Primary Option
About this plan
🥇 Best suited for members who primarily use public hospitals for hospital treatment and only require basic day-to-day medical benefits.
Principal Member
From
R406
per month
Adult Dependant
From
R406
per month
Child Dependant
From
R273
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
Primary Option
Makoti Medical Aid Primary Option (🇿🇦 2025)
Overall, the Makoti Medical Aid Primary Option is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and basic cover to its members. The Makoti Medical Aid Primary Option starts from R406 ZAR.| 👤 Main Member Contribution | R406 – R1,118 |
| 👥 Adult Dependent Contribution | R406 – R870 |
| 🍼 Child Dependent Contribution | R273 – R400 |
| 📉 Annual Limit | Unlimited hospital cover |
| ➡️ Hospital Cover | Unlimited |
| ↪️ Gap Cover | None |
| 💶 Prescribed Minimum Benefits | ☑️ Yes |
| 🟦 Screening and Prevention | ☑️ Yes |
| 🔵 Medical Savings Account | None |
| 💙 Maternity Benefits | ☑️ Yes |
Makoti Medical Scheme Primary Option - 7 Key Point Quick Overview
- ☑️ Makoti Medical Scheme Primary Option Overview
- ☑️ Makoti Medical Scheme Primary Option Contributions
- ☑️ Makoti Medical Scheme Primary Option Benefits and Cover Comprehensive Breakdown
- ☑️ Makoti Medical Scheme Primary Option Exclusions and Waiting Periods
- ☑️ Makoti Medical Scheme Primary Option vs Similar Plans from other Medical Schemes
- ☑️ Our Verdict on the Makoti Medical Scheme Primary Option
- ☑️ Makoti Medical Scheme Primary Option Frequently Asked Questions
Makoti Medical Scheme Primary Option Overview
The Makoti Medical Scheme Primary Option medical aid plan is one of 2, starting from R406, and includes basic cover for GPs, medicines, specialists, radiology, pathology, and more. Gap Cover is not available on the Makoti Medical Scheme Primary 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 Primary Option Contributions
| 💶 Income Bracket | 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| 💵 R0 – R7,596 | R406 | R406 | R273 |
| 💴 R7,597 – R10,206 | R905 | R745 | R333 |
| 💷 R10,207 – R13,608 | R970 | R784 | R358 |
| 💶 R13,609 – R18,144 | R1,042 | R833 | R378 |
| 💵 R18,145 + | R1,118 | R870 | R400 |
Makoti Medical Scheme Primary Option Benefits and Cover Comprehensive Breakdown
Primary Option Day-to-Day Benefits
| 🟥 General Practitioner Consultations | Unlimited primary healthcare from a chosen GP. Covered according to the Makoti Scheme tariff. |
| 🟧 Acute Medicine | Unlimited coverage according to the medication formulary. |
| 🟨 Chronic Medicine | Unlimited coverage according to the medication formulary. |
| 🟩 Over-the-Counter Medicine | Limited to R452 per family per year for generic medication. |
| 🟦 Specialist Consultations | Only PMBs are covered. Members must use State Hospitals. |
| 🟪 Pathology | The following tests are covered: Liquid base cytology (first) Vaginal or cervical smears (Pathology Anatomical Exfoliative cytology) Glucose Glycosylated Haemoglobin Haemoglobin Estimation Platelet count Quantitative Kahn, VDRL, or other flocculation Grouping A, B, and O antigens Grouping: Rh antigens Leucocytes |
| 🟥 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 R1,123 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 | 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. |
Primary 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. |
| 🟠 Services in State Hospitals | PMBs are covered up to 100% as authorized. |
| 🟡 Maternity | Confinement in a private hospital is covered up to R29,400. Pre-authorization is required in the second trimester of pregnancy. |
| 🟢 Internal Prostheses | Limited to R61,728 per family per year. |
Read more about Health Insurance
Makoti Medical Scheme Primary Option Exclusions and Waiting Periods
Makoti Medical Scheme Primary 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
- Member-related traveling expenses
👉 Discover the 5 Best Comprehensive Medical Aid Plans
Makoti Medical Scheme Primary 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.
Medical Aid Comparisons : Makoti Medical Scheme Primary Option vs Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Makoti Medical Scheme Primary Option | 🥈 Momentum Ingwe Plan | 🥉 Fedhealth myFed |
| 👤 Main Member Contribution | R406 – R1,118 | R589 – R4,134 | R1,570 – R3,700 |
| 👥 Adult Dependent Contribution | R406 – R870 | R589 – R4,134 | R1,570 – R3,700 |
| 🍼 Child Dependent Contribution | R273 – R400 | R275 – R1,199 | R711 – R1,170 |
| 📉 Annual Limit | Unlimited hospital cover | None | Unlimited Hospital Cover |
