membership booklet for umvuzo medical aid

M EMBERSH IP BOOKLET

CO NTENT

4 Contact details

5 Umvuzo Health

7 How Umvuzo woks

8 Necessities

11 Frequently asked questions

PHYSICALADRESSPretoria 0183, Fearie GlennGlennwood Office Park14 Sprite AvenueBuilding C, 1st floor

CALLCENTRE0861 083 083

FAXNUMBER086 670 0242

OURWEBSITE www.umvuzohealth.co.za

Contact details 44

About Umvuzo is a medical

aid that provides medical aid cover to our members. This company is committed to preventative health care.

We protect our members from confusion

associated with health care by providing our members with the necessary education.

We co-operate with our members through their chosen union representatives on Um-vuzo’s board of trustees.

We provide affordable full medical ser-vices to our members, because we believe that everyone has to try to make a positive contribution to general health care in South Africa.

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About Umvuzo WEPROVIDE

• Affordable premiums• the best possible private medical health care• Excellent customer service

CALLCENTRE FOR MEMBER CONVENIENCE• 24 hour call centre which is on standby.• Assists customers with all their queries. • Operates in all eleven official languages of South Africa.• Assists members in their own language.

WEKEEPour members informed and are honest with them. We work as a team, a family. Umvuzo Health is dedicated to its members!

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How Umvuzo worksUmvuzo has 3PLANS members can choose from according to their needs:

Ultra Affordable Plan

Standard Plan

Premium Plan

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ONCE YOU ARE A MEMBER, YOU WILL NEED THE FOLLOWING TO MAKE OPTIMAL USE OF UMVUZO:

1 A membership number The membership number is your key to medical care. It is a unique number given to each member, so that access to information about the member, their families and the medical plan which the member is part of, can be gained.

2 A membership cardThis card ensures that our members will get the help that they need when visiting a medical profes-sional. Our members simply need to show this card to the medical profes-sional in order to enjoy the benefits of Umvuzo Health.

Necessities88

3 A medical Kit Umvuzo gives each customer a medi-cation kit and information sheet on how to use the medicine. This kit helps our members to save on the costs of unnecessary visits to the doc-tor. It is important that our members read the warnings and consult a doc-tor in the case of serious illness.

4 Plan It is important for members to know which one of the three plans they are part of, because the benefits of each plan is different. Members need take time and read the information which outlines the benefits of each plan.

5 Prime Cure Network Members can visit any of the doctors who form part of the Prime Cure network. These doctors provide excellent medical care: from any refer-ence to specialists, to X-rays, to blood tests – all to ensure that patients get what they need.

Necessities 99

10106 Pre- authorization

If our members need to go to hospital, they need pre- authorization. This means that the member must notify the medical aid that he / she need to go to the hospital.Umvuzo Health gives dedicated care to all its members until they are well again.

Necessities

11FAQ’s (Frequently asked questions)

1 How do I know which plan I belong to? Members sign up for a specific plan when joining Um-vuzo. Each member receives a letter confirming member-ship once they have joined Umvuzo. This letter contains information regarding the specific plan the member is on.

2 Where do I find the doctors and chemists that are on the network list?

• Call our call centre to find out the names in your area: 0861 083 084.• Visit the Prime Cure website on www.primecure.co.za• SMS the iFind number from your Cell phone.

11FAQ’s (Frequently asked questions)

3 Who can I call for general enquiries? 0861 083 084

4 What is a Medical Emergency?It is a sudden life-threatening illness or injury that strikes and will need immediate medical- or surgical treatment. A Medical Emergency means that if your ailment is not treated as soon as possible, it would result in permanent disability or death.

5 What is an acute condition?This is an illness like flu or infections. This kind of illness requires once-off treatment. When you visit the doctor, he will tell you if your illness is acute or chronic.

1212 FAQ’s (Frequently asked questions)FAQ’s (Frequently asked questions)

6 What is a chronic condition?A chronic condition is a set of symptoms or an illness which will be treated over a long period of time, or for the rest of your life. Examples of chronic conditions are diabetes and HIV. Chronic conditions can be controlled, which means you can live with them, but they are not curable.

