1 reviews | Active since Mar 2023
Umvuso has provided me with poor service so far. Despite submitting the doctor's motivation letter and repeatedly following up on
My son has been diagnosed with clubfoot. I previously contacted the scheme and, as requested, submitted a letter of motivation from his doctor. Despite providing the requested document, the scheme declined to register his condition as a Prescribed Minimum Benefit (PMB). His doctor is also surprised by this decision. They fail to provide the specific clinical and policy reasons for the refusal, explain how the decision was reached, and arrange a review of my son's PMB registration.
I have also sent Khusto Ledwaba proof of payment so that he can process my claims and help me obtain reimbursement. I have not received a response to my ***. I am paying the specialist in cash and urgently need the outstanding claims to be processed.
I am paying my contributions but am having to cover these medical costs myself while struggling to get clear answers. This has caused significant financial pressure and does not provide the peace of mind I expect from my medical scheme.
Dear Member,
Thank you for taking the time to share your experience with us.
We are sorry to learn about the difficulties you have experienced regarding your son's condition, PMB application, and claim submissions. We understand your concerns and appreciate the opportunity to address them.
Please allow us some time to provide feedback regarding the concerns you have raised.
Kind regards,
Umvuzo health
Dear Member,
Thank you for taking the time to share your experience with us.
We are sorry to learn about the difficulties you have experienced regarding your son's condition, PMB application, and claim submissions. We understand your concerns and appreciate the opportunity to address them.
Please allow us some time to provide feedback regarding the concerns you have raised.
Kind regards,
Umvuzo health
Dear Member,
Thank you for taking the time to share your experience with us.
We regret any frustration and inconvenience caused regarding your son's treatment and claims.
Please note that the diagnosis in question is recognised as a Prescribed Minimum Benefit (PMB) condition. However, the Scheme does not maintain a separate benefit pool specifically for this condition. Claims related to the treatment of congenital clubfoot are paid from the available benefits in accordance with the applicable option benefits and Scheme Rules.
Where applicable, PMB benefits are considered during the claims assessment process, particularly once the relevant benefits available on the option have been exhausted.
We can confirm that your claims have been resolved.
We trust that the above clarifies the matter.
Kind regards,
Umvuzo Health
Dear Member,
Thank you for taking the time to share your experience with us.
We regret any frustration and inconvenience caused regarding your son's treatment and claims.
Please note that the diagnosis in question is recognised as a Prescribed Minimum Benefit (PMB) condition. However, the Scheme does not maintain a separate benefit pool specifically for this condition. Claims related to the treatment of congenital clubfoot are paid from the available benefits in accordance with the applicable option benefits and Scheme Rules.
Where applicable, PMB benefits are considered during the claims assessment process, particularly once the relevant benefits available on the option have been exhausted.
We can confirm that your claims have been resolved.
We trust that the above clarifies the matter.
Kind regards,
Umvuzo Health
Dear Member,
We understand how stressful and overwhelming it is to manage continuous, specialized medical care for your child. Seeing your son go through weekly orthopedic treatments is deeply difficult, and it is completely natural that you want to protect your family's day-to-day funds to ensure everyone in your household stays safe and covered. We truly hear your concerns about fairness and the pressure this situation puts on your family.
To help clarify the rules we must operate under, Umvuzo Health is contractually and legally bound to administer benefits strictly in accordance with its registered Scheme Rules, which are approved annually by the Council for Medical Schemes (CMS) under Section 32 of the Medical Schemes Act 131 of 1998. Under the registered rules of the Supreme Option (Annexure B.3), all out-of-hospital claims must first be processed from the specified Family Benefit limit. Once this baseline limit reaches R0.00, funding shifts to the secondary Prescribed Minimum Benefit (PMB) risk pool to cover the remaining care.
To explain the legal structure regarding how these benefits are processed under South African healthcare regulations, there is a fundamental difference between a Personal Medical Savings Account (PMSA) and a Family Benefit limit. Regulation 10(6) of the Medical Schemes Act strictly prohibits medical schemes from depleting a member’s personal savings account to pay for PMB treatments. However, the Supreme Option does not utilize a PMSA. The Family Benefit is a traditional day-to-day allowance funded entirely by the scheme's collective risk pool. Because these funds are provided by the scheme rather than drawn from your personal savings asset, the regulations permit the scheme to utilize this threshold first.
Please rest assured that your son's treatment will not be stopped or capped. In strict compliance with Section 29(1)(p) of the Medical Schemes Act, Umvuzo Health does not limit PMB funding. Your son's weekly orthopaedic treatment and cast changes for congenital clubfoot will continue to be funded at 100% of the Scheme Tariff from the PMB risk pool once the Family Benefit threshold is exhausted, provided that Designated Service Providers (DSPs) are utilized and standard clinical protocols are followed.
Kind regards,
Umvuzo Health
Dear Member,
We understand how stressful and overwhelming it is to manage continuous, specialized medical care for your child. Seeing your son go through weekly orthopedic treatments is deeply difficult, and it is completely natural that you want to protect your family's day-to-day funds to ensure everyone in your household stays safe and covered. We truly hear your concerns about fairness and the pressure this situation puts on your family.
To help clarify the rules we must operate under, Umvuzo Health is contractually and legally bound to administer benefits strictly in accordance with its registered Scheme Rules, which are approved annually by the Council for Medical Schemes (CMS) under Section 32 of the Medical Schemes Act 131 of 1998. Under the registered rules of the Supreme Option (Annexure B.3), all out-of-hospital claims must first be processed from the specified Family Benefit limit. Once this baseline limit reaches R0.00, funding shifts to the secondary Prescribed Minimum Benefit (PMB) risk pool to cover the remaining care.
To explain the legal structure regarding how these benefits are processed under South African healthcare regulations, there is a fundamental difference between a Personal Medical Savings Account (PMSA) and a Family Benefit limit. Regulation 10(6) of the Medical Schemes Act strictly prohibits medical schemes from depleting a member’s personal savings account to pay for PMB treatments. However, the Supreme Option does not utilize a PMSA. The Family Benefit is a traditional day-to-day allowance funded entirely by the scheme's collective risk pool. Because these funds are provided by the scheme rather than drawn from your personal savings asset, the regulations permit the scheme to utilize this threshold first.
Please rest assured that your son's treatment will not be stopped or capped. In strict compliance with Section 29(1)(p) of the Medical Schemes Act, Umvuzo Health does not limit PMB funding. Your son's weekly orthopaedic treatment and cast changes for congenital clubfoot will continue to be funded at 100% of the Scheme Tariff from the PMB risk pool once the Family Benefit threshold is exhausted, provided that Designated Service Providers (DSPs) are utilized and standard clinical protocols are followed.
Kind regards,
Umvuzo Health