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    Makoti 1 Pager 2021

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    Tylor
    The Makoti Medical Scheme provides affordable, high-quality healthcare with the goals of sustaining the plan long-term and preventing illness. It offers unlimited general practitioner and chronic medicine benefits under both the primary and comprehensive options. The comprehensive option provides additional benefits including specialized dentistry, optometry, and physiotherapy. Both options cover medical emergencies and HIV/AIDS fully.

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    Makoti 1 Pager 2021

    Uploaded by

    Tylor
    33 views2 pages
    The Makoti Medical Scheme provides affordable, high-quality healthcare with the goals of sustaining the plan long-term and preventing illness. It offers unlimited general practitioner and chronic medicine benefits under both the primary and comprehensive options. The comprehensive option provides additional benefits including specialized dentistry, optometry, and physiotherapy. Both options cover medical emergencies and HIV/AIDS fully.

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    The Makoti Medical Scheme provides affordable, high-quality healthcare with the goals of sustaining the plan long-term and preventing illness. It offers unlimited general practitioner and chronic medicine benefits under both the primary and comprehensive options. The comprehensive option provides additional benefits including specialized dentistry, optometry, and physiotherapy. Both options cover medical emergencies and HIV/AIDS fully.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views2 pages

    Makoti 1 Pager 2021

    Uploaded by

    Tylor
    The Makoti Medical Scheme provides affordable, high-quality healthcare with the goals of sustaining the plan long-term and preventing illness. It offers unlimited general practitioner and chronic medicine benefits under both the primary and comprehensive options. The comprehensive option provides additional benefits including specialized dentistry, optometry, and physiotherapy. Both options cover medical emergencies and HIV/AIDS fully.

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    Benefits and Contributions

    Summary 2021
    The Makoti Medical Scheme was developed with the following in mind:
    • To provide high quality medical care at affordable cost
    • To introduce control measures in order to sustain the plan for a long period
    • To prevent illness wherever possible by dealing with healthcare issues in the community we serve
    • All benefits are paid at the scheme tariff and are subject to managed care protocols

    Benefit Primary Option Comprehensive Option

    Overall Limit No Limit No Limit

    General Practitioner Services Unlimited Unlimited

    Medicines as per formulary


    Unlimited Unlimited
    Acute and chronic

    Over the counter medicine (OTC) Limited to R364 per family per annum Limited to R382 per family per annum

    Chronic Illness Screening by General


    Annual or when requested Annual or when requested
    Practitioner
    All the following services must be authorised by calling 0860 00 24 00 or
    060 982 3823 in the case of an emergency
    Benefit Primary Option Comprehensive Option
    Radiology: CXR, suspected fractures of
    extremities and two obstetric sonars per
    pregnancy Limited to list of codes
    Basic Pathology and Radiology Subject to pre-authorisation and managed
    Pathology: PAP smear single slide, care protocols
    Glucose, HbA1c, Hb, WCC, Platelets RPR,
    Blood Group and HIV
    As per Prescribed Minimum Benefits only in
    Specialist Services Subject to managed care protocols
    State Hospitals
    As per Prescribed Minimum Benefits only in Private Hospitals
    Hospitalisation
    State Hospitals Subject to managed care protocols
    Emergency Stabilisation / Casualty in a
    Medical Emergencies only Medical Emergencies only
    private hospital
    In private hospitals limited to R25 000 per
    pregnancy or access to the Birthing Team
    Maternity Benefit Subject to managed care protocols
    units where available;
    Subject to managed care protocols
    HIV/AIDS Fully Covered Fully Covered

    Other services
    Benefit Primary Option Comprehensive Option
    Fully Covered through Lifemed on Fully Covered through Lifemed on
    Ambulance for medical emergencies
    0861 086 911 0861 086 911
    Clinical Psychology Prescribed Minimum Benefits in state facility only 8 consultations per family per year
    Hearing Aids Prescribed Minimum Benefits only R3 235 per beneficiary every 4 years
    External Prostheses / Appliances Prescribed Minimum Benefits only R3 203 per family every year
    Internal Prostheses R49 690 per family per year R49 690 per family per year
    Physiotherapy and Occupational Therapy Prescribed Minimum Benefits only 20 consultations per family per year
    R905 per beneficiary every 24 months R2 469 per beneficiary every 24 months
    Optometry
    including full cost of eye test including full cost of eye test

    Dentistry
    Benefit Primary option Comprehensive option
    Basic prevention, fillings and extractions Subject to managed care protocols Subject to managed care protocols
    Specialised Dentistry No Benefit R3 337 per family per year
    Dentures No Benefit 1 set per beneficiary every 4 years

    Contribution table effective 1 January 2021


    Primary Principal Adult Child Comprehensive Principal Adult Child
    Plan (R) (R) (R) Plan (R) (R) (R)
    0 - 3 240 294 294 191 0 - 10 082 1 976 1 702 656
    3 241 - 6 966 311 311 209 10 083 - 13 352 2 284 1 902 744
    6 967 - 9 720 692 571 255 13 353 - 17 712 2 463 2 067 800
    9 721 - 12 960 742 601 274 17 713+ 2 701 2 315 878
    12 961 - 17 280 798 639 290
    17 281+ 856 666 307

    Emergency services are available 24 hours a day, 7 days a week


    Enablemed: 0860 002 400 / Ambulance services: Lifemed 0861 086 911 / National 24-hour call line: 0860 002 400 / Alternative number: 0609 823 823

    TM

    Administered by Universal Healthcare Administrators (Pty) Ltd

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