Doctor s name and practice number Name of hospital Procedure to be performed and ICD-10 code(s) Date of admission WHAT IF I M DIAGNOSED WITH CANCER? Register with the SAMWUMED Oncology Management Programme by calling or send an to cancerinfo@medscheme.co.za. A SAMWUMED Oncology case manager will provide support and guidance that will continue throughout your treatment. As soon as you and your team of doctors agree on a treatment plan, ask your doctor to forward it to the SAMWUMED Oncology Management Programme. An Oncology case manager will review the plan, discuss it with your doctor and advise on the outcome of your application. You will then receive an authorisation letter for the authorised treatment. If there are certain items that are not covered, you will need to discuss this with your doctor. Please ensure that your doctor informs the SAMWUMED Oncology Management Programme of any change in your treatment, as your authorisation will have to be re-assessed and updated accordingly to ensure that your claim(s) are not rejected or paid from the incorrect benefi t. WHAT HAPPENS IN AN EMERGENCY? Don t worry. In the case of an emergency situation you or a family member may pre-authorise the admission on the fi rst working day after being admitted. HEALTHY FAMILY, HEALTHY COMMUNITY LETS BRING GOOD HEALTH HOME SAMWUMED MEMBER GUIDE

66 WHAT IS A PMB? Prescribed Minimum Benefi ts (PMB) is a set of defi ned benefi ts that ensure you have access to certain minimum health services, regardless of the benefi t option you have selected. In accordance with the Medical Scheme s Act, medical schemes have to cover the costs related to these conditions which include: Any emergency medical admission A limited set of 270 pre-defi ned medical conditions Twenty-six (26) chronic medical conditions Your doctor will guide you in determining whether your condition falls into one of the PMB conditions. It is vital that you obtain a pre-authorisation for any PMB condition as your scheme may require you to be referred to a designated service provider so that all associated costs are in line with SAMWUMED s Scheme Rules. WHAT IS CASE MANAGEMENT AND CARE CO-ORDINATION? While you are in hospital, our case managers will ensure that the appropriate length of stay and level of care is provided at all times and that appropriate discharge planning takes place. Medscheme also focuses on care co-ordination to improve the quality of care that you receive while in hospital, and to improve your health status after you are discharged. The benefi t of this is that, with your consent, we will share information about your condition, well-being and health within the different managed health care departments as well as with your nominated doctor. Co-ordinating your care is done through various interventions from pre-admission to eight weeks after you are discharged so that you receive the best health care; reduce your chances of re-admission and encourage you to take responsibility for your own health. Through care co-ordination you will receive a pre-admission hospital checklist (depending on your type of admission) that will assist you in preparing for hospitalisation and post discharge recovery. You will also be referred to various managed care services and appropriate healthcare providers as and when required. ACCESS AND CARE SAMWUMED has adopted the State hospital system as its Designated Service Provider (DSP) for the treatment of Prescribed Minimum Benefi t (PMB) conditions. This ensures that the Scheme can manage costs associated with these conditions effectively. The Scheme has also negotiated favourable rates with various private hospital groups classifying these as Preferred Providers (PPs). This excludes services rendered by attending specialists at these PPs. While the Scheme has secured agreements with certain providers, members might still be faced with possible out-of- pocket expenses based on tariffs above the Scheme s rate. SAMWUMED pays for all healthcare services according to the Scheme Tariff, except in cases where involuntary utilisation of a non-dsp took place*. In cases of an emergency, you can access the hospital nearest to you if you are not within reasonable travelling distance from one of the Scheme s Designated Service Providers (the State hospital system) or a Preferred Provider (PP). Depending on where you are in the country, you can access hospital care. Kindly contact the Managed Care call centre for available facilities. 60 SAMWUMED MEMBER GUIDE 2018

