COVID-19 related queries? Take a look at the FAQs listed below. If your question isn’t there, drop us a line.
Does CompCare pay for both positive and negative COVID-19 tests, and will it affect my day-to-day benefits?
Pathology laboratory claims for the first test will be paid from Scheme benefits as a Prescribed Minimum Benefit. The first test will also be paid on the MEDX and MEDX ED options, although they are hospital plans. It is however important that the claim is submitted to the Scheme under the correct diagnosis code (ICD10 code). The diagnosis code should reflect the COVID diagnosis code, as opposed to the general “Z” diagnosis code under which blood tests are submitted. The claim will not pay correctly if the diagnosis code is not correct.
Subsequent negative tests will be paid from your day-to-day benefits, subject to the availability of funds.
What are the criteria for a COVID-19 test?
Is there a limit to the test that CompCare will pay for?
There is no limit to the number of tests paid for by the Scheme from risk when the test results are positive.
Does CompCare have additional benefits to the Prescribed Minimum Benefit for members who tested positive for COVID?
Will CompCare pay for the vaccine?
Yes. The vaccine is a Prescribed Minimum Benefit and will be paid from risk. It will therefore not impact your day-to-day benefits.
Why can I not obtain my vaccine through CompCare?
All “branded” vaccinated sites are not exclusively for their members. It remains a government registered site and members who are not members of that specific brand, but live close to the site, are directed there when they register on the EVDS system. All citizens should register on the EVDS site (irrespective of their Scheme membership or special arrangements made by their Schemes).
All Scheme members still have to follow the same process as non-medical scheme members by registering on the EVDS system). Upon registration you will be directed to a site closest to you – in urban areas within a radius of 10 kilometers and in rural areas 30kms.
If another “branded” site is within 10 kilometers of you and you are not a member of that company or a medical aid member, you can still be directed there. The only source for registration is the EVDS site.
Scheme related queries? Take a look at the FAQs listed below. If your question isn’t there, drop us a line.
How many chronic conditions are covered on the PINNACLE option?
74 conditions (27 CDL + 47 chronic conditions).
How is the specialist reimbursed on the PINNACLE and the other plans?
Specialists on PINNACLE are reimbursed at 200% of Agreed Tariff and other options reimbursed at 100% of Agreed Tariff.
How does the day-to-day benefit work on PINNACLE?
- Step 1 – Medical savings account (MSA): Claims are initially paid from MSA.
- Step 2 – Annual flex benefit (AFB): Once MSA is depleted claims are paid from your AFB.
- Step 3 – Self-payment gap (SPG): Once MSA and AFB have been depleted you must pay cash and hand in your claims as they are accumulated to reach your threshold.
- Step 4 – Threshold level: When you have reached your threshold, ‘Above Threshold’ kicks in.
- Step 5 – Claims are now paid from ‘Above Threshold’.
How are day-to-day claims paid on MUMED?
- Step 1 – Claims are paid from Annual Flexi Benefit (AFB).
- Step 2 – Balance of GP consultations payable from risk once your AFB has been depleted.
Through which benefit is specialised radiology, MRI scans and PET scans paid from on MUMED?
Claims are paid from Risk and pre-authorisation is required.
How does CompCare’s Member Mobi App work?
Our Member App is your mobile gateway to information. Access and view your option, benefits and claims anywhere, anytime.
- CLAIMS — Submit new claims and view your claims history.
- HOSPITAL PRE-AUTHORISATION — Submit new pre-authorisation requests and view your pre-authorisation history.
- QUERY — Submit queries and view important contact details.
- MEMBERSHIP CARD — See a digital version of your membership card and never be caught without it again.
- BENEFITS — View all your benefits, annual limits and your available balances.
- MUCH MORE — Request your Tax or Member certificates. See all your registered chronic conditions, register for new conditions, update your scripts and apply for an extended supply of medicines. Access your personal details, your dependant details and your Scheme details. You can also search for a Network Specialist in your area.
