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South Africa is fast striving to develop a range of different Medical Aid schemes that will surely benefit its people. The Engen Medical Aid is a subsidiary of the JSE MMI Holdings, which forms the Metropolitan Health Group where the Engen Scheme belongs to. Low-cost and highly efficient medical care is what the Scheme intends to introduce to the market. In fact, if there is one thing that the care programme aims to deliver it will be the management services for the necessary medical treatments and such.
Membership to the Engen Medical Aid requires its patients to be part of the Engen Group or at least be beneficiaries of such. Employees are in fact obligated to be part of the medical Scheme unless the he or she happens to be part of their respective spouses’ medical plan. Application is quite easy as all the employee needs to do is to fill out the necessary forms from the Human Resources Offices.
The Two Main Covered Benefits
Two main categories are covered by the basic plans offered in the Engen Medical Aid. Insured and day-to-day benefits are these areas, and each will have its own range of policy coverage that will bring credibility for its members. Insured portion of the policy means the hospitalisation, chronic medication, optical care, confinements, chemotherapy and more. The Daily Benefits, meanwhile, cover the cost of practitioners and specialist care outside the hospital, acute medication, and auxiliary services.
The hospitalisation benefits that are part of the insured portion are covered up to a hundred percent of the Scheme Package. The company highly suggests that the patient-members try to work with the providers that are able to give the best for the Scheme rates. Daily benefits are generally claimed from the Individual account of the member while the excess will be derived from the Pool accounts of up to 80 percent of the total.
Diseases and conditions are specified on the limits that can be used for its treatments. Chronic conditions, for example, can have medication as long as the stated limits are within reason. Among the elements that have to be looked into as the life threatening elements of the disease and perhaps the need of such medication to sustain the life of the patient. Disease progression and intermittent therapy sessions are also factors that have to be considered in order for the disease to be covered.
The best thing about the medical aid system offered by Engen is it aims to give modern uptakes on the modern medical care. Online accessibility to the customer query and information is quick and easy. Patient-members are given this option to access their files in the fastest timeframes possible. Information-wise, the data contained inside the site are updated and current, and it includes the latest available limits that members and their beneficiaries can claim.
Among the medical treatments and conditions that are not covered by the Engen Medical Aid include cosmetic surgery, infertility issues, obesity, slimming preparations, tonics, and accommodation in retirement or senior care facilities.