67 CHECKING AVAILABLE BENEFITS You can check your available benefi ts by logging onto the Scheme s website at OBTAINING PRE-AUTHORISATION FROM THE CALL CENTRE The Call Centre can assist you with the pre-authorisation for procedures and tests done in doctors or any other equipped procedure rooms, advanced dentistry such as orthodontics, crown and bridgework and appliances, for example: wheelchairs, walking frames or neck braces related to hospital admissions. BENEFITS THAT REQUIRE MOTIVATION AND/OR REFERRAL LETTERS Clinical motivation and cost estimates will be requested from your treating doctor or specialist before appliances are approved. Approved appliances would be subject to Scheme s list. Clinical motivation is required for all advanced dentistry procedures. To access the mental health or substance dependency benefi t, clinical motivation will be required after the fi rst two visits for continued sessions. Physiotherapy clinical motivation required after two visits. Prostheses clinical motivation and costing. Specialised radiology and radiography. WHAT IS COVERED UNDER THE MEDICATION BENEFIT? The medication benefi t provides cover for acute/ prescribed; over-the-counter and chronic medication and the Primary Healthcare Programme. Chronic medication cover includes the diagnosis, medical management and medication of conditions on the Chronic Disease List (CDL) as provided under PMB legislation. The Scheme has contracted a medicine risk management department to provide a service to members and their registered dependants who need treatment for their chronic conditions which include the following: Making sure that your chronic benefi ts are allocated accordingly. Access to expert advisors who will assess medication/ treatment. Useful advice and information regarding various chronic conditions. HOW TO REGISTER AND OBTAIN MEDICATION FOR A CHRONIC CONDITION: A chronic condition is a persistent or otherwise long-lasting illness that may be longer than three months or lifelong. SAMWUMED will cover for the diagnosis, treatment and care of 26 chronic conditions (PMBs). SAMWUMED will also cover the treatment of four (4) additional chronic (Non- PMB) conditions on Option B, such as: Depression Gastro-oesophageal refl ux disease (GORD) Gout Menopause SAMWUMED works with Medscheme to give members the best advice on the use of their chronic medication, as well as to ensure that their chronic benefi ts are correctly allocated. YOUR TREATING DOCTOR WILL NEED TO CALL OUR MANAGED CARE PROVIDER, MEDSCHEME ON TO REGISTER YOUR CHRONIC MEDICATION. SAMWUMED MEMBER GUIDE

68 HIV MANAGEMENT PROGRAMME HIV is a chronic condition where treatment is available and must be taken for life. SAMWUMED will cover the treatment, pathology monitoring and doctor consultations in order to keep all HIV positive benefi ciaries healthy. SAMWUMED works with Aid for AIDS to give members the best advice on how to manage their HIV status and the use of their HIV medication, blood monitoring tests and other associated medication. YOUR TREATING DOCTOR WILL NEED TO FAX THE HIV APPLICATION FORM TO OUR HIV MANAGED CARE PROVIDER, AID FOR AIDS ON OR CALL TO REGISTER YOU ON THE HIV MANAGEMENT PROGRAMME. HOW AND WHEN TO USE THE SAMWUMED PRIMARY HEALTHCARE PROGRAMME BENEFIT You can only access the benefi t after your acute, prescribed/ dispensed; and over-the- counter (PAT) medicine benefi t has been depleted. The Scheme s Pharmacy Benefi t Partner with a wide range of pharmacy networks across the country. Ask your pharmacist for the specifi c list of medicines that have been allocated to the condition that you need care for and remind them to include the correct ICD-10 code on the account. If you are unsure about your medicine benefi ts, please contact the SAMWUMED Call Centre for advice This benefi t provides you with a safety net by granting access to essential medicine benefi ts to treat ten common ailments every family can experience including but not limited to: 1. Stomach pain, heartburn, indigestion (including reflux) 2. Headache 3. Acute gastroenteritis: vomiting and diarrhoea 4. Bacterial conjunctivitis: eye infection 5. Upper and lower respiratory tract infections 6. Urinary tract infection (acute uncomplicated cystitis) 7. Oral and topical candidiasis: thrush/fungal or yeast infections 8. Urticarial: skin rashes, usually due to an allergic reaction; insect bites and stings 9. Helminthic infestation: tapeworm 10. Wound care and infections of the skin/subcutaneous tissue (excluding post-operative care.) 62 SAMWUMED MEMBER GUIDE 2018

