GP Network Plan Comparison - 2010 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.
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| OXYGEN |
| ESSENTIAL CARECROSS |
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IN HOSPITAL BENEFIT |
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100% MSR |
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R500,000 Per Family per annum |
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Primary Network Hospitals to be used |
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Co-payments apply for certain |
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procedures |
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Annual Sub-limits per person: |
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Oncology Medicines |
R 200,000 |
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Wisdom Teeth Removal |
R 1,750 |
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Internal Prostheses: |
R 20,000 |
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Organ Transplants |
R200,000 |
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Psychiatric treatment |
R 10, 000 |
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CHRONIC MEDICATION BENEFIT |
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100% Medicine Price |
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27 PMB Chronic Disease Conditions |
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Subject CareCross formulary |
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Only from CareCross provider |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% MSR |
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GP's & Acute Medication: |
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No limit from CareCross Network |
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Providers. |
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Specialists: |
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2 visits per annum. Must be referred |
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by CareCross GP |
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Conservative Dentistry: |
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No limit from CareCross Network |
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Providers. Subject to Scheme |
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Protocols |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Income p/m |
R0 - R7,000 |
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Principal Member |
R 799 |
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Spouse /Adult dependant |
R 730 |
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1st Child Only |
R 339 |
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Income p/m |
R7,001 + |
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Principal Member |
R 1,178 |
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Spouse /Adult dependant |
R 1,026 |
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1st Child Only |
R 368 |
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IN HOSPITAL BENEFIT |
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100% MSR |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Annual Sub-limits per person: |
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Mental Health Benefit |
21 days |
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Terminal Care Benefit |
R 16,950 |
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Alcohol and Drug |
21 days |
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Rehabilitation |
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CHRONIC MEDICATION BENEFIT |
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100% MSR |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% MSR |
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GP's: |
No Limit from KeyCare |
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Network Providers |
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Specialists: |
R 2, 000 per person |
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Network Providers. |
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Conservative Dentistry: |
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No Limit from KeyCare |
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Network Providers. |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Income p/m: R0 - R3,750 |
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Principal Member |
R 412 |
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Spouse /Adult |
R 412 |
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dependant |
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Per Child (Max 3) |
R110 |
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Income p/m: R3,751-R6,000 |
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Principal Member |
R 494 |
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Spouse /Adult |
R 494 |
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dependant |
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Per Child (Max 3) |
R 143 |
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Income p/m: R6,001 - R8,000 |
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Principal Member |
R 692 |
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Spouse /Adult |
R 692 |
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dependant |
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Per Child (Max 3) |
R 193 |
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Income p/m: R8,001 + |
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Principal Member |
R 1,030 |
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Spouse /Adult |
R 1,030 |
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dependant |
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Per Child (Max 3) |
R 275 |
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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 021 712 6626. 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 21 712-6686 at any point in your decision making process for further information on these Network Hospital Plans.
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