Witbank Coalfields Medical Aid Scheme

01. Show Benefit Info

Benefits

Benefits & Members' Guide for Comprehensive Option 2024

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.

02. Show Contribution Info

Contribution Tables

Premium Shown Below Includes Employer Subsidy

Contributions for 2024 Comprehensive option

Salary Code	Salary Range	Principal Member	Adult Dependant	Child Dependant
Salary Code	Salary Range	A	R 0 to R 2 000	R 2 610	R 2 610	R 692
B	R 2 001 to R 3 000	R 2 898	R 2 898	R 692
C	R 3 001 to R 5 000	R 3 714	R 3 714	R 692
D	R 5 001 to R 8 000	R 4 066	R 4 066	R 692
E	R 8 001 to R 10 000	R 4 226	R 4 226	R 692
F	R 10 000 +	R 4 639	R 4 639	R 692

03. Show DSP Info

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

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.

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.

15% co-payment will apply to medicine obtained from a non-DSP.

04. Show On-Site Visits Info

Site-Visits By Our Representatives

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

05. Show FAQ's Info'

Frequently Asked Questions

Frequently Asked Questions