makotihealth.co.za Makoti Medical Scheme Membership Application : Universal Healthcare Administrators

Name of the Organization : Universal Healthcare Administrators (Pty) Ltd
Type of Facility : Makoti Medical Scheme
Head Office : Sandton

Website : http://www.makotihealth.co.za/Members.aspx
Application Form : https://www.southafricain.com/uploads/3084-makotiApplicationform.pdf

How To Apply For Makoti Medical Scheme Membership?

** Universal Healthcare (Pty) Ltd is responsible for registering the rules and benefits of the Makoti Medical Scheme.
** The Scheme will apply underwriting as allowed by the Medical Schemes Act to all new entrants.

Related : Join Genesis Medical Scheme Online Application : www.southafricain.com/2566.html

The following administrative guidelines apply :
** A spouse or partner, biological children, adopted children and immediate family members that are dependent on the member for family care and support are eligible.

Cover for children as dependants :
Your children may remain on the Makoti Medical Scheme as your dependants, until they :
** Become employed, or
** Reach the age of 21 years
** After 21 years of age your children may remain as adult dependants

Adding adult dependants :
** If you wish to add adult dependants underwriting will be done according to the Medical Schemes Act.
How many medical aid schemes can a person belong to?
You may not belong to more than one medical aid.

How often can I change my option?
Once a year, at the end of the year, change affective 1 January. Option change form must reach MAKOTI by 30 November.

Your membership status :
** Please report the following changes to your membership status to the human resources department of your company.
** The birth or legal adoption of a child
** The new ID number of a dependant – Passing away of a dependant
** Removal of a dependant from the Makoti Medical Scheme
** Divorce

** Addition of dependants
** Change of option may only be done once a year in January
** Change of address
** Changes in dependant status must be recorded in order for a new card to be issued.
** You need to check all the details on your membership card to make sure they are correct.
** Any mistakes must be reported as soon as possible so that a new card can be issued to you.

Your membership cards :
** Each member is issued with a membership card.

Contributions :
** Contributions to the Makoti Medical Scheme will be deducted from your wages.
** These are paid each month in advance by your employer to the scheme.

Accounts :
** It is the member’s responsibility to ensure that Enablemed receives all accounts immediately.
** Accounts received four months after the service date will not be paid by the Scheme and become the member’s responsibility.

Benefit Options and Exclusions :
Option 1: Primary Option
General Practitioner Services, Medication and Statutory Prescribed Minimum Benefits. All benefits are subject to pre-authorisation and include :
** Unlimited primary health care from your chosen general practitioner
** Medication as per formulary – acute and chronic

** Basic pathology and radiology as authorised (Radiology: CXR – suspected fractures of extremities and two obstetric sonars per pregnancy) (Pathology: PAP smear single slide, Glucose, Hb, WCC, Platelets RPR, Blood Group)
** Ambulance services for medical emergencies. Lifemed ambulance 0861086911
** Optometry and Primary Care Dentistry benefits are provided by accredited providers, subject to authorisation and limits

** Statutory Prescribed Minimum Benefits as authorised, in respect of the relevant health services as described in terms of section 67(1)(g) of the Act Accessed in State Hospitals.
** Experienced risk managers review all hospital admissions to optimise care and expenditure.

Option 2: Comprehensive Option
All benefits are subject to pre-authorisation and include :
** Unlimited primary health care from your chosen general practitioner
** Medication as per formulary – acute and chronic

** Hospitalisation including step down care as appropriate – subject to pre-authorisation and PMB’s
** Specialist services – subject to pre-authorisation (items excluded Items Excluded);
** Pathology and Radiology services are available provided they are pre-authorised subject to standard treatment protocols

** Ambulance services for medical emergencies Lifemed ambulance 0861 086 911
** Statutory Prescribed Minimum Benefits as authorised, in respect of the relevant health services as described in terms of Section 67(1)(g) of the Act. The purpose in specifying Prescribed Minimum Benefits is to avoid incidents where individuals lose their medical scheme cover in the event of serious illness

Contact Address :
Universal Healthcare Administrators (Pty) Ltd.
Universal House
15 Tambach Road
Sunninghill Park
Sandton
2157

Postal Address :
Private Bag X47
Rivonia
2128

Features of Makoti Medical Scheme

Makoti Medical Scheme is a South African medical aid scheme that provides healthcare coverage to its members. It was established in 2001 and is focused on providing affordable healthcare solutions to people living in rural areas, although it is open to all South Africans.

Here are some key features of Makoti Medical Scheme:

Benefit options:
Makoti Medical Scheme offers a range of benefit options to suit the healthcare needs and budgets of its members. These options include traditional medical aid options as well as hospital plan options.

Affordable contributions:
Makoti Medical Scheme is committed to providing affordable healthcare solutions to its members. It offers competitive contribution rates, and members can choose to pay their contributions either monthly or annually.

Access to private healthcare providers:
Makoti Medical Scheme gives its members access to private healthcare providers across South Africa. This includes doctors, hospitals, and other healthcare facilities.

Chronic medication cover:
Makoti Medical Scheme covers the cost of chronic medication for its members, subject to certain conditions and limits.