Netcare Medical Aid
Overall, Netcare Medical Aid is a trustworthy and comprehensive medical aid that offers 24/7 medical emergency assistance and comprehensive gap cover to up to 3 Family Members. The Netcare Medical Aid starts from R3,012 ZAR.
| 👤 The average number of members | 1,000+ |
| 1️⃣ Number of Markets | 1 |
| 👥 Number of Employees | 150+ |
| ➡️ Average Customer Rating | 2.6 |
| ↪️ Average Number of Reviews | 80+ |
| 📉 Market Share | <1% |
| 🟦 The number of plans offered | 23 |
| 🔵 Number of Hospitals in Network | 122 |
| 💙 Home care provided | ✅ Yes |
| 📱 Mobile App | ✅ Yes |
| 💻 Medical Claims Portal | ✅ Yes |
| 😷 Information Hub for COVID-19 | ✅ Yes |
| 🤧 Chronic Illness Benefits | ✅ Yes |
| 🥰 Number of PMB Diagnoses | 271 |
| 🔟 Number of PMB Chronic Conditions | 26 |
| ✔️ Screening and Prevention offered | ✅ Yes |
| 🍼 Maternity Benefit | ✅ Yes |
| 💶 Medical Aid Contribution Range (ZAR) | 3,012 – 5,429 ZAR |
| 📊 Average Waiting Period | 3 to 12 months |
| 💴 Late-joiner penalties charged | ✅ Yes |
| 🌎 International Medical Cover | Only minor incidents are covered |
Netcare Medical Aid – Analysis of Medical Aids’ Main Features
- ☑️ Netcare Medical Aid Salary Bands and Contributions
- ☑️ Netcare Medical Aid – Advantages over Competitors
- ☑️ How to apply for Medical Aid with Netcare Medical Aid
- ☑️ How to apply for Gap Cover with Netcare Medical Aid
- ☑️ How to Submit a Claim with Netcare Medical Aid
- ☑️ How to Submit a Compliment or Complaint with Netcare Medical Aid
- ☑️ Overview of Netcare Medical Aid Gap cover
- ☑️ Netcare Medical Aid Medical Savings Account
- ☑️ Netcare Medical Aid vs Notable Competitors – A Comparison
- ☑️ Netcare Medical Aid Customer Support
- ☑️ Netcare Medical Aid Customer Reviews
- ☑️ Netcare Medical Aid Pros and Cons
- ☑️ Our Verdict on Netcare Medical Aid
- ☑️ Netcare Medical Aid Frequently Asked Questions
Netcare Medical Aid Salary Bands and Contributions
| 💶 Income Bracket | 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| 💴 R0 – R2,724 | R3,012 | R1,460 | R600 |
| 💵 R2,725 – R3,633 | R3,090 | R1,504 | R608 |
| 💶 R3,634 – R4,539 | R3,171 | R1,552 | R635 |
| 💷 R4,540 – R6,571 | R3,306 | R1,661 | R674 |
| 💴 R6,572 – R7,265 | R3,526 | R1,780 | R727 |
| 💵 R7,266 – R9,084 | R3,839 | R2,033 | R801 |
| 💶 R9,085 – R10,897 | R4,093 | R2,319 | R920 |
| 💷 R10,898 – R12,712 | R4,220 | R2,531 | R1,000 |
| 💴 R12,713 – R14,528 | R4,312 | R2,634 | R1,060 |
| 💵 R14,529 – R16,345 | R4,431 | R2,839 | R1,096 |
| 💶 R16,346 – R18,162 | R4,527 | R3,016 | R1,196 |
| 💷 R18,163 – R19,977 | R4,561 | R3,046 | R1,203 |
| 💴 R19,978 – R21,796 | R4,584 | R3,067 | R1,214 |
| 💵 R21,797 – R23,611 | R4,626 | R3,130 | R1,229 |
| 💶 R23,612 – R25,427 | R4,678 | R3,238 | R1,246 |
| 💷 R25,428 – R27,243 | R4,807 | R3,324 | R1,273 |
| 💴 R27,244 – R29,059 | R4,844 | R3,354 | R1,288 |
| 💵 R29060 – R30,875 | R4,883 | R3,397 | R1,300 |
| 💶 R30,876 – R32,690 | R4,991 | R3,459 | R1,330 |
| 💷 R32,691 – R34,508 | R5,091 | R3,528 | R1,351 |
| 💴 R34,509 – R36,325 | R5,091 | R3,528 | R1,351 |
| 💵 R36,326 – R45,404 | R5,202 | R3,609 | R1,379 |
| 💶 R45,405 – R54,485 | R5,531 | R3,691 | R1,412 |
| 💷 R54,486 – R99,999 | R5,429 | R3,769 | R1,437 |
Medical Aid Netcare – Advantages over Competitors
Comprehensive benefit options that cater to different needs and budgets, including traditional and savings options. Access to a wide network of healthcare providers, including hospitals, doctors, specialists, and pharmacies.
