Medical benefits are provided to two categories of beneficiaries:
- Persons hospitalized
All beneficiaries hospitalized for any disease and treated in the general ward of the hospital are entitled to free medical services, including medical and surgical care and services, drugs, X-rays, laboratory tests, and electro-cardiograms and similar services.
- Persons not hospitalized
Persons in Group I are entitled to free X-rays, laboratory tests and electro-cardiograms conducted at the Holberton Hospital. Where this treatment is not available at the hospital, and the beneficiary obtains the treatment elsewhere as a result, the beneficiary is allowed to claim the costs incurred. However, if the beneficiary elects to receive the treatment from a third party provider instead of through the Hospital, the amount reimbursed is limited to the fees regularly charged at the Hospital.
There are two groups of beneficiaries:
- All persons who have paid contributions to the Scheme for 26 weeks in any calendar year or in any period of 12 months.
- Persons who are under the age of 16 years.
- Persons who are permanently incapable of work by virtue of age.
- Persons certified by a medical practitioner to be suffering from any of the specified diseases.
Those persons suffering from the specified diseases are entitled to free medical benefits, including drugs, X-rays, laboratory tests, and electro-cardiograms and similar services.
A beneficiary who seeks refunds for medical services is required to present his or her Medical Benefits Scheme card and the original receipts from the service provider to the Medica Benefits Scheme.
Every beneficiary is required to register with the MBS by presenting an original birth certificate or passport along with his/her Social Security Card.
Non-contributors (i.e. persons in Group II) should additionally present a medical certificate from a medical practitioner certifying that they suffer from one of the listed diseases.