GP Network Plan Comparison - 2015 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 Plus Keycare Access
Momentum Ingwe Opt 1
  Momentum Ingwe Opt 2 Momentum Ingwe Opt 3  
 
DISCOVERY HEALTH
  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 31,300  
  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 3,000 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 - R7,050  
  Principal Member R 695  
  Spouse /Adult R 695  
  dependant    
  Per Child (Max 3) R 251  
       
  Income p/m:     R7,051 - R10,000  
  Principal Member R 973  
  Spouse /Adult R 973  
  dependant    
  Per Child (Max 3) R 272  
       
  Income p/m:                 R10,000+  
  Principal Member R 1,448  
  Spouse /Adult R 1,448  
  dependant    
  Per Child (Max 3) R 388  
       
       
       
       
       
       
       
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  State Hospitals to be used  
  Access 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 31,300  
  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 3,000 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 - R4,400  
  Principal Member                    R538    
  Spouse /Adult                         R538  
  dependant  
  Per Child (Max 3)                    R235  
     
  Income p/m:      R4,401 - R7,050  
  Principal Member R 718  
  Spouse /Adult R 718  
  dependant    
  Per Child (Max 3) R 258  
       
  Income p/m:    R7,051 - R10,000  
  Principal Member R 1,036  
  Spouse /Adult R 1,036  
  dependant    
  Per Child (Max 3) R 292  
       
  Income p/m:                R10,001 +  
  Principal Member R 1,556  
  Spouse /Adult R 1,556  
  dependant    
  Per Child (Max 3) R 420  
       
       
       
       
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  R1,060,000 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 R1,400  
  per annum and/ or R850 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- R5,500  
  Principal Member    R 473  
       
  Spouse/Adult dependant R 473  
       
  Per Child R 255  
       
       
  Income p/m      R5,501- R7,400  
  Principal Member R 540  
  Spouse/Adult dependant R 540  
  Per Child R 260  
       
  Income p/m      R7,401- R9,900  
  Principal Member R 631  
  Spouse/Adult Dependant R 631  
  Per Child R 273  
       
  Income p/m    R9,900 +    
  Principal Member R 1,096  
  Spouse/Adult Dependant R 1,047  
  Per Child R 330  
     
     
     
     
 
 
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  R1,060,000 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 R1,400  
  per annum and/ or R850 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- R5,500  
  Principal Member    R 591  
       
  Spouse/Adult dependant R 591  
       
  Per Child R 271  
       
       
  Income p/m      R5,501- R7,400  
  Principal Member R 753  
  Spouse/Adult dependant R 753  
  Spouse/Adult dependant R 282  
       
  Income p/m      R7,401- R9,900  
  Principal Member R 1,050  
  Principal Member R 1,018  
  Per Child R 309  
       
  Income p/m    R9,900 +    
  Principal Member R 1,488  
  Principal Member R 1,443  
  Principal Member R 438  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  R1,060,000 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 R1,400  
   per annum and / or R850 per event  
   with a 10% co-payment  
                    
     
     
  No Limit from Network Providers   
         
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
   Income p/m             R0- R5,500  
  Principal Member R 768  
  Spouse/Adult Dependant R 768  
  Per Child R 288  
       
   Income p/m      R5,501- R7,400  
   Principal Member R1,073  
   Spouse/Adult dependant R1,073  
   Spouse/Adult dependant R 324  
       
   Income p/m      R7,401- R9,900  
   Principal Member R1,468  
   Principal Member R1,404  
   Per Child R344  
       
   Income p/m    R9,900 +    
   Principal Member R1,880  
   Principal Member R1,838  
   Principal Member R 546  
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
     
 
     
     
     
     
     
     
       
       
       
       
       
       
       
       
               
               
               
               
               
               
               
               
     
     
     
     
     
               
               
      
    
 
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
               
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
 


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.