- ✅ Generous cover for hospitalization, including unlimited in-hospital specialist consultations and private ward accommodation.
- ✅ Chronic medicine benefits cover a broad range of conditions, with no overall limit on the cover.
- ✅ Maternity benefits cover antenatal consultations, scans, tests, childbirth, and postnatal care.
- ✅ Preventative care benefits include annual check-ups and screenings, immunizations, and mammograms.
- ✅ Emergency medical services, including ambulance transportation and emergency room treatment.
- ✅ Mental health benefits that cover in-hospital and out-of-hospital care, as well as medication.
- ✅ Wellness benefits include gym memberships, smoking cessation, and weight management programs.
- ✅ Access to Netcare Plus, a loyalty program that offers discounts on healthcare products and services.
- ✅ A range of value-added services includes telemedicine consultations, medical second opinions, and trauma counseling.
Easy claims process through the Netcare Medical Scheme app or online portal. Transparent and competitive pricing, with no hidden costs or co-payments.
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How to apply for Medical Aid with Netcare Medical Aid
Medical Aid Quote Netcare Medical Scheme process explained
To apply for Medical Aid through Netcare Medical Aid, Netcare Limited employees must:
- ☑️ Visit the Netcare Medical Aid website to learn more about the available benefit options and to compare them.
- ☑️ Choose the benefit option that best suits your needs and budget.
- ☑️ Complete the online application form or request a call back from a Netcare Medical Aid consultant to assist you with the application process.
Submit the required supporting documentation, which may include proof of identity, proof of income, and proof of dependents. Wait for the application to be processed and for confirmation of acceptance and payment details from Netcare Medical Aid.
Get a Netcare Medical Aid quote from our Dedicated Medical Aid Specialists Broker
How to apply for Gap Cover with Netcare Medical Aid
To apply for NetcarePlus Gap Cover, South Africans can follow these steps:
- ✅ Download and read the brochure from the Netcare website to understand the benefits and limitations of the product.
- ✅ Complete the application form available on the Netcare website or from a Netcare Plus consultant.
- ✅ Provide relevant documentation for the member and their dependents, such as proof of medical scheme membership and ID documents.
- ✅ Submit the application form and documentation to NetcarePlus by email or fax.
Wait for confirmation of acceptance and payment details from Netcare Plus.
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How to Submit a Claim with Netcare Medical Aid
Here is a step-by-step procedure to submit claims to Netcare Medical Aid:
- ✅ Ensure that the claim is submitted within four months of the service rendered. Claims submitted after this period may be rejected.
- ✅ Complete the claim form accurately and in full, providing all the required information. The claim form can be downloaded from the Netcare Medical Aid website or requested from the scheme.
- ✅ Include all necessary documentation with the claim form, such as the invoice or statement from the healthcare provider, referral letter, prescriptions, or receipts for medication.
- ✅ Submit the claim form and supporting documents to Netcare Medical Aid via post, email, fax, or online through the Netcare Medical Aid member portal. Members paying cash for services received should remember to submit the claim with the receipt as proof of payment.
- ✅ Track the claim’s progress by logging into the Netcare Medical Aid member portal or by contacting the Netcare Medical Aid call center.
- ✅ Receive payment once the claim has been processed and approved. Members will be reimbursed at the relevant Scheme Rate. If there is a difference between the claimed amount and the benefit amount, members may request the Scheme in writing for the difference to be settled from their Member Savings Account (MSA).
