GP Network Plan Comparison - 2016 Plans

Network Plans are generally designed for younger people entering the medical aid market for the first time or for those clients that have a limited medical aid budget.

The Medical Aid companies generally contract with a group of hospitals and GP’s on a capitation* basis and in this way are able to offer medical cover at more affordable rates.

*Capitation means that a member will be able to visit his/her chosen GP without having to pay for the consultation. The Medical Aid agrees to pay a monthly amount to the GP, regardless of how often the member visits that GP.

Members generally need to work through their GP (the Gatekeeper), regardless of the particular ailment.

With spiraling medical aid inflation , the Network Plans have become far more popular in the last few years.

 
Network Plans: Discovery Keycare Access Discovery Keycare Plus
Resolution Millenium
  Momentum Ingwe Opt 1 Momentum Ingwe Opt 2  Momentum Ingwe Opt 2
  Medihelp Necesse
Medihelp Necesse (Full time student)
 
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  State Hospitals to be used  
  Acces Network Hospitals to be used  
  for emergencies, trauma & childbirth  
  Certain procedures only covered at  
  Network Day Clinics  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 34,000  
  Oncology PMB  
       
               
               
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from DSP   
     
               
               
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
  GP's: No Limit from KeyCare  
    Network Providers  
  Specialists: R 3,250 per person  
    from Network Providers  
   (must be referred by network GP)  
  Conservative Dentistry:  
    No Limit from KeyCare  
    Network Providers.  
     
     
     
     
     
     
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
               
  MONTHLY CONTRIBUTIONS  
  Income p/m:            R0 - R4,700  
  Principal Member R 586  
  Spouse /Adult R 586  
   dependant    
  Per Child (Max 3) R 256  
     
  Income p/m:        R4,701 - R7,550  
  Principal Member R 782  
  Spouse /Adult R 782  
  dependant    
  Per Child (Max 3) R 281  
       
  Income p/m:     R7,551 - R10,750  
  Principal Member R 1129  
  Spouse /Adult R 1129  
  dependant    
  Per Child (Max 3) R 317  
       
  Income p/m:                 R10,751+  
  Principal Member R 1,695  
  Spouse /Adult R 1,695  
  dependant    
  Per Child (Max 3) R 458  
       
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Certain procedures only covered at  
  Network Day Clinics  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 34,000  
  Oncology PMB  
       
               
               
               
               
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from DSP   
     
     
     
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
  GP's: No Limit from KeyCare  
    Network Providers  
  Specialists: R 3,250 per person  
    from Network Providers  
   (must be referred by network GP)  
  Conservative Dentistry:  
    No Limit from KeyCare  
    Network Providers.  
       
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
               
  MONTHLY CONTRIBUTIONS  
  Income p/m:            R0 - R7,550  
  Principal Member R 832  
  Spouse /Adult R 832  
  dependant    
  Per Child (Max 3) R 301  
       
  Income p/m:    R7,551 - R10,750  
  Principal Member R 1165  
  Spouse /Adult R 1165  
  dependant    
  Per Child (Max 3) R 326  
       
  Income p/m:                 R10,751+  
  Principal Member R 1,734  
  Spouse /Adult R 1,734  
  dependant    
  Per Child (Max 3) R 464  
       
       
       
       
       
       
       
RESOLUTION HEALTH
MILLENIUM
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Co-payments are due for certain  
  procedures (eg R3,539 Arthroscopy)  
  *7 days Take Home Medicine  
  *Contracted Specialists paid at  
   150% Scheme Rate  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment R17 693  
  Hospice Care 18 days  
  Oncology (subject to ICON Unlimited  
   network & scheme    
   protocols    
    Internal Prosthesis    
     (see detailed benefits)    
       
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  (Additional 7 Chronic disease  
  conditions)  
     
  Annual Limit  
       
   Single R2,499  
   Family R5,009  
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
     
