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Metrocare Medical Aid is part of the MedScheme group and they offer a comprehensive range of medical aid products to their members. Membership to the Metrocare Scheme is however very restricted and is only available to employees and employers. These employees need to be members of the scheme, as it is compulsory. An employee may also add his or her family as dependents, but they are not forced to join this medical aid and can choose to be part of another medical aid if they want to. However, if they choose to be part of another medical aid, they will need to provide proof of their membership.
When a member joins, their partner, spouse, or family members can be added as dependants, as long as children is under the age of 21. If they are over the age of 21 but under the age of 30, they can be accepted as a dependant if they are a current student and can provide proof of this. A dependant of a member that is recently deceased, are entitled to continue being a member, but they need to have been declared as a dependant prior to the date of the main member’s death. Their benefits will then continue and they will remain a member of the scheme for as long as they require.
In addition to these benefits, this scheme makes use of Netcare 911 for their medical transportation and emergency needs. They also provide emergency evacuation assistance if needed, which is a great benefit for members to have. The scheme has a hospital management plan that allows their members to receive quality care while they are admitted in hospital. This is a great benefit for member to have and benefits include most of the procedures in hospital. Although it is subject to pre authorisation, the scheme will cover most of the procedures and consultations that are needed in hospital.
Before checking into hospital, always make sure that you have been pre authorised for the specific procedure you are going in for. Approval from the fund is required before procedures can be performed. If the member did not apply for pre authorisation, they might incur a penalty for this, which will be payable by the member. If it is an emergency, authorisation will not be required in these cases. Planned procedures are referred to as an operation or other procedure performed in the hospital.
Metrocare Scheme is customer focused and confidentiality is always guaranteed. Their strategic intent is to be the leading medical aid provider and to enhance the access to quality medical care for all members. The main objectives of the society is to establish as fund that will finance all the medical requirements of their members and to make sure that they have access to quality medical care when they need it. Their core values include honesty and integrity as two main focus points for the scheme.