Comprehensive


COMPREHENSIVE OPTION

Benefits

 Benefits & Members' Guide for Comprehensive Option 2019

Please note:
If you require any information on the clinical entrance criteria, prescribed minimum benefits algorithms, medicine exclusions and tariff codes and amounts, please refer to the WCMAS Call Centre at (013) 656-1407.

Contribution Tables

Premium Shown Below Includes Employer Subsidy

Contributions for 2019 for Comprehensive option

Salary Code Salary Range Principal Member Adult Dependant Child Dependant
A
R 0 to R 2 000
R 1 932
R 1 932
R 512
B
R 2 000 to R 3 000
R 2 212
R 2 212
R 512
C
R 3 001 to R 4 000
R 2 748
R 2 748
R 512
D
R 4 001 to R 5 000
R 2 748
R 2 748
R 512
E
R 5 001 to R 6 000
R 3 008
R 3 008
R 512
F
R 6 001 to R 7 000
R 3 008
R 3008
R 512
G
R 7 001 to R 8 000
R 3 008
R 3 008
R 512
H
R 8 001 to R 9 000
R 3 128
R 3 128
R 512
I
R 9 001 to R10 000
R 3 128
R 3 128
R 512
J
R 10 001 and Higher
R 3 432
R 3 432
R 512

Designated Service Providers (DSP)

What is a Designated Service Provider (DSP)?

A Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, oncology programme, opticians, etc.) with whom a medical scheme enters into a preferential rate agreement to render treatment, diagnosis or care to members and beneficiaries. Schemes may insist that you go to a DSP as soon as your condition is diagnosed, in which case the Scheme will cover the costs from the start.  Treatment at a DSP will be covered in full by the medical scheme under the PMB conditions when delivered according to scheme protocols, clinical reviews and formularies.

What happens should you make use of a non-DSP?

If you choose not to use the DSP selected by your scheme, you may have to pay a portion of the bill as a co-payment. This could either be a percentage co-payment or the difference between the DSP’s tariffs and that charged by the provider you went to.

Hospitals

In terms of the Medical Schemes Act, Medical Schemes are allowed to enter into Designated Service Provider (DSP) or Preferred Provider (PP) arrangements whereby specific service providers or hospitals can be appointed to provide services to Scheme members.

Part of the agreement is a preferential rate offered to WCMAS members which is substantially lower than the rates offered by most of the other Private Hospitals. WCMAS wish to encourage members to make use of these hospitals in order to derive the savings the arrangements offer for the benefit of all members of the Scheme and to avoid co-payments by members.

WCMAS has entered into such an agreement with the following Hospital Groups for hospital services rendered to WCMAS members:-

  • Life Healthcare hospital group
  • Netcare hospitals
  • NHN hospitals including Emalahleni Hospital
  • Mar-Peh Medical Care (Standerton)
  • Joint Medical Holdings
  • Clinix Health Group
  • Some Mediclinic hospitals: Mediclinic Hospitals
  • Unicare Hospitals

Please note that when certain Mediclinic Hospitals are used, a co-payment of R532.00 per beneficiary per day will need to be paid by the member. Low-flow anaesthetic machine costs (R754.60) will be charged by Mediclinic hospitals and will be for the member's own account.

Emergency cases

Members are reminded that in the case of an emergency, they are entitled to use any of their nearest hospitals and that they will not be penalized in terms of the Designated Service Provider or Preferred Provider arrangement for the emergency.

Involuntary and out of area admissions

Members residing in areas where there are no Designated Service Providers or Preferred Providers may go to any other hospital without a co-payment. The same will apply for specific medical treatment that may only be available in a hospital other than a Designated Service Provider or Preferred Provider. Our Board of Trustees has further resolved that members from New Vaal Colliery (Vaal Triangle), New Denmark Colliery (Standerton), Isibonelo Colliery (Secunda, Trichardt), Kriel Colliery, Zibulo Colliery and Matla Coal (Kriel) be considered out of the area of the DSP arrangement and that they may make use of the other hospitals in their area without having a co-payment.

Doctors / Specialists

Members must take note that Doctors/Specialists may charge fees in excess of the Scheme Rate (contracted-out fees) for which they will be liable. We encourage you to obtain a quotation before undergoing any procedures.

Oncology

Universal manages the oncology benefit management programme and network of oncologists.

For a list of ICON Network Doctors, please Click Here, or you can contact the Call Centre on 0861 486 472.

