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Membership Related Information

  Member Brochure in PDF format Benefits and contributions summary 2020
  Member Brochure in PDF format Download the application form

Your Membership and Administration

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.

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.

Option Comparison

Benefit Comparison Benefit Comparison

Contribution Table

Contributions Table

Complaints and disputes procedure

Members may lodge complaints with the scheme in writing (makoti@universal.co.za) or telephonically (011 208 1000) to the scheme’s telephone line. Call centre agents will assist the member immediately if possible. All unresolved telephonic complaints or complaints received in writing will be responded to by the scheme in writing within 30 days of receipt thereof.

Any dispute, which may arise between a member, prospective member, former member or a person claiming by virtue of such member and the scheme or an officer of the scheme, must be referred by the principal officer to a disputes committee (appointed by the Board of Trustees) for adjudication. On receipt of a request in terms of this rule, the principal officer must convene a meeting of the disputes committee by giving not less than 21 days’ notice in writing to the complainant and all the members of the disputes committee, stating the date, time and venue of the meeting and particulars of the dispute.

The disputes committee may determine the procedure to be followed. The parties to any dispute have the right to be heard at the proceedings, either in person or through a representative. An aggrieved person has the right to appeal to the Council for Medical Schemes against the decision of the disputes committee. Such appeal must be in the form of an affidavit and directed to Council and shall be furnished to the Registrar not later than three months after the date on which the decision concerned was made. Complaints can be submitted by any reasonable means such as a letter, fax, e-mail or in person at the Council’s Offices from Mondays to Fridays during 08:00 – 17:00. Visit www.medicalschemes.com for more information. See Contacts page for all Council of Medical Schemes contact information.

 
 

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