What are networks and what do you get out of using them?

In short, network healthcare providers are doctors, pharmacies, hospitals and other medical professionals the Scheme recommends. We have an agreement with them so they charge our rate and have to meet our care standards.

This means when you go to a network provider:

  • You’re getting quality care
  • You don’t have to send us claims as we pay them directly
  • You get the most affordable care
  • For day-to-day benefits you get the lowest co-payment
  • For major medical expenses, we pay them in full

Knowing how your option treats networks can help you get the most of your membership and help your benefits stretch to last the whole year.

If you’re on the Essential Option, you have to use networks

We negotiate with our network providers on your behalf so they charge our members the best rates. We keep the contributions for the Essential Option down by giving you the best cover when you use our networks. You have to pay more yourself if you use a provider who isn’t part of our network.

To get the best cover and pay the least yourself on the Essential Option:

  • Visit your chosen GP in our network
  • If you need a specialist, ask your chosen GP to refer you to a network specialist
  • Get your chronic medicine from Clicks Direct Medicines
  • Visit hospitals in the Acute Hospital List for full cover. If you go to another private hospital and it is not a medical emergency, you have to pay R7 650 upfront.

If you’re on the Comprehensive Option, our networks still save you money

On the Comprehensive Option we pay a set amount into your Medical Savings Account each year. The Scheme pays the biggest part of your day-to-day claims and we pay the rest from the available money in your Medical Savings Account.

Using network providers is the key to making your Medical Savings Account last as long as possible. Once you’ve used up the funds in your Medical Savings Account, you either have to pay part of the cost from your salary or using a debit order.

Negotiate with other providers

You don’t have to negotiate prices with doctors and specialists in our networks; we’ve already done that for you. You also don’t have to pay network providers and claim back. We take care of the hassle for you. But if you can’t visit a network provider, you can still discuss their fees with them and negotiate a lower rate.

Always check if a provider is part of our network before you visit them. It can save you time, money and even admin!

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