  Limits per annum  
       
       
  Member R8,628  
  Member + Spouse R16,008  
  Member+ Spouse +Child 1 R18,012  
  Member+ Spouse +Child 2 R20,016  
  Member+ Spouse +Child 3 R20,016  
       
       
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
     
  Principal Member                  R11,791  
  Spouse/Adult dependant        R9,770  
  Per Child                              R2,579  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 3,592  
  Spouse/Adult dependant R 3,078  
  Per Child (max 3) R 838  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
 
 
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  R1,120,000 per family per annum  
  *7 days Take Home Medicine  
     
     
  Annual Sub-limits :
 
     
   Psychiatric Treament PMB  
   Hospice Care n/a  
   Oncology PMB  
       
       
       
       
       
       
       
       
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Ingwe Primary Care network  
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Primary Care Network    
       
  GP's:   
  No Limit from Ingwe Primary Care  
  Network  
     
     
  Specialists:  
  2 visit per family limited to R1,480  
  per annum and/ or R900 per event  
    with 10% co-payment              
     
  Conservative Dentistry:  
  No Limit from Ingwe Primary Care  
   Network    
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Income p/m             R0- R5,800  
  Principal Member    R 510  
       
  Spouse/Adult dependant R 510  
       
  Per Child R 275  
       
       
  Income p/m      R5,801- R7,800  
  Principal Member R 583  
  Spouse/Adult dependant R 583  
  Per Child R 281  
       
  Income p/m      R7,801- R10,400  
  Principal Member R 681  
  Spouse/Adult Dependant R 681  
  Per Child R 295  
       
  Income p/m  R10,401 +    
  Principal Member R 1,138  
  Spouse/Adult Dependant R 1,138  
  Per Child R 356  
       
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  R1,120,000 per family per annum  
  *7 days Take Home Medicine  
     
     
  Annual Sub-limits :
 
     
    Psychiatric Treament PMB  
    Hospice Care n/a  
    Oncology PMB  
       
       
       
       
       
       
       
       
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Ingwe Primary Care network  
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Primary Care Network    
       
  GP's:   
  No Limit from Ingwe Primary Care  
  Network Providers   
     
     
  Specialists:  
  2 visit per family limited to R1,480  
  per annum and/ or R900 per event  
   with 10% co-payment               
     
  Conservative Dentistry:  
  No Limit from Network Providers   
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Income p/m             R0- R5,800  
  Principal Member    R 638  
       
  Spouse/Adult dependant R 638  
       
  Per Child R 292  
       
       
  Income p/m      R5,801- R7,800  
  Principal Member R 812  
  Spouse/Adult dependant R 812  
  Spouse/Adult dependant R 304  
       
  Income p/m      R7,801- R10,400  
  Principal Member R 1,133  
  Principal Member R 1,098  
  Per Child R 333  
       
  Income p/m   R10,400 +    
  Principal Member R 1,606  
  Principal Member R 1,557  
  Principal Member R 473  
       
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  R1,120,000 per family per annum  
  *7 days Take Home Medicine  
     
     
  Annual Sub-limits :
 
     
     Psychiatric Treament PMB  
     Hospice Care n/a  
     Oncology PMB  
       
       
       
       
       
       
       
       
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  IngwePrimary Care Network  
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Primary Care Network    
   No limit from Ingwe Primary Care  
   Network  
     
     
     
   2 visits per family limited to R1,480  
   per annum and / or R900 per event  
   with a 10% co-payment  
                    
     
     
  No Limit from Network Providers   
         
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
   Income p/m             R0- R5,800  
  Principal Member R 829  
  Spouse/Adult Dependant R 829  
  Per Child R 311  
       
   Income p/m      R5,801- R7,800  
   Principal Member R1,158  
   Spouse/Adult dependant R1,158  
   Spouse/Adult dependant R 350  
       
   Income p/m      R7,801- R10,400  
   Principal Member R1,584  
   Principal Member R1,515  
   Per Child R371  
       
   Income p/m  R10,401 +    
   Principal Member R2,029  
   Principal Member R1,983  
   Principal Member R 589  
       
       
       
       
.
 
