Enablemed is a Managed Care Company accredited by the Council of Medical Schemes, managing the following options:
- Makoti Medical Scheme:
- Primary Option
- Comprehensive Option
- Malcor: Plan D
- Sizwe: Gomomo (Day to Day benefits)
Enablemed runs a 24-hour Call Centre: 0860 00 24 00
Please contact 0860 002 400 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 to one of the following:
- Electronically via Healthbridge or Mediswitch
- Email: firstname.lastname@example.org (for non-switching providers); or
- Fax: 086 660 7023
c) Chronic Care
- Registration only to email@example.com
- Pharmacy claims electronically (via Mediscor PBM)
d) Radiology & Pathology approved as per formulary (refer to billing codes below)
These are the Basic Formulary Codes that will be reimbursed, anything outside of this or more complex requires pre-authorisation.
The content should not be considered complete, and does not cover all drugs, procedures and formulary codes / items. We do our best to ascertain that all information on this site is correct and up-to-date, however, we cannot guarantee that it is. The Restricted List is subject to scheme rules, specified benefit limits, clinical protocols and policies. Please confirm benefits and scheme rules. Certain medication and/or items, especially high cost drugs/items are excluded from benefit unless specifically pre-authorised.
Enablemed specifically disclaims all responsibility for any liability, loss, or risk, personal or otherwise, which may be incurred as a consequence, directly or indirectly, of the use and application of any of the Restricted List/ Formulary content on this site. Even though care has been taken in the preparation and publication of the contents of this website, Enablemed does not assume legal or other liability for any inaccuracy, mistake, mis-statement or any other error of whatsoever nature contained herein. The information contained within this site is of a condensed and general information nature only and can change from time to time.