GP Network Plan Comparison - 2019 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 Start
Discovery Keycare Plus
  FedHealth MyFED
   
 
MOMENTUM INGWE OPTION
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No overall Annual Limit  
  *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 per year limited to  
  R1,000 per person and R2,000 per  
  family. Must be referred by a  
  Network GP  
     
  Conservative Dentistry:  
  No Limit from Network providers.  
   Pre authorisation    
   required if more than 4    
   fillings or extractions    
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Income p/m         R701- R6,800  
  Principal Member    R 835  
  Spouse/Adult dependant R 835  
  Per Child R 382  
       
       
  Income p/m      R6,801- R9,000  
  Principal Member R 1,062  
  Spouse/Adult dependant R 1,062  
  Per Child R 397  
       
  Income p/m      R9,001- R12,500  
  Principal Member R 1,479  
  Spouse/Adult Dependant R 1,479  
  Per Child R 435  
       
  Income p/m  R12,501 +    
  Principal Member R 2,094  
  Spouse/Adult Dependant R 2,094  
  Per Child R 617  
       
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 44,050  
  Oncology PMB  
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from a State Hospital  
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
   GP's:  No Limit from KeyCare  
     Network Providers  
     (2 out of network visits)  
  Specialists:  R 2,000 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 - R9,150  
  Principal Member R 839  
  Spouse /Adult R 839  
  dependant    
  Per Child (Max 3) R505  
       
  Income p/m: R9,151 - R13,050  
  Principal Member R 1,412  
  Spouse /Adult R 1,412  
  dependant    
  Per Child (Max 3) R 551  
       
  Income p/m: R13,051+  
  Principal Member R 2,198  
  Spouse /Adult R 2,198  
  dependant    
  Per Child (Max 3) R 596  
       
       
       
       
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 44,050  
  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  
     (4 out of network visits)  
  Specialists:  R 4,050 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 - R8,500  
  Principal Member R 1,088  
  Spouse /Adult R 1,088  
  dependant    
  Per Child (Max 3) R 396  
       
  Income p/m: R8,551 - R13,050  
  Principal Member R 1,532  
  Spouse /Adult R 1,532  
  dependant    
  Per Child (Max 3) R429  
       
  Income p/m: R13,051 +  
  Principal Member R 2,249  
  Spouse /Adult R 2,249  
  dependant    
  Per Child (Max 3) R 602  
       
       
       
       
 
FEDHEALTH
MYFED (replaced FedHealth Entryzone)
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No overall annual limit  
  Network hospitals to be used  
  R11,500 co-payment on voluntary  
  non-network admissions  
     
     
   *Oral Contraceptives  
  *7 days Take Home Medicine  
  *Emergency Trauma at Out Patients  
  Psychiatric Treatment - R8,800  
  Hospice Care - n/a  
  Internal Prosthesis - PMB  
  Oncology (only at DSP) -PMB  
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Medicine Price  
  27 PMB Chronic Disease Conditions  
  Only from MED-Rite,Clicks, Dischem &  
          Pharmacy Direct    
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
 
 100% Scheme Rate
 
     
   GP's: No Limit from Network  
    Providers (2 out-of Network visits  
     
   Specialists: 2 Visits limited to R1 750  
     per person from Network Providers  
     (must be referred by Network GP)  
     
   Conservative Dentistry:  
    Only from a Network Provider  
    (Fillings, extractions, consultations)  
     Plastic dentures limited to 1 set per  
     person every 2 years.    
       
       
       
       
  ANNUAL THRESHOLD BENEFIT  
   Does not Apply    
     
  MONTHLY CONTRIBUTIONS  
  Income p/m   R1 - R5,953    
  Principal Member R 916  
  Spouse/Adult dependant R 784  
  Per Child (Max 3) R 440  
       
  Income pm  R5954 - R9732
   
  Principal Member R1,161  
  Spouse/Adult dependant R 989  
  Per Child (Max 3) R 567  
       
  Income pm  R9733-R12021
   
  Principal Member R1627  
  Spouse/Adult dependant R1393  
  Per Child (Max 3) R624  
       
  Income pm R12022-13739
   
  Principal Member R2,068  
  Spouse/Adult dependant R1,672  
  Per Child (Max 3) R808  
       
  Income pm R13740 +
   
  Principal Member R2,804  
  Spouse/Adult dependant R2,506  
  Per Child (Max 3) R1,068  
       
 
     
     
     
     
     
     
   
 
     
       
       
       
       
       
       
       
       
       
               
     
     
     
     
     
     
               
   
 
 
     
       
       
     
     
     
     
     
     
     
     
     
     
     
     
     
       
       
     
     
               
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
 
     
     
     
     
     
     
   
 
     
       
       
       
       
       
       
       
       
       
               
     
     
     
     
     
     
               
   
 
 
     
       
     
     
     
     
     
     
     
     
                    
     
     
     
         
       
       
       
     
     
               
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
 
     
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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.