Comprehensive
About this plan
🥇 Best suited for individuals and families wanting comprehensive medical cover with access to private hospitals.
Principal Member
From
R2,738
per month
Adult Dependant
From
R2,359
per month
Child Dependant
From
R910
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Comprehensive
Makoti Medical Aid Comprehensive Option (🇿🇦 2025)
Overall, the Makoti Medical Scheme Comprehensive Option is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and auxiliary benefits to its members. The Makoti Medical Scheme Comprehensive Option starts from R2,738 ZAR.| 👤 Main Member Contribution | R2,738 – R3,744 |
| 👥 Adult Dependent Contribution | R2,359 – R3,209 |
| 🍼 Child Dependent Contribution | R910 – R1,218 |
| ↪️ Gap Cover | None |
| 📉 Annual Limit | Unlimited hospital cover |
| ☑️ Hospital Cover | Unlimited |
| ➡️ Oncology Cover | PMB Level of Care |
| 💶 Prescribed Minimum Benefits | ☑️ Yes |
| 🔁 Screening and Prevention | ☑️ Yes |
| 🔍 Medical Savings Account | None |
Makoti Medical Scheme Comprehensive Option - 7 Key Point Quick Overview
- ☑️ Makoti Medical Scheme Comprehensive Option Overview
- ☑️ Makoti Medical Scheme Comprehensive Option Contributions
- ☑️ Makoti Medical Scheme Comprehensive Option Benefits and Cover Comprehensive Breakdown
- ☑️ Makoti Medical Scheme Comprehensive Option Exclusions and Waiting Periods
- ☑️ Makoti Medical Scheme Comprehensive Option vs Similar Plans from other Medical Schemes
- ☑️ Our Verdict on the Makoti Medical Scheme Comprehensive Option
- ☑️ Makoti Medical Scheme Comprehensive Option Frequently Asked Questions
Makoti Medical Scheme Comprehensive Option Overview
The Makoti Medical Scheme Comprehensive Option is one of 2, starting from R2,738 and includes cover for clinical psychology, hearing aids, external and internal prostheses, auxiliary benefits, COVID-19, and more. Gap Cover is not available on the Makoti Medical Scheme Comprehensive Option. However, Makoti offers 24/7 medical emergency assistance. According to the Trust Index, Makoti Medical Scheme has a trust rating of 2.7. Makoti Medical Aid Scheme has two options namely ✅ Makoti Comprehensive Option and ✅ Makoti Primary Option
Makoti Medical Scheme Comprehensive Option Contributions
| 💶 Income Bracket | 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| 💴 R0 – R10,586 | R2,738 | R2,359 | R910 |
| 💵 R10,587 – R14,020 | R3,166 | R2,636 | R1,032 |
| 💷 R14,021 – R18,598 | R3,413 | R2,867 | R1,108 |
| 💶 R18,599+ | R3,744 | R3,209 | R1,218 |
Makoti Medical Scheme Comprehensive Option Benefits and Cover Comprehensive Breakdown
Comprehensive Option Day-to-Day Benefits
| 👩⚕️ General Practitioner Consultations | Unlimited primary healthcare from a chosen GP. Covered according to the Makoti Scheme tariff. |
| ☑️ Medicines | - |
| 💊 Acute Medicine | Unlimited coverage according to the medication formulary. |
| 💉 Chronic Medicine | Unlimited coverage according to the medication formulary. |
| 📌 Over-the-Counter Medicine | Limited to R482 per family per year for generic medication. |
| 👨⚕️ Specialist Consultations | Subject to pre-authorization. A referral from a GP is required. |
| 🧪 Pathology | Subject to pre-authorization. A referral from a GP is required. |
| 🚑 Ambulance Services | Available only for emergencies. Makoti Medical Scheme uses Lifemed as the preferred provider. Transport is not offered for non-life-threatening situations. |
| 🤓 Optometry | Limited to R3,116 per beneficiary every 2 years. This will include the eye test, frames, and lenses. Pre-authorization is required. The cover is only provided where needed for correcting significant visual impairment. Replacement of lost glasses is not covered. |
| ☑️ Dentistry | - |
| 🦷 Basic Dentistry | Covers consultations, fillings, extractions, and preventative care according to managed care protocols. A registered and accredited dentist or dental therapist must provide dentistry services. Pre-authorization from the Dental Information Systems (Pty) Ltd is required. |
| 📍 Advanced Dentistry | Limited to R4,211 per family per year. Includes root canal treatment and periodontal treatment. A registered and accredited dentist or dental therapist must provide dentistry services. Pre-authorization from the Dental Information Systems (Pty) Ltd is required. |
Comprehensive Option In-hospital Benefits
| 🟥 In-hospital Benefits | Benefits are covered up to 100% of the Makoti tariff. Pre-authorization is required before admission. Risk managers review all admissions to optimize care. |
