Metropolitan OpenPlan

Metropolitan Health administers about twenty different medical aids including OpenPlan, which is a relatively small scheme, but backed by the Metropolitan group. They market a range of new generation and traditional options and cover about 40,000 lives. The only option that falls within our value proposition is the Primary Classic, their network option.

All benefits are pro-rated depending on when in the year one joins the scheme.

A member has the option of changing their plan without medical underwriting once per year effective from the 1st of January the following year.

Metropolitan Primary Classic

This is one of the cheapest network options for lower income earners available, premiums are dependant on income. It makes use of the Qualsa GP and dentist network with approximately 95 GPs and 110 dentists in Cape Town alone. This is a typical primary plan with unlimited doctors, dentists and medicines from a formulary. There is no specialist dentistry and limited cover for medical specialists. Hospitalisation is limited to the overall annual limit of R570,000, which is very high for this type of plan.

Optional Additional Benefits

Top-Up Cover

This is an independent product that can be used to increase your hospital cover limits to R2,000,000.

Gap Cover

This independent cover will pay the additional amount charged by the surgeon and anaesthetist above the NHRPL rate up to a maximum of 3 X NHRPL rate.