If a claim has been rejected in error, report the error within 60 days and resubmit the claim, failing which the claim will be classified as stale. Remember to obtain pre-authorization at least 72 hours before a planned event or within 72 hours following an emergency.
How to Submit a Compliment or Complaint with Netcare Medical Aid
Here are the steps to follow to escalate a complaint with Netcare Medical Aid:
- ✅ Contact the Scheme’s call center during office hours to try and resolve your query.
- ✅ If you are unsatisfied with the result, you can contact the Principal Officer, whose contact details are available in the Contact Detail section of the brochure.
Lodge your written complaint, addressed to the Disputes Committee, c/o The Principal Officer. The contact details for the Disputes Committee are available on the website. If you are still dissatisfied with the decision made by the Disputes Committee, you can take your appeal further by approaching the Council for Medical Schemes (CMS) for resolution.
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Overview of Netcare Medical Aid Gap cover
NetcarePlus Gap Cover is a product offered by Netcare Medical Scheme designed to supplement existing medical aid cover and protect members from unexpected medical expenses that may arise during hospitalization. The product is available to members of any medical scheme, not just the Netcare Medical Scheme. In addition, some advantages of NetcarePlus Gap Cover include the following:
- ☑️ Cover for co-payments and deductibles, which are not covered by most medical schemes.
- ☑️ Cover for in-hospital medical expenses that exceed the medical scheme rate or the maximum benefit limit of the medical scheme.
- ☑️ Cover for certain out-of-hospital procedures, such as chemotherapy and radiotherapy.
- ☑️ No age limit for members or their dependents.
- ☑️ No medical underwriting is required, meaning pre-existing conditions are covered from the start.
- ☑️ No waiting periods for claims, except for claims related to pregnancy and childbirth.
GapCover Plus, GapCover+300, and GapCover+500 are three options for a Gap Cover product that provide additional benefits to medical scheme members. The product offers in-hospital specialist shortfall cover, which pays for the difference between the medical scheme tariff and the actual specialist fee, up to 500% or 300% of the medical scheme tariff, depending on the chosen option. Furthermore, it covers all consultations while the member is admitted, and any approved medical procedures performed in the hospital, day clinic, or specialist rooms.
The product also covers co-payments and deductibles the medical scheme requires for certain day procedures, such as scopes or scans performed in hospitals or day clinics. In addition, the amount covered could be a fixed cost or a percentage of the total procedure cost, and this benefit is available on all options. Lastly, the Gap Cover product covers shortfalls and co-payments for approved cancer treatment, including treatment provided by healthcare providers outside the medical scheme’s network or when the oncology benefit limit is reached. This benefit is also available on all options.
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Netcare Medical Aid Medical Savings Account
All members of the Scheme must contribute 15% of their total monthly contribution to their Member Savings Account (MSA). For example, suppose a member’s total Scheme contribution is R1,000. In that case, R150 (15% of R1,000) will be allocated to their savings account and R850 towards the risk pool. Interest will be paid on positive savings balances in the MSA at month-end. If members resign from the Scheme, their savings balance will be kept for four months to settle any claims incurred before resignation. After four months, the balance will be paid to the member or transferred to their new medical scheme in compliance with the Medical Schemes Act 131 of 1998.
The Scheme may use a member’s savings to offset any debt owed by the member upon termination of membership. The Scheme advances six months of savings to members effective 1 January and 1 July each year. Overdrawn savings must be repaid if a member resigns from the Scheme. Payments from the MSA will be made at 100% of the NMS rate, subject to funds being available when processing a claim. Members may give written instructions to the Scheme to fund any co-payments or shortfalls they may be responsible for from their MSA.
If savings are available at the end of the financial year (31 December), they will be carried over to the next year. In the event of a member’s death, the savings balance due will be transferred to their dependents if they decide to continue the scheme’s membership. The savings will be paid into the member’s estate without such dependents.