| 🟧 Private Hospital Benefit | Makoti offers unlimited hospitalization in private hospitals. Step-down benefits are available if medically appropriate. Pre-authorization applies. Clinical protocols apply. The benefit is subject to PMBs. |
| 🟨 Maternity | Confinement is covered in any private hospital. Subject to pre-authorisation and protocols. |
👉 Discover more about the Advantages of Hospital Plans
Comprehensive Option Other Services
| 🧠 Clinical Psychology | Limited to eight consultations per family per year. Must be referred by a GP. Pre-authorization is required. |
| 🦻 Hearing Aids | Limited to R4,082 per beneficiary every 4 years. Pre-authorization is required. |
| 🦾 External Prostheses and Appliances | Limited to R4042, per family per year for the following: Wheelchairs Walking frames Crutches Home Oxygen Glucometers are limited to R315 per member every 2 years. Pre-authorization and clinical protocols apply. |
| 🦿 Internal Prostheses | Limited to R61,728 per family per year. Subject to pre-authorization. Clinical protocols will apply. Cardiac stents are limited to 3 stents (1 per lesion) |
| 🅰️ Back and Neck Program | Subject to clinical protocols. |
👉 Read more about medical aid plans that cover Glaucoma
Comprehensive Option Auxiliary Services
| 📌 Allied Healthcare Services Physiotherapy Occupational Therapy Dieticians Speech Therapy Podiatry | Limited to 20 consultations per family per year. Subject to pre-approval and clinical protocols. |
| 📍 Oncology Chemotherapy Radiotherapy Radiology Related Consultations Pathology | Limited to the PMB level of care. It must be according to an authorized ICON treatment plan. Biologicals and Brachytherapy materials are not covered. |
| 🅰️ COVID-19 Vaccines | Tests and vaccinations are according to Scheme protocol. |
| 🅱️ Immunisation/Vaccinations | One flu vaccine per beneficiary per year. One HPV vaccine for female beneficiaries between 9 and 27. One pneumococcal vaccination for all immune-compromised beneficiaries and those older than 65 years every 5 years. |
| ❤️ Organ Transplants and Kidney Dialysis | Subject to PMBs. Clinical protocols will apply. Pre-approval is required. |
| 🩸 Emergency Room or Casualty visits | Only covers life-threatening emergencies. |
👉 You might like the 10 Best Medical Aids in South Africa
Makoti Medical Scheme Comprehensive Option Exclusions and Waiting Periods
Makoti Medical Scheme Comprehensive Option Exclusions
Makoti Medical Scheme will NOT cover the following costs unless it forms part of the Prescribed Minimum Benefits (PMBs):- The treatment of obesity and its direct complications
- Items or treatments that are not medically indicated
- Willfully self-inflicted injuries
- Injuries arising from professional sports and speed contests
- The hire of medical, surgical, and other appliances
- The cost of surgical stockings
- Medical services provided by any person not registered with the Health Professions Council of South Africa, the South African Nursing Council, or the South African Pharmacy Council
- Recuperative holidays
- Dental extractions for non-medical purposes
- Gold inlays
- Unproven or experimental treatment
- Cosmetic and reconstructive surgery, treatment, or appliances
- Frail care and convalescence
- Employee medical examinations initiated by an employer
- Injuries where another party is responsible for the costs (e.g., Road Accident Fund or Workmen’s Compensation claims)
- Roaccutane and Retin A for the treatment of skin conditions
- Contraceptives and contraceptive devices
Makoti Medical Scheme Comprehensive Option Waiting Periods
Makoti Medical Scheme may apply waiting periods to individuals applying for membership or as a dependent and who were not part of a medical scheme for at least 90 days before the date of application. This includes a general waiting period of up to three months and a condition-specific waiting period of up to 12 months.👉 POLL: 5 Best Medical Aids under R1500
Makoti Medical Scheme Comprehensive Option vs Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Makoti Medical Scheme Comprehensive Option | 🥈 Sizwe Hosmed Gold Ascend | 🥉 Momentum Custom |
| 👤 Main Member Contribution | R2,738 – R3,744 | R3,726 | R2,353 ZAR – R4,047 |
| 👥 Adult Dependent Contribution | R2,359 – R3,209 | R3,578 | R1,780 ZAR – R3,248 |
| 🍼 Child Dependent Contribution | R910 – R1,218 | R1,029 | R834 ZAR – R1,444 |
| 📉 Annual Limit | Unlimited hospital cover | Unlimited Hospital Cover | Unlimited |
| 💙 Hospital Cover | Unlimited | Unlimited for PMBs | Unlimited |
