Network Option
Day-to-day Benefits
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Benefits will be allocated pro rata for members and their beneficiaries joining during the year.
You may only use network providers.
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WHAT ARE DAY-TO-DAY MEDICAL EXPENSES?
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Day-to-day medical expenses are your everyday medical expenses such as GP consultations, dentist visits, optical visits, etc.
Members on the Network Option must obtain all healthcare services from network providers. To access your day-to-day medical benefits, you must choose a network GP, dentist and optometrist from the Network Option lists.
If you do not use a network provider you will have to pay for the difference out of your own pocket. Please contact 0800 765 432 to find a suitable network provider.
The Network Option does not offer a medical savings account (MSA).
| Benefits | Description | ||
|---|---|---|---|
| Professional services benefit | No benefit | ||
| Network providers | You may ONLY use network providers | ||
| General practitioners (GPs) |
100% of the agreed tariff at your chosen network GP GP visits are limited to six per beneficiary per year Additional medical assistance will be available to all beneficiaries via virtual consultation through Hello Doctor |
100% of the agreed tariff | |
| Specialists |
Only network specialists, limited to: R2 950 per Beneficiary per year These amounts include the cost of consultations, medication, procedures, radiology and pathology Call 0800 765 432 for specialist referral and authorisation |
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| Pathology and radiology |
100% of the agreed tariff if referred by a network provider Restricted to the network provider list of investigations |
100% of the agreed tariff | |
| Basic dentistry - Consultations, fillings, extractions, scaling and polishing |
100% of the agreed tariff at network dentists Subject to the approved dental tariff list Click here for Dental Formulary |
100% of the agreed tariff | |
| Specialised dentistry - dentures, crowns, bridges and orthodontic treatment | No benefit | ||
| Optical benefits - eye tests, lenses, frames and contact lenses |
One eye test per beneficiary every 24 months at a network optometrist One pair of clear, mono-, bi- or multifocal lenses, plus standard frame every 24 months at a network optometrist A benefit of R230 will be paid towards a frame selected outside the standard range every 24 months at a network optometrist OR One set of approved contact lenses limited to the value of R600 per beneficiary every 24 months at network optometrists |
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No benefit if a non-network provider is used |
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| OptiClear Network | Members can receive services and materials at reduced rates from accredited OptiClear providers | ||
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| Prescribed acute medication | 100% as prescribed by a network provider from the acute medication formulary. | ||
| Over-the-counter medication | No benefit | ||
| Associated health services - chiropractors, homeopaths, naturopaths and dieticians | No benefit | ||
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Auxiliary services out of hospital:
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No benefit | ||
| Registered private nurse practitioners | No benefit | ||
| Emergency visits / outpatients |
Limited to three visits per Family per year up to a limit of R2 420 Paid at the agreed tariff rate per visit |
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