7 What is pre-authorisation and why is it important?It means that you must get permission from the Um-vuzo Authorization Centre before using certain ser-vices. Examples of this are specialist visits, hospitali-zation and emergency treatments. When you call the centre, they will give you a special pre-authorization number that you can to get access to these services. If you don’t get pre-authorisation, you will not be able to make use of your Umvuzo benefits.

1313FAQ’s (Frequently asked questions)FAQ’s (Frequently asked questions)

8 What happens if I don’t get a pre-authorisation number?You will not be able to make the best use of your Umvuzo Health benefits. If you use services that need pre-authorization and you don’t have the necessary code, you may have to pay all the costs of the treatment yourself.

9 How do I get a pre-authorisation number?Call 0861 083 084 – the Umvuzo Authorization Centre is open 24 hours a day for medical emergencies. For authorization for visits to a specialist, or for hospital admission that isn’t an emergency, call from 08h00 to 16h30 from Monday to Thursday and from 08h00 to 16h00 on Fridays.

10 What happens if I need an ambulance? Call Network 911 on 082 911 OR 0861 083 084 and choose Netcare 911


11 Can I go directly to a specialist?

12 What happens to HIV positive members or dependants?

Register on our voluntary HIV pro-gramme at a Prime Cure network doctor and become part of the Umvuzo HIV-wellness program.

ULTRA AFFORDABLE

You have to be re-ferred by a doctor. You need pre-authorisation

STANDARD

You have to be re-ferred by a doctor. You need pre-author-isation

PREMIUM

You can go straight to a specialist, subject to the Family Benefit.


13 Can I use my Umvuzo Health medical aid at any doctor, dentist, optometrist or pharmacy?

14 What happens if I need X Rays or blood tests ?

You must use the sup-pliers that are on the Prime Cure network list.

You must use the sup-pliers that are on the Prime Cure network list .

You can use any professional of your choice and any Me-discor pharmacy.

ULTRA AFFORDABLE STANDARD PREMIUM

Your network doctor will tell you where to go and what to do.

Your network doctor will tell you where to go and what to do.

You will be referred by a doctor of your choice.



15 How do I get my medicine?

You will receive a prescription from a network doctor and you can get the medi-cine from a pharmacy on the network list

You will receive a prescription from a network doctor and you can get the medi-cine from a pharmacy on the network list.

You will get a pre-scription from your doctor and you can use it at any Mediscor pharmacy.



16 How do I register for chronic medication?

Your Prime Cure doctor will register you on the program and arrange for you to receive your medicine.

Your Prime Cure doc-tor will register you on the program and arrange for you to re-ceive your medicine.

Your prescriptions will be arranged through Mediscor Chroniline. Contact the Umvuzo helpline so that we can do the registering for you.



17 What happens if I need to see a doctor after working hours?

You must call the Umvuzo 24 hour Authorisation Centre on 0861 083 084. You will then get access to any doctor or casualty department.





18 Can I go directly to a specialist without being referred by my network doctor?

No. You must be referred by a network doctor and you need pre-authorization from the Authoriza-tion Centre (0861 083 084)

No. You must be referred by a network doctor and you need pre-authorization from the Authoriza-tion Centre (0861 083 084)

Yes, you can go directly to specialists, subject to your Family Benefit.



19 What happens if I am so ill that the doctor decides to admit me to hospital?

Call the 24 hour authorization number 0861 083 084 and get your hospital visit authorized.


KEEP THIS BOOKLET AND ALL YOUR PERSONAL AND MEDICAL NEARBY WHEN YOU PHONE, BECAUSE YOU WILL NEED TO TELL US:

• Your membership number.

• The dependant code (on your membership card).

• The full name and surname of the person needing treatment.

• The date of birth of the person needing treatment.

• The number of the practice of the doctor who is treating you (he/she will give this to you when they refer you to a specialist or to hospital).

• The date of the visit to the specialist, the admission to hospital or the operation and the reasons. Your doctor will give you this as well.

2222 About Umvuzo

membership booklet for umvuzo medical aid

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