Name of the Organization : Metropolitan Medical Scheme
Type of Facility : Metropolitan Medical Scheme Membership Application
Head Office : Vlaeberg
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Website : metromed.co.za
Application form : https://www.southafricain.com/uploads/4681-application.pdf
Guideline : https://www.southafricain.com/uploads/4681-memguideline.pdf
Metropolitan Medical Scheme
Objectives of a Medical Scheme :
** The main objective of a medical scheme is to collect sufficient money, in the form of contributions from its members and income from investments, and to assist with the payment of members‘ medical bills.
Related : LA Health Medical Scheme Application : www.southafricain.com/4674.html
** It is important to note that medical schemes HELP members pay their medical bills and cannot always provide full cover for all medical bills.
** The better the range of benefits offered by a scheme and the more members claim, the higher the level of contributions has to be.
** You are therefore encouraged to manage your medical expenditure prudently.
Who qualifies to join the Scheme?
** The Metropolitan Medical Scheme is a restricted membership scheme and membership is available to employees of MMI Holdings Limited only.
** As an employee of MMI Holdings Limited, your membership of the Scheme is a condition of employment, unless otherwise agreed, and compulsory for all permanent staff in the employ of MMI Holdings Limited and its subsidiaries* and voluntary for continuation members who qualify for membership, unless you are entitled to benefits as a dependant of a principal member of another registered medical scheme.
Members have the option to retain membership of the Scheme with their registered dependants if :
** they retire from the service of the employer; or
** their employment is terminated by the employer on account of age, ill health or other disability.
** The Scheme will inform you of your right to continue membership and of the contribution payable from the date of your retirement or termination of employment.
** You will remain a member unless you inform the Board in writing that you want to terminate your membership.
Who qualifies as a dependant :
In terms of the Scheme rules, a dependant is defined as :
** a member’s spouse or common-law spouse who is not a member or a registered dependant of another medical scheme;
** the dependent child of a member who is not a member or a registered dependant of a member of another medical scheme;
** a child under the age of 21;
a child older than 21, up to the age of 25, unmarried and :
** a full-time student at a recognised tertiary institution; or
** not self-supporting due to physical or mental incapacity.
Notice of change in membership details and registration of dependants :
You should notify your Human Resources Department and the Scheme within 30 days of :
** a change in marital status;
** the birth of children;
** the adoption of a child (a copy of the final legal documents should accompany your request to register the child as a dependant);
** the exclusion of any of your dependants who no longer qualify as dependants;
** from this date onwards the dependant will no longer be eligible for benefits;
** any change in your residential and/or postal address (applicable to pensioner members only).
** Where appropriate, contributions will be adjusted accordingly in the above cases.
** Should a member elect not to register his/her dependants until a later stage, the dependant’s membership will be subject to a three-month waiting period before he/she becomes eligible for benefits.
** Contributions will be payable during the waiting period.
Membership card and certificate of membership :
** After you have been registered as a member of the Scheme, a membership card will be issued to you.
** This card is proof of membership of the Scheme and it remains your sole responsibility to ensure that the card is presented to service providers and that they record the correct membership number and name of the Scheme.
** In the event of the membership card being lost or stolen, please contact the Scheme immediately.
** Nobody may use your membership card besides you and your registered dependants.
A. Scope of benefits :
** During a financial year you and your registered dependants will enjoy the benefits as set out in the benefit schedules, subject to limitations and exclusions.
B. Changing from one option to another :
** Members who want to change to another option may only do so with effect from 1 January of each year.
** If you wish to change from one benefit option to another, you should notify the Scheme in writing of your intention to change to another benefit option in the stipulated time.
** Your contributions will change in accordance with the contribution table of the benefit option that you have selected.
C. Exclusions :
** Unless cover is provided as per the prescribed minimum benefits or otherwise provided for or decided by the Board, expenses in connection with any of the following will not be paid by the Scheme:
** All costs of whatsoever nature incurred for treatment of sickness conditions or injuries sustained by a member or a dependant, and for which any other party may be liable, unless the Board is satisfied that there is no reasonable prospect of the member or dependant recovering adequate damages from the other party.
** Where such a claim, after deliberation, is repudiated by the parties concerned,the member is entitled to such benefits as would have applied under normal conditions, irrespective of the lapse of time.
** Costs arising directly or indirectly from intentional, self-inflicted injury even if the member or dependant was psychologically unstable at the time.
** All costs in respect of injuries arising from speed contests, speed trials and professional sports.
** All costs for operations, medicines, treatment and procedures for cosmetic purposes and any complications arising from such services.
** Holidays for recuperative purposes or treatment or exercise in a gymnasium, whether medically necessary or not.
Contact Address :
PO Box 15716