Frequently Asked Questions

• Previous medical scheme membership certificates.
• Copy of IDs for adults and birth certificates for children.
• Marriage certificate.
• An affidavit should surnames differ or a common law spouse or partner are added as dependant.
• Adopted children – legal documentation to be provided.
• Student certificate and / or proof of registration from the university or college if a child dependant is studying.

On joining members will receive a single card when joining without any dependants. Two cards are issued when a member registers dependants.

Please remember that you can keep your CompCare Medical Scheme card with you at all times by downloading your membership card on the Mobi App.

Managed Care consists of processes and policies that most medical schemes apply in an effort to manage the increasing costs of healthcare as well as to prevent the over utilisation of benefits and to ensure quality of care. Managed Care ensures that members are able to access healthcare services that will provide cost effective, clinically appropriate care.

The focus is not only on cost, but also on appropriate, effective care.

The purpose of CompCare’s Hospital Benefit Management team is to assist members in obtaining pre-authorisation for hospital admissions and to manage access to care that is affordable, appropriate, safe and quality healthcare. This is not only to improve the quality of care that you receive while in-hospital, but extends to improving your health status after you have been discharged.

CompCare has ‘Standard’ and Plus options. For the standard options you may use:
Netcare: SelfCare and SelfCare Plus, ExtraCare, UltraCare, ExecuCare
Mediclinic: SelfCare and SelfCare Plus, ExtraCare
Any hospital: SaverCare and SaverCare Plus, UltraCare Plus, ExecuCare Plus

Important to remember:

Always make sure you use a network hospital (where applicable) to avoid co-payments. Ask your specialist if they work in one of the network hospitals before you consult them to ensure that if needed, you are admitted to a network hospital. A 35% co-payment will apply to the voluntary use of a non-DSP/network hospital/facility.

All hospital admissions must be pre-authorised by the Scheme at least 48 hours prior to admission.  The process of pre-authorisation is where you inform the Scheme of your admission to hospital and obtain approval for your stay.  

Please have the following information at hand in order to obtain pre-authorisation:

• Medical aid number
• Dependent number
• The practice number for the hospital that you are being admitted to
• The practice number of the doctor who will be treating you
• The admission date
• The diagnosis and procedure codes for your admission (the treating provider usually provides this information)

In the case of an emergency, pre-authorisation should be obtained on the first working day after your admission. Where you are unable to contact the Scheme yourself, a family member or the hospital may do so on your behalf.

Failure to obtain pre-authorisation may result in a co-payment or the non-payment of the account.

Pre-authorisation is not a guarantee of payment. Payment will depend on your membership being active and benefits being available on the date of treatment. Payment will also always be in terms of the Scheme rules applicable to your selected benefit option.

The hospital account will be paid at the negotiated rate, which is a fee negotiated by Universal Healthcare, the Scheme’s Administrator, on behalf of CompCare.

Service providers submit claims electronically, directly to CompCare which provides for a seamless member experience. Members do however sometimes need to submit claims to the Scheme for example in instances where they have paid upfront for a claim.  For member refunds members need to submit a detailed account as well as proof of payment in order for the Scheme to reimburse the expense. An account or statement requires the following compulsory information in terms of the Medical Schemes Act:

• The surname and initials of the member;
• The surname, first name and other initials of the patient;
• The name of the medical scheme concerned;
• The membership number of the member;
• The practice code number, group practice number and individual provider registration number issued by the registering authorities for providers, if applicable of the supplier of service, and in the case of a group practice, the name of the practitioner who provided the service;
• The relevant diagnostic and such other item code numbers that relate to such relevant health service;
• The date on which each relevant health service was rendered;
• The nature and cost of each relevant health service rendered; including the supply of medicine to the member concerned or to a dependant of that member; and the name, quantity and dosage of and net amount payable by the ember in respect of the medicine;
• Where a pharmacist supply medicine according to a prescription to a member or to a dependant of a member of a medical scheme, a copy of the original prescription or a certified copy of such prescription, if the scheme requires it.

The Act further specifies requirements in cases where a theatre was used (usually in hospital) or in respect of orthodontic treatment.  Please refer to Regulation 8 of the Medical Schemes Act for more information.

The Scheme rate is determined by the Board of Trustees and is adjusted from time to time following consultation with suppliers in the industry. It is important to note that providers are under no obligation to charge the scheme rate and that it is important for you to understand that you may be liable should there be a difference between what is charged on the account and the scheme rate.  It is therefore advisable to confirm the rate that your doctor will be charging beforehand, and to establish whether you can negotiate with the doctor to reduce their fee and the likelihood of a co-payment.

• You can e-mail your claim to [email protected]
• Post your claims to: CompCare Claims Department, P.O. Box 1411, Rivonia, 2128
• Submit your claims via the universal.one Mobi App