 
MEDIHELP
NECESSE
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
   Network Hospitals to be used  
     
     
  *Take Home Medicine limited to  
   R310 per admission  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment PMB  
   (per family)    
  Hospice Care n/a  
  Oncology (PMB) PMB  
       
       
       
       
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
            Only from DSP    
       
       
       
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
     
   GP's: 9 visits from Necesse Network  
    Providers    
       
   Conservative Dentistry:  
    1 consultation, scale and polish  
    2 root canals per person per annum  
    Fillings on 4 teeth, once per tooth  
      in 365 days.  
  1 set plastic dentures p/ family every  
      2 years  
  4 Intra-oral Xrays p/person p/ annum  
  1 Extra-oral Xray p/person p/ annum  
     
  Specialists:  
   R 2 650 per person and R3 710 per  
   from Network Providers.  
   (must be referred by a Necesse  
     Network GP)  
     
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Income pm R401 - R5,000  
  Principal Member R 1,266  
  Spouse/Adult dependant R 1,002  
  Per Child (max 2) R 540  
       
  Income pm R5,001 - R7,000  
  Principal Member R1,320  
  Spouse/Adult dependant R1,056  
  Per Child (max 2) R594  
       
  Income pm R7,001 - R11,000  
  Principal Member R1,494  
  Spouse/Adult dependant R1,164  
  Per Child (max 2) R654  
       
  Income pm R11,001+  
  Principal Member R1,740  
  Spouse/Adult dependant R1,356  
  Per Child (max 2) R750  
     
MEDIHELP
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
   Network Hospitals to be used  
  *Take home medicine limited to  
  R310 per admission  
  Annual Sub-limits per person:  
  Psychiatric Treatment PMB  
    (per family)    
  Hospice Care n/a  
  Oncology (PMB) PMB  
       
       
       
       
       
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 MB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from DSP  
               
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
     
   GP's: 9 visits from Necesse Network  
     Providers    
       
    Conservative Dentistry:    
    1 consultation, scale and polish  
    2 root canals per person per annum  
    Fillings on 4 teeth, once per tooth  
        in 365 days.  
    1 set plastic dentures p/ family  
      every 2 years  
   4 Intra-oral Xrays pp p/ annum  
    1 Extra-oral Xray pp p/ annum  
      
    Specialists:  
     R 2 650 per person and R3 710 per  
     from Network Providers.  
     (must be referred by a Necesse  
      Network GP)  
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
       
  MONTHLY CONTRIBUTIONS  
  Income: R0 - R400 pm    
  Principal Member
R 396
 
  Spouse/Adult dependant R 396  
  Per Child (Max 2) R 396  
     
     
 
     
     
     
     
     
     
     
     
       
       
       
       
       
       
       
       
       
       
       
               
     
     
     
     
     
               
               
               
     
     
     
       
       
       
       
       
     
     
     
     
     
     
     
     
     
     
     
       
     
       
       
       
     
     
       
     
       
       
       
       
     
     
.
As additional Network Plans become available we will continue to update this page in our effort to provide our clients with the most up to date information and advice on the medical aid industry in South Africa. If you are still deciding which plan type is best suited to your situation, why not take a look at the Medical Aid Plans page to see the full range of plans.

 

For more detailed information on any of the above plans, just click on the name of the relevant Network plan in the tables above. If you already know what you want, why not make use of our site to download the relevant Medical Aid Application form and then fax it back to us on 0866 200 320 . Alternatively, if you would like us to confirm some of the finer details and pricing just fill in our Medical Aid Quote Request form and we will get back to you promptly.

Finally, we invite you to contact us on +27 21 712-8866 at any point in your decision making process for further information on these Network Hospital Plans.