Managed Care Initiatives

CompCare Wellness offers members a number of Managed Care initiatives, which are all designed to ensure that members receive quality healthcare at an affordable cost. These are:
(The contact details for the 3rd parties who provide these services are listed under the contact details.)

Members are required to register chronic medication prescriptions with Universal to receive the chronic medication benefit.
To register your chronic medication prescription with Universal, you, your doctor or your pharmacist need to contact or send an e-mail to Universal.

Universal Care offers a complete hospital utilisation management service. It is the member's responsibility to ensure that all non-emergency hospital admissions areauthorised. These must be authorised at least 48 hours prior to admission. The member, doctor or hospital may phone in for this authorisation. A penalty will apply for late requests for authorisations. Emergency admissions must be authorised on the first working day after admission. There will be a penalty if the member does not obtain authorisation. This service also applies to Oncology treatment.

Universal Care offers a comprehensive disease management service including HIV/AIDS counselling. This service is designed to empower members to manage their chronic conditions more effectively. Members are provided with telephonic counselling, e-mail information as well as on-line health and wellness information. This information can be communicated to the patient via: the Disease Management call centre, internet, e-mail, fax, post and physical handout point.

All CompCare Wellness members and their adult dependants diagnosed with a chronic condition such as HIV/AIDS, asthma, diabetes, hypertension etc should register on the Disease Management programme. By registering, an individual will have access to personalised health and wellness Information.

Members are also invited to phone the Disease Management Call Centre should they wish to speak to a nurse counsellor.

Universal Care provides a service that ensures that the standard pathology guidelines are followed.

Universal Care offers a pre-authorisation service for all specialised dentistry. Prior to having specialised dentistry the member is required to obtain pre-authorisation.

Universal Care offers a service where medical expenses that are the liability of a 3rd party are recovered for CompCare. In most cases these recoveries refer to road accidents where a 3rd party was involved.

Netcare911 offers an emergency evacuation service that will transport members to the nearest hospital for treatment. Members have access to this benefit in and outside of the borders of South Africa (worldwide).

Netcare911 personnel, including paramedics, nurses and doctors are available 24 hours a day to provide general medical information and advice. This is an advisory service as a telephone conversation does not permit an accurate diagnosis.

In addition to general medical advice, Netcare911 medical operators can also guide you through a medical crisis situation, provide emergency advice and organise for you to receive the support you need.

CompCare Wellness Medical Scheme is committed to conducting healthy business practices with honesty and integrity, which ensures the continued and future success of the Scheme. Fraud presents increasing challenges in our country. Too often, it is undetected and goes unreported, resulting in financial losses for schemes which eventually leads to the detriment of all members. CompCare Wellness Medical Scheme is no different. For this reason, we have subscribed to a service that will enable all members to report fraud and other crime anonymously. This service involves a Fraud Hotline, independently and anonymously managed by an external firm, Vuvuzela Hotline. Confidentiality and anonymity are guaranteed, and therefore, no member reporting suspected fraudulent activity will ever be identified.

What can be reported?

  • Fraud
  • Corruption
  • Unethical behaviour
  • Misuse of funds
  • Procurement irregularities
  • Bribery
  • Maladministration

How does it work?

Anyone can report their suspicion(s) through the Vuvuzela Hotline, using the following means of communication:

Toll free number: 080 111 4447
Fax: 086 672 1681
E-mail: universal@thehotline.co.za
Website: www.thehotline.co.za
WebApp: www.thehotlineapp.co.za
Callback No (please call me’s) 072 595 9139

This is a 24/7/365 Fraud Hotline.

The Vuvuzela Hotline is part of CompCare Wellness Medical Scheme’s commitment to zero tolerance for dishonest and unethical behaviour.

anonymous — secure — confidential