Furthermore, the following is covered by the member’s Medical Savings Account:
- ☑️ General Practitioner services out-of-hospital
- ☑️ Non-emergency consultations at any Netcare emergency department
- ☑️ All optical services (note: one optometric consultation per beneficiary per annum is payable from the insured risk portion of your benefits and is deducted from your specialist consultation limit)
- ☑️ Prescribed acute medication
- ☑️ Self-medication or over-the-counter (OTC) medication
- ☑️ Vitamins
- ☑️ Homeopathic formulations
- ☑️ Physiotherapy and bio-kinetics out-of-hospital
- ☑️ Psychology and social services.
Treatment for the services above will be paid from your MSA only if there is an available balance.
Medical Aid Comparisons : Netcare Medical Aid vs Notable Competitors – A Comparison
| 🔎 Medical Aid | 🥇 Netcare Medical Aid | 🥈 Platinum Health | 🥉 Discovery Health |
| 📌 Years in Operation | 23 years | 22 Years | 30 Years |
| 📍 Average # Members | 1,000+ | <55,000 | 3.3 million |
| ☑️ GCR Rating | – | A+ | AAA |
| ✅ Number of Employees | 150+ | 100+ | 13,500 |
| ➡️ Market Share | <1% | <5% | 56.7% |
| ↪️ Market Cover | South Africa | South Africa | 40 Markets |
| 💙 Customer Rating | 2.6 | 3/5 | 4.4/5 |
| 🟦 Number of reviews | 80+ | 3,000+ | 20,000+ |
| 🔵 Mobile App | Yes | No | Yes |
| 💶 Contribution Range (ZAR) | 3,012 – 5,429 ZAR | ZAR | 1,102 – 10,303 ZAR |
Netcare Medical Aid Customer Support
Netcare Medical Aid Customer Support can be contacted via several channels, including channels for:
- General inquiries and claims
- Ambulance and emergency services
- Member claim submission
- Maternity registration
- Appliance and prostheses authorizations
and many more.
Netcare Medical Aid Customer Reviews
Exceptional service.
I wish to express my appreciation for the exceptional service provided by the doctors and staff at Netcare Sunninghill. Their admirable professionalism, patience, and caring attitude toward patients created an environment that felt like home. – Marthinus Claassen
Very Impressed.
This year, I have had more interactions with Netcare Medical Aid, or its administrator Discovery, than usual. I am impressed by the level of service received, even when things did not go as planned. The team has demonstrated a commitment to resolving issues efficiently and effectively. – Lindiwe Mashinini
Great Support.
I thank Netcare Customer Support for their understanding and assistance during a challenging situation. The team displayed a personal touch and took the time to help me navigate the list of doctors, which was greatly appreciated. – Blake Wood
Netcare Medical Aid Pros and Cons
| ✅ Pros | ❎ Cons |
| Large network of healthcare providers, including Netcare hospitals and clinics | More expensive premiums compared to some other medical aid schemes |
| Multiple plan options with varying levels of cover and costs | Benefit limits and exclusions may not cover all medical needs and treatments |
| Access to a range of wellness and preventative care benefits, such as screening tests and chronic disease management programs | Some benefits, such as the MSA, may require careful management to ensure adequate funds are available |
| Option to add gap coverage to help cover potential out-of-pocket expenses | Some complaints about customer service and claims processing times |
| Multiple channels for submitting claims and seeking assistance, including online portal and customer call center | Limited cover for alternative therapies and complementary medicine |
| Regularly recognized for excellence in service and innovation in the healthcare industry | Some plan options may restrict provider choice or require referrals for certain services. |
Our Verdict on Netcare Medical Aid
Netcare Medical Aid offers a variety of health insurance options to cater to the different needs and budgets of individuals and families. The medical aid covers in-hospital treatments, day-to-day medical expenses, and chronic conditions. Furthermore, members also have access to a wide range of healthcare professionals and facilities, including hospitals, specialists, and pharmacies. One of the stand-out features of Netcare Medical Aid is its Member Savings Account (MSA), which allows members to save 15% of their monthly contributions and use it to pay for certain day-to-day medical expenses. This feature provides flexibility and control over healthcare spending. Medical aid also offers various value-added benefits, such as access to emergency medical services and a wellness program. In addition, members can take advantage of discounts on gym memberships, healthy food, and fitness devices.