Can I register dependants anytime during the year?
A newborn has to be registered within 30 days of birth to ensure that no waiting periods are applied to the child’s membership, and membership will then be activated from the date of birth.
The Scheme needs to be notified of all other changes in status (for example when the principal member gets married or divorced) as soon as possible. All additions are effective from the 1st of a month and waiting periods (underwriting) may be applied in terms of the Medical Schemes Act.
Terminations are effective on the last day of the month. A member who has not joined the Scheme as part of a participating employer group may terminate membership by giving one (1) month’s written notice.
When does my cover end if I resign from the Scheme?
A member who has not joined the Scheme as part of a participating employer group may terminate membership by giving one (1) month’s written notice. Membership will be terminated at the end of the third month.
Who may I register as a dependant?
The following may qualify to be registered as dependants on CompCare in terms of the Scheme rules:
- Your spouse or partner who is not a member of a medical scheme. Copies of the following documents are to be submitted with the application form:
- Marriage Certificate or an affidavit confirming your relationship, copy of the dependant’s Identity Document and Membership Certificate of previous medical scheme(s).
- Child dependants (a member’s biological children, stepchildren or legally adopted children) under the age of 21, but not older than 27. Copies of the following documents to be submitted with the application form:
- Biological child – birth certificate and an affidavit if the child’s surname is different from the principal member;
- Stepchild – birth certificate and an affidavit to confirm the dependency status;
- Legally adopted child – birth certificate and adoption papers.
Please contact our membership department for more information on eligibility for membership.
What is the difference between the “Standard” and ED options?
All options on CompCare, with the exception of the UNISAVE, SELFNET and SELFSURE options, have Efficiency Discounted (ED) Options which
Which options do not have an over-the-counter medication benefit?
Which Designated Service Provider (DSP) hospitals and pharmacies must the ED option members use?
Netcare hospitals and Dis-Chem pharmacies.
What is the DSP ambulance or emergency assistance service for CompCare?
It is Netcare 911.
Any general queries? Take a look at the FAQs listed below. If your question isn’t there, drop us a line.
What are the limits for a Mammogram?
One test per female beneficiary over the age of 35 every second year.
What is Specialised Radiology?
How is Specialised Radiology paid?
Please refer to your
Do I need pre-authorisation for Specialised Radiology?
All Specialised Radiology (both in and out of hospital) requires pre-authorisation.
What are the limits for Pathology?
In-hospital Pathology is paid at 100% of the Scheme rate, subject to Scheme protocols. It is unlimited on the PINNACLE and DYNAMIX options and limited on the other options (refer to the
Pathology out of
Please refer to your
How is Specialised Radiology paid?
Please refer to your
Do I need to register on the Maternity Programme?
You can contact the call
Please also remember to register your newborn baby within 30 days from the date of birth to avoid waiting periods.
How is Maternity covered?
CompCare has various benefits that are paid for by the Scheme that will not impact your day-to-day benefits for all options. Please refer to your guide for more information.
The maternity benefit includes cover for 12 antenatal visits with your General Practitioner, Specialist or midwife (paid at the Scheme tariff) on the options that offer this benefit.
In addition to this, there is also a benefit for ante-natal classes (subject to specified Rand limits), as well as a breastfeeding consultation with a midwife after birth.
The birth (confinement) in
Is there a benefit for Infertility?
Although Infertility is a Scheme exclusion, some aspects form part of the Prescribed Minimum Benefits (PMBs), and
What is the benefit for psychiatric hospitalisation?
Please contact out pre-authorisation department for more information.
How will Psychologists be paid?
Psychologists or any registered mental health professional are paid from your available day-to-day benefits and subject to sub-limits according to the benefit option that you have selected.
In addition to this, the Scheme has a telephonic counselling benefit available for all members and their registered dependants 24 hours a day, 7 days a week, 365 days a year. The counselling is provided by registered counselling professionals (psychologists, social workers and registered counsellors) and is completely confidential.