69 It is important to note that there are sub-limits for each incident and that a specific list of suitable and cost efficient medicines has been prepared by the Scheme so that you can obtain these from your pharmacist without paying extra. The details and guidelines for this benefit category is outlined in the benefit tables on pages (Option A) and (Option B). HOW TO REPLACE LOST MEMBERSHIP CARDS Your SAMWUMED membership card is one of the most important items in your wallet because it ensures that you have access to the relevant healthcare services, therefore always take care to keep it in a safe place. Please contact the Premiums Department on to request your newly branded membership card, should your card be lost or stolen. SUBMISSION OF CLAIMS [RULES EXTRACT] 1. Every claim submitted to the Scheme in respect of the rendering of a relevant health service as contemplated in these Rules, must be accompanied by an account or statement as prescribed in regulation 5 of the regulations to the Act containing; 1.1. the surname and initials of the member; 1.2. the surname, fi rst name and other initials, if any, of the patient; 1.3. the name of the medical scheme concerned; 1.4. the membership number of the member; 1.5. the practice code number, group practice number and individual provider registration number issued by the registering authorities for providers, if applicable, of the supplier of service and, in the case ofa group practice, the name of the practitioner who provided the service; 1.6. the relevant diagnostic and such other item code numbers that relate to such relevant health service; 1.7. the date on which each relevant health service was rendered; 1.8. the nature and cost of each relevant health service rendered, including the supply of medicine to the member concerned or to a dependant of that member and the name, quantity and dosage of and net amount payable by the member in respect of the medicine; 1.9. where a pharmacist supplies medicine according to a prescription to a member or to a dependant of a member of a medical scheme, a copy of the original prescription or a certifi ed copy of such prescription; where mention is made in such account or statement of the use of a theatre: the name and relevant practice number and provider number contemplated in Rule of the medical practitioner or dentist who performed the operation; SAMWUMED MEMBER GUIDE

70 the name or names and the relevant practice number and provider number contemplated in Rule of every medical practitioner or dentist who assisted in the performance of the operation; and all procedures carried out together with the relevant item code number contemplated in Rule ; and in the case of a fi rst account or statement in respect of orthodontic treatment or other advanced dentistry, a treatment plan indicating: the expected total amount in respect of the treatment; the expected duration of the treatment; the initial amount payable; and the monthly amount payable. 2. If an account, statement or claim is correct or where a corrected account, statement or claim is received, as the case may be, the Scheme must, in addition to the payment contemplated in Section 59 (2) of the Act, dispatch to the member a statement containing at least the following particulars The name and the membership number of the member; 2.2. The name of the supplier of service; 2.3. The fi nal date of service rendered by the supplier of service on the account or statement which is covered for the service concerned; 2.4. The total amount charged for the service concerned; 2.5. The amount of the benefi t awarded for such service; 3. In order to qualify for benefi ts, any claim must be received by the Scheme not later than the last day of the fourth month following the last date on which the service was rendered as stated on the account, statement or claim; or during which such account, statement or claim was returned for correction. 4. Where a member has paid an account, he shall, in support of his claim, submit an original receipt and where the account is to be submitted to the Scheme by the healthcare provider it is the responsibility of the member to ensure that such submission takes place in accordance with the time limits set out in this rule. 5. Accounts for the cost of treatment of injuries and/or any expenses recoverable from third parties, must be supported by a statement, setting out particulars of the circumstances in which the injury or accident was sustained. 6. In the case of any claim in respect whereof the cost of treatment of injuries and/or any expenses are recoverable from third parties, the Scheme shall advance the payment of the benefi ts to which the benefi ciary is entitled in these Rules subject to the benefi ciary hereby irrevocably agreeing: 64 SAMWUMED MEMBER GUIDE 2018

