5 Best GP Network Plans on Medical Aid
The 5 Best GP Network Plans on Medical Aid in South Africa revealed.
We tested them side by side and verified their medical aid plans.
This is a complete guide to the best GP Network Plans for Medical Aid in South Africa.
In this in-depth guide you’ll learn:
- What are GP Network Plans?
- How do you find affordable medical aid in South Africa?
- Which medical aids offer the best GP Network Plans on Medical Aid?
- How to compare medical aids against each other?
- Which medical aid network doctors are offered by Discovery?
So if you’re ready to go “all in” with the best GP Network Plans on Medical Aid in South Africa, this guide is for you.
Let’s dive right in…
5 Best GP Network Plans on Medical Aid (2023)
|🩺 Medical Aid||✔️ Offer GP Network Plans?||⚕️ Plan Offered||👉 Sign Up|
|1. Discovery Health||Yes||Discovery KeyCare Plan||👉 Apply Now|
|2. Momentum Medical Aid||Yes||Ingwe Student Option||👉 Apply Now|
|3. Bonitas||Yes||Boncap Student||👉 Apply Now|
|4. BestMed||Yes||Network Plans||👉 Apply Now|
|5. MediHelp||Yes||Rhythm1 Option Plan||👉 Apply Now|
Introduction to Medical Aids in South Africa for GP Network Plans
👉 Options for medical aid that are based on a network provide the most cost-effective health care coverage at a predetermined network of designated service providers. Each medical aid programme will negotiate an affordable tariff with a certain grouping of hospitals, clinics, general practitioners, specialists, and pharmacies.
👉 A Designated Service Provider Network (DSPN) is a group of healthcare providers that has been designated by a certain scheme to provide services to their members for the diagnosis, treatment, and care of medical illnesses, including PMB disorders.
👉 People have a tendency to think that a designated service provider and a state hospital are the same thing whenever you talk about them together in the same phrase. This is not the case though. DSPs include more than only state hospitals in their scope.
👉 The purpose of including a provision for DSPs in Medical Schemes Act 131 of 1998 was to promote DSP arrangements to be made between medical schemes and healthcare providers in order to guarantee the correct delivery of specified minimum benefits (PMBs) to all beneficiaries of all schemes.
👉 However, in certain cases, this provision has resulted in the unfavourable redirection of patients to state hospitals when such redirection was not warranted. This occurred because schemes did not ensure that hospitals were easily accessible to offer the necessary service to their members.
👉 Schemes do have the legal authority to choose the state as their DSP; nevertheless, it is the responsibility of the schemes to make sure that the designated provider is easily available to accommodate and serve the needs of its members.
👉 The Registrar’s Office requires schemes to demonstrate that they have done an assessment of their DSPs and that they have assurance of the availability of services before approving scheme rules. This is a prerequisite for the approval of scheme rules.
👉 In order to guarantee that members receive quality service, schemes may explore DSP partnerships not just with the public sector but also with the commercial healthcare sector.
👉 And despite the fact that members could experience feelings of confinement when they have presented the list of service providers from which they could receive their PMBs, the fact of the matter is that direct service providers offer quality benefits to all parties involved.
1. Discovery Health Medical Scheme
👉 Discovery Health Medical Scheme (DHMS) is probably South Africa’s biggest open medical aid. It is a registered open medical scheme, which means that anyone can join as long as they follow the scheme’s rules and laws.
👉 The Discovery Health Medical Scheme gives you more than 20 different health plans to choose from. Each plan includes unlimited coverage for private hospital care and a variety of other perks, including visits to GPs that may be applicable if you use a DSP network.
👉 You will have access to many different perks, care programmes, and services that will make sure you can get the best medical care whenever you need it.
👉 Discovery says that its monthly premiums are, on average, 14.9% less than what other South African medical schemes ask for the same amount of coverage.
👉 Vitality is the company’s health and fitness programme. If you live a healthy life, you can join and get rewards for doing so.
👉 The Medical Schemes Act and the Council for Medical Schemes, which is a separate, non-profit organisation, are in charge of the Discovery Health Medical Scheme.
