GP Network Plan Comparison - 2017 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: Momentum Ingwe Network
Discovery Keycare Plus

       
 
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  R1,190,000 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. Pre authorisation required  
   from 11th visit. 1 out of Network visit  
   per person and max 2 visits per family  
   per year with a R100 co payment  
     
  Specialists:  
  2 visit per family with a R100  
   co-payment. Must be referred by a  
   Network GP  
     
  Conservative Dentistry:  
  No Limit from Ingwe Primary Care  
   Network. Pre authorisation    
   required if more than 4    
   fillings or extractions    
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
  MONTHLY CONTRIBUTIONS  
  Income p/m             R0- R6,100  
  Principal Member    R 701  
  Spouse/Adult dependant R 701  
  Per Child R 321  
       
       
  Income p/m      R6,101- R8,200  
  Principal Member R 892  
  Spouse/Adult dependant R 892  
  Per Child R 334  
       
  Income p/m      R8,201- R11,000  
  Principal Member R 1241  
  Spouse/Adult Dependant R 1241  
  Per Child R 365  
       
  Income p/m  R11,001 +    
  Principal Member R 1,758  
  Spouse/Adult Dependant R 1,758  
  Per Child R 518  
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Full Cover Network Hosp to be used  
  Certain procedures only covered at  
  Network Day Clinics  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 37,350  
  Oncology PMB  
       
               
               
               
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from a Network Pharmacy or  
   chosen GP  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
   GP's:  No Limit from KeyCare  
     Network Providers  
  Specialists:  R 3,570 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 - R8,100  
  Principal Member R 914  
  Spouse /Adult R 914  
  dependant    
  Per Child (Max 3) R331  
       
  Income p/m: R8,101 - R11,550  
  Principal Member R 1,280  
  Spouse /Adult R 1,280  
  dependant    
  Per Child (Max 3) R 358  
       
  Income p/m: R11,551+  
  Principal Member R 1,906  
  Spouse /Adult R 1,906  
  dependant    
  Per Child (Max 3) R 510  
       
       
       
 
 
     
     
     
     
     
     
     
     
     
     
     
       
       
       
       
       
       
       
     
     
     
     
     
     
       
   
 
 
     
     
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
     
     
     
     
               
     
       
       
       
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
 
 
     
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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.