Members can access this benefit by calling 0800 390 003 (toll free from a landline) or by sending a “Please call me” to *134*952#.
Is Optical Refractive Surgery covered?
Refractive Surgery is covered with specified sub-limits on PINNACLE, DYNAMIX and SYMMETRY.
On MEDX Refractive Surgery is covered in terms of the Prescribed Minimum Benefit protocols.
Refractive Surgery requires pre-authorisation.
What are my Optical Benefits?
Your Optical benefits are paid from your day-to-day benefits according to the option that you have selected.
What is a Prosthesis?
A Prosthesis refers to an artificial body part or device to replace or augment a missing or impaired part of the body such as a limb, a heart, etc.
Please refer to your
What are the limits for Prosthesis?
Surgical Prosthesis, Electronic and Nuclear appliances are covered from the Prosthesis benefit and are subject to specific sub-limits for your chosen option. Please note that this requires pre-authorisation and is funded in terms of Scheme protocols.
How are out-of-hospital GP visits paid?
Visits to your General Practitioner are paid from your available day-to-day benefits according to the option that you have selected.
In addition to this, members on PINNACLE, DYNAMIX, SYMMETRY, MUMED, UNISAVE, SELFNET
Which Practitioners are covered under the Auxiliary / Allied Services Benefit?
The following Healthcare providers are covered under the Auxiliary/ Allied services benefit:
Audiologists, Dieticians, Physiotherapists, Occupational Therapists, Speech Therapists, Social Workers, Homeopaths/ Naturopaths, Chiropractors and Biokineticists.
Kindly note that these service providers should be registered with the Board of Healthcare Funders and have valid practice numbers in order for the Scheme to make payment to these providers.
What is the Auxiliary / Allied Services Benefit?
This is a benefit where the services of healthcare providers other than your doctor or specialist are covered and
This benefit is usually paid from your available day-to-day benefits according to the option that you have selected as this benefit has a combined in and out of hospital benefit limit.
How are Medicines paid?
Members are required to register chronic medicine with Universal to have access to the Chronic Medicine Benefit. In order to register your medicine, your doctor or pharmacist is required to contact Universal or to send an e-mail.
Please refer to your
Acute Medicine refers to prescription medicine, schedule 3 and higher, for which you require a prescription from your doctor.
Acute Medicine is usually covered from your available day-to-day benefits. Please refer to your
Over-the-Counter Medicines (OTC)
What is the Chronic Medicine Management Programme?
The Chronic Medicine Management Programme
- Medicines for life-threatening illnesses (e.g. hypertension).
- Medicines used on an ongoing basis to treat disabling chronic illnesses that significantly affect productivity and quality of life (e.g. arthritis).
What is the difference between Conservative and Specialised Dentistry?
Conservative (or basic) dentistry refers to the diagnosis, prevention and treatment of tooth and gum diseases as well as the repair of defective teeth. This usually includes the consultation, scale and polish, fillings, x-rays and extractions and is work usually performed by a General Dentist.
Specialised (or advanced) dentistry refers to dental services not covered under basic dentistry and is usually performed by a ‘specialist’ Dentist for example an Orthodontist, Periodontist, Maxillofacial and Oral Surgeon. This usually occurs when teeth need to be replaced or repaired. This includes orthodontic treatment, crowns and bridges.
Not all options cover specialised dentistry and it is therefore important to refer to your benefit guide for option specific information.
How is Dentistry covered?
Dentistry is usually covered from your available day-to-day benefits according to the option that you have selected.
In addition to this, members on PINNACLE, DYNAMIX, SYMMETRY, MUMED, UNISAVE
CompCare offers a pre-authorisation service through Universal Care for
What Preventative Care is covered?
CompCare is known to have one of the best preventative care and wellness
And we cover many more. Please refer to your member guide for more information or contact our call