In addition, Netcare Medical Aid has also received recognition for its service excellence and commitment to sustainability, which is a testament to its quality of care. However, one potential drawback of Netcare Medical Aid is that its premiums may be higher than some of its competitors. The medical aid also limits certain benefits, such as the number of yearly specialist consultations. Furthermore, these limitations may affect members who require frequent medical attention or have chronic conditions. However, despite these drawbacks, Netcare Medical Aid offers a range of benefits and features that cater to a diverse range of healthcare needs.
Netcare Medical Aid Frequently Asked Questions
What is Netcare Medical Aid?
Netcare Medical Aid is a registered medical scheme offering its members a range of healthcare benefits.
What benefits does Netcare Medical Aid offer?
Netcare Medical Aid offers a range of benefits, including in-hospital coverage, day-to-day benefits, chronic medication coverage, and emergency medical services.
How do I join Netcare Medical Aid?
To join Netcare Medical Aid, you can apply online or contact their call center to request an application form.
How do I submit a claim to Netcare Medical Aid?
You can submit a claim to Netcare Medical Aid by completing a claims form and submitting it via email, fax, or post.
Does Netcare Medical Aid cover pre-existing conditions?
Yes, Netcare Medical Aid covers pre-existing conditions subject to waiting periods and other terms and conditions.
Does Netcare Medical Aid have a network of healthcare providers?
Yes, Netcare Medical Aid has a network of healthcare providers that members can use to access healthcare services.
Does Netcare Medical Aid offer gap cover?
Yes, Netcare Medical Aid offers gap coverage to members to cover shortfalls on specialist claims.
How do I log into my Netcare Medical Aid account?
To log into your Netcare Medical Aid account, visit the website and click the “Login” button. Then, enter your username and password to access your account.
What maternity benefits does Netcare Medical Aid offer?
Netcare Medical Aid offers a range of maternity benefits, including antenatal consultations, ultrasound scans, childbirth classes, and hospitalization for childbirth. Some plans also cover fertility treatments.
Where can I find the Netcare Medical Aid brochure?
The Netcare Medical Aid brochure can be found on the Netcare Medical Aid website under the “Resources” or “Downloads” section. It provides information on plan options, benefits, and exclusions.
How do I request pre-authorization for a medical procedure with Netcare Medical Aid?
To request pre-authorization for a medical procedure with Netcare Medical Aid, log in to your account, go to the “Pre-authorisation” section, and follow the instructions provided. You may also call the customer service center for assistance.
Where can I find the Netcare Medical Aid application form?
The Netcare Medical Aid application form can be found on the Netcare Medical Aid website under the “Join Us” or “Apply Now” section. You can fill out the form online or download and print it out to complete it manually.
How long does it take for Netcare Medical Aid to process a claim?
Netcare Medical Aid typically processes claims within 7-10 business days from receipt of all necessary documentation. However, processing times may vary depending on the complexity of the claim and any outstanding issues.
Does Netcare Medical Aid cover chronic medication?
Yes, Netcare Medical Aid covers chronic medication for certain conditions such as hypertension, diabetes, and asthma. However, specific plan options may have different coverage limits and requirements.
What happens to my Netcare Medical Aid membership if I move to a new province?
Netcare Medical Aid membership is national, covering members throughout South Africa. However, members may need to update their contact information to ensure effective communication and access to healthcare services in their new location.
How do I add a Beneficiary to Netcare Medical Aid?
If you want to add a child or adult dependent, you can log into your Netcare Medical Aid profile and obtain the necessary documentation. Complete the relevant application form and Submit the application form and supporting documents.
How do I Switch my Medical Aid to Netcare Medical Aid?
To switch your medical aid to Netcare Medical Aid Research and compare the different medical aid options available from Netcare Medical Aid to determine which option best suits your needs. Once you have decided on the option that suits you, complete and submit the application form online, by email, or by post. Ensure that all required supporting documents are included with your application.
How to Downgrade my Plan with Netcare Medical Aid?
To downgrade your plan with Netcare Medical Aid, Contact Netcare Medical Aid via phone or email to request a downgrade in your benefit option. A consultant will guide you through the process.