71 6.1. to appoint a legal representative to institute an action to recover the cost of such treatment of injuries and/or expenses; and 6.2. to instruct the legal representative to provide the Scheme with an irrevocable undertaking to pay to the Scheme all such cost of treatment and/or expenses recovered from any third party in the action so institute; and in the event that the legal representative is replaced with another legal representative prior to the recovery of the cost of such treatment of injuries and/or expenses from the third party, the benefi ciary hereby irrevocably agrees to ensure that the replacement legal repre sentative provides a replacement irrevocable undertaking to pay to the Scheme all such cost of treatment and/or expenses recovered from any third party pursuant to any action instituted for recovery. 7. In the event of recovery of any sums by the benefi ciary from a third party relating to the cost of treatment of injuries and/or any expenses in respect whereof the Scheme has made payment as contemplated by Rule 19.6 or is obliged to make payment in the future pursuant to the Rules of the Scheme; such sums shall be paid forthwith by the benefi ciary and/or the benefi ciary s legal representative (as the case may be) to the Scheme. 8. In the event that the benefi ciary fails to appoint a legal representative as contemplated by Rule 19.6 above: 8.1. The Scheme shall be entitled to appoint a legal representative, at its cost, to pursue an action against the third party as contemplated in Rule 19.6 above; and 8.2. the benefi ciary and the Member shall cooperate fully with such legal representative in the prosecution of such action; and 8.3. the Scheme shall not be required to seek to recover any sum from such third party save for the cost of the treatment of injuries and/or expenses as contemplated by Rule Any sums awarded to the benefi ciary in respect of future medical expenses and/or any indemnity against future medical expenses granted to the benefi ciary by any third party as a consequence of the institution of action as contemplated by Rule 19.6 shall be utilised to pay for all such future medical expenses to the exclusion of any benefi ts payable by the Scheme until such sums and/or indemnity is exhausted. 10. Without derogating from the provisions of Rules 20.3 and 20.4 below, where the Scheme is of the opinion that an account, statement or claim is erroneous or unacceptable for payment, the Scheme shall notify both the member and/or the healthcare provider, whichever is applicable, accordingly within thirty (30) days after receipt thereof. The Scheme shall state the reasons why such claim is erroneous or unacceptable and afford such member or provider the opportunity to correct and resubmit such corrected claim to the Scheme within sixty (60) days following the date from which it was returned for corrections. SAMWUMED MEMBER GUIDE

72 PAYMENT OF ACCOUNTS [RULES EXTRACT] 1. Payment of accounts or reimbursement of claims is restricted to the maximum amount of the benefi t entitlement in terms of the applicable benefi t and option elected, and payment is made in accordance with the Scheme Tariff. 2. The Scheme may, whether by agreement or not with any supplier or group of suppliers of a service, pay the benefi t to which the member is entitled, directly to the supplier who rendered the service. 3. Where the Scheme has paid an account or portion of an account or any benefi t to which a member is not entitled (on whatsoever basis), whether payment is made to the member or to the supplier of the service, the amount of any such payment is recoverable by the Scheme and may be deducted from any benefi t payable by the Scheme to the member and/or the supplier of the service. 4. Where the Scheme has suffered any loss due to theft, fraud, negligence or any misconduct on the part of the member and/or the supplier of the services which the Scheme becomes aware of, the Scheme may recover such loss from the member and/or the supplier of the services as applicable. 5. Notwithstanding the provisions of this Rule, the Scheme has the right to pay any benefi t directly to the member concerned. 6. Payment may be withheld unless an account is submitted in the prescribed format, in terms of the Act. SAMWUMED has LOW MONTHLY CONTRIBUTIONS and we aim to be the lowest in the market, without compromising on your benefits 66 SAMWUMED MEMBER GUIDE 2018