Optometrists

Optometrists that provide a further discount on scheme tariffs:

  • Adele Cowley - Saveways Witbank - 20% discount lenses & frames
  • Retief Optometrists - Middelburg - 20% discount lenses & frames
  • Stanley & De Kock - Witbank - 20% discount lenses & frames
  • Execuspecs - Highveld Mall Witbank - 20% discount lenses & frames
  • Specsavers - Highveld Mall Witbank - 20% discount lenses & frames
  • Specsavers - Secunda - 20% discount lenses & frames
  • Specsavers - Middelburg - 20% discount lenses & frames
  • Specsavers - Standerton - 20% discount lenses & frames
  • Gert Luus - Ben Fleur Witbank - 20% discount lenses & frames
  • Witbank Optomotrist - 20% discount lenses & frames
  • Olivier Optomotrist - Kriel - 20% discount lenses & frames
  • Execustore - Vereeniging - 20% discount lenses & frames
  • JP Taylor & Cullen - Highveld Mall Witbank - 20% discount lenses & frames
  • Mark Lawrence - Standerton - 20% discount lenses & frames
  • A Brink - Witbank - 20% discount lenses & frames
  • Middelburg Opticians - 20% discount lenses & frames
  • Carla Lyle Optometry - Middelburg - 20% discount lenses & frames
  • Janease Venter - Witbank - 20% discount lenses & frames
Pharmacies

Pharmacies that charge our scheme dispensing rates.

For CDL conditions co-payment only 5% (non-DSP 15%).

  • Clicks Pharmacies - Countrywide
  • Dischem Pharmacies - Countrywide
  • Netcare Pharmacies - Countrywide
  • Dischem Direct Courier Pharmacy
  • Medi-Rite - Countrywide
  • Pick & Pay Pharmacies - Countrywide
  • Ridge Pharmacy - Witbank
  • Tasbet Park - Witbank
  • Mom's Pharmacy - Witbank
  • Highland Pharmacy - Witbank
  • U-Pharmacy - Witbank
  • U-Pharmacy - Middelburg
  • U-Pharmacy - Kriel
  • U-Pharmacy - Excelsior (Groblersdal)
  • U-Pharmacy - Nevada
  • U-Pharmacy - Randburg
  • U-Pharmacy - Horison (Lydenburg)
  • U-Pharmacy - Vorna Valley
  • U-Pharmacy - Transvalia
  • U-Pharmacy - Fochville
  • U-Pharmacy - Waverley
  • Maximed 1 & 2 - Standerton
  • Lethabo Pharmacy - Vaalpark
  • Roodia Pharmacy - Vaalpark
  • Aquarius Pharmacy - Port Shepstone
  • Eastdene Pharmacy - Middelburg
  • Medipost Pharmacy - Arcadia (Pretoria)
  • Pharmacy at SPAR - Countrywide
  • Script Wise Pharmacy (Carletonville)
  • Van der Walt Pharmacy (Meyerton)
  • Modjadji Pharmacy (Modjadji's Kloof)
  • Tzaneen Pharmacy
  • Bophelomed Pharmacy
  • Nu-centre Pharmacy (Standerton)
  • Medicare Linden Pharmacy
  • Mutakalo Pharmacy (Thohoyandou)
  • Medicare-Highveld Pharmacy (Pretoria)
  • Botes Pharmacy (Port Shepstone)
  • Lombards Pharmacy (Tzaneen)
  • Medicare-Grosvenor Pharmacy (Bryanston)
  • Queens-Mall Pharmacy (Oudtshoorn)
  • Alpha Script Pharmacy (Pretoria)
  • Anglo Coal Highveld Hospital Pharmacy
Dispensing Doctors (GP)

The dispensing doctors may submit medicine accounts to the scheme for direct payment.
(Non-DSP: member has to pay medicine and claim refund from scheme).

  • Dr Meintjies & Partners (Ermelo)
  • Dr JJ Lutaaya (Witbank)
  • Dr TG Berry (Roossenekal)
  • Dr Dindar & Partners (Breyten)
  • Dr PE Maetisa (Witbank)
  • Dr JM Marole (Kwaguqa Ext 7, Witbank)
  • Dr Jan Pienaar (Witbank ACHH)
  • Dr RTM Mokoka (Witbank)
  • Dr A Booysen (Witbank)
  • Dr Danie du Toit (Witbank)

Designated Service Providers

Important Information And Promotions

Please click on the links below for additional information shared from our Designated Service Providers (DSP).

Pharmacies

 Medipost Chronic Courier Pharmacy Important Information
 U Pharmacy Emalahleni

Site-Visits By Our Representatives

For more information on site-visits by our representative, please contact your HR office.

Frequently Asked Questions

 Frequently Asked Questions

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