Member Guide

Complaints and Disputes PRINT OR DOWNLOAD According to the Scheme rules, members may lodge a complaint with the Scheme in any of the following ways: contact: 0861 000 300; email: complaints@mhcmf.co.za; or write: to Moto Health Care at PO Box 2338, Durban 4000. When you lodge a complaint, the Scheme will acknowledge receipt within 2…

Scheme Exclusions All medical schemes have a list of services and products that they will not pay for. The Scheme’s exclusions are split into general and dental exclusions to make it easy for you to determine what will not be covered by the Scheme. General exclusions Search and rescue Complications or the direct and indirect…

Important to Remember! How to get the most out of your option Have an annual check-up at your general practitioner to make sure that you are healthy and, if there are any concerns, request your doctor to start treatment sooner rather than later. Remember to check if your option has network providers – using these…

PRE-AUTHORISATION PROCESS The pre-authorisation process ensures that the treatment or procedure is both necessary and appropriate. Except in emergencies, pre-authorisation must be obtained 48 hours before any hospital admission. Pre-authorisation is required for the following, among others: all admissions to hospital outpatient treatment in a hospital, i.e. when you do not stay overnight at the hospital…

HOW DO I REGISTER FOR CHRONIC MEDICATION? Remember: Chronic medicines approved from the additional non-PMB chronic condition benefit on the Classic, Classic Network and Optimum options will be paid subject to an annual limit. ESSENTIAL/CUSTOM OPTION STEP 1 STEP 2 STEP 3 STEP 4 STEP 1 Ask your network doctor to complete the chronic application…

CLAIMS PROCEDURE Who can claim? You and your healthcare providers (general practitioner, specialist, pharmacy or hospital) can submit claims directly to the Scheme. What information must be included on your claims? Your membership number The Scheme name Your benefit option (for example Optimum, Custom, etc.) Your surname and initials The patient’s name and beneficiary code…

Changing benefit options each year You can only change your benefit option once a year. The member guide containing the benefit information and an option selection form will be sent to you in the last quarter of each year, so that you can make an informed decision in time for the following year. If you change…

MEMBERSHIP Who can join the Scheme? Any person who is employed in the retail motor industry may join the Scheme. How to apply for Membership in FIVE easy steps ACTIVE EMPLOYEE MEMBERSHIP STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 1 Visit your HR Department to obtain a copy of the membership application…

Emergency Services The Scheme has a contract with Europ Assistance to provide emergency medical services to members. Call 0861 009 353 for the emergency operations centre to assign an ambulance to the incident. Emergency medical services include: Access to a 24-hour emergency medical assistance contact centre. Assisted by medically trained and registered agents with the…

Integrated Care To ensure you get high quality coordinated healthcare and the best outcomes, we have care programmes that will assist you in maximising your benefits and help you manage your condition optimally. These programmes assist our at-risk members to manage their health and benefits better so that they are always able to get the…