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GP Network Plan Comparison - 2012 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	Resolution Foundation Plan	Momentum Ingwe Opt 1
	Momentum Ingwe Opt 2

DISCOVERY HEALTH

KEYCARE PLUS

	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:
	Mental Health Benefit				21 days
	Terminal Care Benefit				R 20,000
	Alcohol and Drug				21 days
	Rehabilitation

	CHRONIC MEDICATION BENEFIT
	100% Scheme Rate
	27 PMB Chronic Disease Conditions
	Subject to scheme formulary

	ANNUAL DAY TO DAY BENEFIT (including savings)
	100% MSR
	GP's:		No Limit from KeyCare
			Network Providers
	Specialists:		R 2,300 per person
			from Network Providers
	Conservative Dentistry:
			No Limit from KeyCare
			Network Providers.

	ANNUAL THRESHOLD BENEFIT
	Does not apply

MONTHLY CONTRIBUTIONS
Income p/m: R0 - R3,900
Principal Member	R 485
Spouse /Adult	R 485
dependant
Per Child (Max 3)	R129

Income p/m: R3,901-R6,250
Principal Member	R 581
Spouse /Adult		R 581
dependant
Per Child (Max 3)	R 168

Income p/m: R6,251 - R8,300
Principal Member	R 813
Spouse /Adult		R 813
dependant
Per Child (Max 3)	R 228

Income p/m: R8,301 +
Principal Member	R 1,211
Spouse /Adult		R 1,211
dependant
Per Child (Max 3)	R 324

RESOLUTION HEALTH

FOUNDATION PLAN

	IN HOSPITAL BENEFIT
	100% Scheme Rate
	No Overall Annual Limit
	*7 days Take Home Medicine
	Co-payments apply for certain
	procedures

	Emergency Casualty Annual Limit
	R1,000 and R300 for associated
	medecine per family per annum

	Annual Sub-limits per person:
	Prosthesis				R30,000
	(subject to prosthesis sub-
	limits)

	CHRONIC MEDICATION BENEFIT
	100% Scheme Rate
	27 PMB Chronic Disease Conditions
	Subject to scheme formulary
	Only from Network Provider

	ANNUAL DAY TO DAY BENEFIT (including savings)

	100% Scheme Rate
	GP's:
	No Limit from Network Providers

	Specialists
	4 visits limited to R1,050 per family
	from Network Providers

	Conservative Dentistry
	Fillings: 2 check ups and 1 scale and
	polish, 2 emergency consultations per
	annum from Network Provider

	ANNUAL THRESHOLD BENEFIT
	Does not apply

MONTHLY CONTRIBUTIONS
Income pm	R0 - R3,750
Principal Member		R 492
Spouse/Adult dependant		R 480
Per Child		R 148

Income pm	R3,751 - R5,800
Principal Member		R587
Spouse / Adults dependant		R525
Per Child		R203

Income pm	R5,801 - R8,000
Principal Member		R744
Spouse / Adult dependant		R656
Per Child	R237

Income pm	R8,001- R9,500
Principal Member	R972
Spouse/Adult	R863
dependant
Per Child	R333

Income pm	R9,501+
Principal Member		R 1124
Spouse/Adult dependant		R 998
Per Child		R 385

MOMENTUM INGWE OPTION

STATE HOSPITALS

	IN HOSPITAL BENEFIT
	100% Scheme Rate
	R900,000 per family per annum
	*7 days Take Home Medicine


	Annual Sub-limits :

	High and Intensive Care				10 days
	(per admission)
	Confinements and				R 19,500
	Caesareans
	(uncomplicated delivery)
	Confinements				R 29,000
	(complicated delivery)
	Neo-natal Intensive Care				R 40,600
	(per confinement)
	Medical and Surgical				R 3,500
	Appliances (per family)
	Rehabilitation and Step-				R 8,400
	down facilities (p/person)

	CHRONIC MEDICATION BENEFIT
	100% Scheme Rate
	27 PMB Chronic Disease Conditions
	Subject to scheme formulary
	CareCross or Prime Cure

	ANNUAL DAY TO DAY BENEFIT (including savings)
	100% Scheme Rate
	CareCross or Prime Cure.

	GP's:
	No Limit from
	Network Providers


	Specialists:
	2 visit per family limited to R1,150
	per annum and/ or R700 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-				*R3,950*
	Principal Member				R 357 /
					R 428
	Spouse/Adult dependant				R 357 /
					R 428
	Per Child				R 194/
					R 206

	Income p/m R3,951-				*R6,300*
	Principal Member				R 428
	Spouse/Adult dependant				R 428
	Per Child				R 206

	Income p/m R6,301-				*R8,400*
	Principal Member				R 491
	Spouse/Adult Dependant				R 491
	Per Child				R 213

	Income p/m R8,400 +
	Principal Member				R 828
	Spouse/Adult Dependant				R 792
	Per Child				R 250

MOMENTUM INGWE OPTION

INGWE NETWORK HOSPITALS

	IN HOSPITAL BENEFIT
	100% Scheme Rate
	R900,000 per family per annum
	*7 days Take Home Medicine


	Annual Sub-limits :

	High and Intensive Care				10 days
	(per admission)
	Confinements and				R 19,500
	Caesareans
	(uncomplicated delivery)
	Confinements				R 29,000
	(complicated delivery)
	Neo-natal Intensive Care				R 40,600
	(per confinement)
	Medical and Surgical				R 3,500
	Appliances (per family)
	Rehabilitation and Step-				R 8,400
	down facilities (p/person)

	CHRONIC MEDICATION BENEFIT
	100% Scheme Rate
	27 PMB Chronic Disease Conditions
	Subject to scheme formulary
	CareCross or Prime Cure

	ANNUAL DAY TO DAY BENEFIT (including savings)
	100% Scheme Rate
	CareCross or Prime Cure.

	GP's:
	No Limit from
	Network Providers


	Specialists:
	2 visit per family limited to R1,150
	per annum and/ or R700 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-				*R3,950*
	Principal Member				R 445 /
					R 627
	Spouse/Adult dependant				R 445 /
					R 627
	Per Child				R 213/
					R 230

	Income p/m R3,951-				*R6,300*
	Principal Member				R 627
	Spouse/Adult dependant				R 627
	Per Child				R 230

	Income p/m R6,301-				*R8,400*
	Principal Member				R 839
	Spouse/Adult Dependant				R 797
	Per Child				R 252

	Income p/m R8,400 +
	Principal Member				R 1,125
	Spouse/Adult Dependant				R 1,069
	Per Child				R 338

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.