Healthcare Provider Information

Enablemed is a Managed Care Organisation accredited by the Council for Medical Schemes, managing the following options:

  • Makoti Medical Scheme:
    • Primary Option
    • Comprehensive Option
  • Malcor:  Plan D
  • Sizwe: Gomomo (Day to Day benefits)
  • Essential Employee Benefits (Health Insurance Product)

Enablemed runs a 24-hour Call Centre 0860 00 24 00

Please contact 0860 00 24 00 for Pre-authorisation & Enquiries

a) Specialist Visits

  • Pre-authorisation with GP referral letter a requirement
  • Managed Care formulary, Scheme rules & protocols apply to all referrals – refer to Enablemed website / 24 hour Call Centre for any queries
  • Back pain protocol to be followed

b) Accounts must be submitted within 4 months after the date of service in one of the following ways:

  1. Electronically;
  2. Email:  admin@enablemed.com (for non-switching providers); or
  3. Fax:  086 660 7023

c)  Chronic Care

  • Registration only to chronic@enablemed.com
  • Pharmacy claims electronically (via Mediscor PBM)

d)  Radiology & Pathology approved as per formulary

  • Subject to pre-authorisation