73 HOW OUR CLAIMS PROCESSING WORKS Members have four (4) months to submit claims for adjudication and processing Claims older than four months will be rejected as Stale Claims. Once a claim has been processed, you will receive a statement that details the payments that were made to service providers. It will also indicate your remaining benefi ts. Statements are sent via post or . Receiving your statement electronically is safe and convenient. Please provide the Scheme with your updated address. Please make sure that all claims indicated are accurate and that your bank details are correct. STEP 1 Service Provider submits account to Switchhouse STEP 2 Switchhouse submits to Scheme STEP 3 Account processed via system STEP 4 If approved, claim awaits payment during claims run STEP 5 Claims Submission Validation Process STEP 6 Approved: No STEP 6 Approved: Yes STEP 7 Account to be re-submitted STEP 7 Account paid STEP 8 Quarterly Claims Statement sent to member Should you have any queries regarding claims, please contact our Benefits Management Department by dialling SAMWUMED MEMBER GUIDE

74 FAQ'S FREQUENTLY ASKED QUESTIONS WHAT IS A CO-PAYMENT? This is the part of the account that a member might have to pay out of their own pocket where benefi ts do not cover the treatment or medication received. WHAT IS THE SCHEME TARIFF? The rate at which the Scheme pays for health services to service providers on behalf of members. It is based on the National Reference Price List published by the Department of Health. MUST I GIVE NOTICE TO THE SCHEME IF I WISH TO TERMINATE MEMBERSHIP? Yes, members must comply with the notice period stipulated in the Rules. CAN A MINOR BECOME A MEMBER? Yes, based on the following: With the assistance of his/her parents or guardian and provided that the relevant contributions are paid. Only if minor was a dependant on the medical aid when the main member passed away CAN I OR MY DEPENDANTS BELONG TO MORE THAN ONE MEDICAL SCHEME AT A TIME? No, the Medical Schemes Act 131 of 1998 prohibits it. No person shall be a member or dependant of more than one (1) medical scheme. IS MEMBERSHIP OF A MEDICAL SCHEME AVAILABLE TO ANY PERSON? Yes, except in a restricted membership scheme, where a particular employer, profession, trade, industry, calling or association has established a scheme exclusively for its employees or members. MUST MY EMPLOYER SUBSIDISE MY CONTRIBUTIONS TO THE MEDICAL SCHEME? No, subsidies are conditions of employment and the Act does not address such conditions. IF I DO NOT CLAIM FROM MY MEDICAL SCHEME, MAY I RECEIVE A NO-CLAIM BONUS OR REBATE? No, the Act prohibits the payment of bonuses, rebates or re-funding of a portion of contributions other than in respect of savings accounts in certain circumstances. WHAT IS A DESIGNATED SERVICE PROVIDER (DSP)? A healthcare provider or group of providers that the Scheme has chosen to provide certain medical care for Prescribed Minimum Benefi ts. 68 SAMWUMED MEMBER GUIDE 2018

75 TALK TO TT SAMWUMED TODAY AMBULANCE SERVICES NETCARE 911 Tel: (Share Call) or OPERATING HOURS Contact Centre: 08h30-16h00, Mon - Fri Physical Address: Cnr Trematon & Lascelles Streets, Athlone, Postal Address: P.O. Box 134, Athlone, info@samwumed.org Website: MEDSCHEME Benefit Management: samwumed.authorisations@medscheme.co.za Chronic Medicine Management: samwumedcmm@medscheme.co.za Oncology Management: cancerinfo@medscheme.co.za HIV MANAGEMENT - Aid for Aids Member Enquiries: afa@afadm.co.za FRAUD HOTLINE Tel: SMS: (R1,50) fraud@medscheme.co.za SAMWUMED SAMWUMEDHEALTH SAMWUMED SAMWUMED MEDICAL HEALTH DISCLAIMER: This Member Guide is prepared and distributed for purposes of providing you with essential information to help you select the best benefit option for you and your family. It is not a full guide to the Scheme Rules and Benefits and does not supersede the Scheme Rules. All contributions and benefit options presented in the 2018 Member Guide are subject to the approval by the Council for Medical Schemes. Kindly familiarise yourself with your chosen benefit option and note where pre-authorisations, motivations and or letters of referral are required to access benefits. SAMWUMED MEMBER GUIDE

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