👉 The members of the Scheme own it, and it is run by an independent Board of Trustees. The fund is run by a different company called Discovery Health (Pty) Ltd, which is a licenced financial services provider.
👉 Discovery option plans range from the most comprehensive private healthcare cover to basic plans where a member just gets cost-effective private healthcare cover through a network of providers.
👉 The following Network health plan options are available:
Smart Series of Plans
👉 The smart series of plans provide the most cost-effective in-hospital cover, essential chronic medicine cover plus limited day-to-day cover if you use providers in the specified network.
👉 The KeyCare Plans is a basic series of plans offer affordable but basic medical cover providing you make use of providers in a specified network for both in-hospital and out-of-hospital treatment.
2. Momentum Health Medical Scheme
👉 Momentum Health is one of the most important open-plan medical aid providers in South Africa.
👉 Momentum Medical Scheme is a non-profit, open medical plan that is recognised under the Medical Schemes Act 131 of 1998, in its revised form.
👉 Momentum Medical fund Administrators, which is a part of Momentum Metropolitan Life Limited (MMI) Group (Pty) Ltd., runs and manages the fund.
👉 Its Board of Trustees is made up of many people with experience and knowledge in different areas of medicine, business, and law.
👉 Because its solvency ratio is higher than 31%, the plan is very stable and will be able to take care of its members’ needs both now and in the future.
👉 Members of the Momentum Medical Scheme can choose from a wide range of health insurance plans and benefits, including six different medical aid schemes, of which the following options prescribe the use of designated networks of providers.
The Evolve Option Plan
👉 The Evolve option provides coverage for hospitalisation at any of the private hospitals that are part of the Evolve Network, and there is no annual cap on the total benefit amount for beneficiaries.
👉 Members have access to two consultations with virtual doctors, and other day-to-day services will be subject to the HealthSaver+ membership fee.
The Custom Option Plan
👉 The Custom choice offers full coverage for hospitalisation as well as chronic conditions from any providers, but members have the option of receiving treatment at a predetermined list of private hospitals to reduce the amount of required co-payment.
The Ingwe Option Plan
👉 The Ingwe option provides affordable and easily accessible entry-level medical coverage if the beneficiary receives medical care at any hospital in the Ingwe Network of private hospitals or state hospitals.
3. Bonitas Medical Aid
👉 Bonitas Medical Aid has been in business for many years and has gained a lot of experience and expertise in relation with the private healthcare market in South Africa.
👉 Its team of professionals is always looking for new ways to make sure that its members get high-quality health care that is also affordable. Keeping up with changes in technology, managing care so that lifestyle diseases are found before they become chronic, and negotiating better rates, especially within designated networks of service providers, are all steps that need to be taken to reach their goal.
👉 Bonitas’s management team has a lot of experience, and the company is run by a Board of Trustees made up of professionals from the medical, legal, financial, and business fields who are not part of Bonitas.
👉 Bonitas has a lot of different plans, so any family can find one that meets all of their wants and give them access to GPs, specialists and more.
👉 The plans are easy for customers to understand and use, and they help them get the most out of their benefits.
The Edge Option
👉 This option gives members access to day-to-day benefits including unlimited GP consultations, dental and optical consultations, layers of virtual care, a network of private hospitals, and more.
Traditional Standard Select Option
👉 Bonitas series of Traditional options give an overall day-to-day limit with sub-limits for GP and specialist consultations, acute and over-the-counter medicine, X-rays and blood tests and other out-of-hospital medical expenses. The Standard Select Option offers day-to-day benefits and comprehensive hospital cover at a network of quality providers. Read more about the Traditional Standard Select Option
The Primary Select Option
👉 This option offers simple day-to-day benefits and hospital cover when members use the network of quality providers. Read more about the Primary Select Option
The BonFit Select Option
👉 This select option offers essential hospital cover and basic cover for day-to-day medical needs, provided by the selected network of healthcare providers. Read more about BonFit Select Option
The BonEssential Select Hospital Plan
👉 This hospital plan option uses a provider network for comprehensive hospital benefits and some other value-added benefits. Read more about BonEssential Select Hospital Plan
The BonCap Income-Based Entry-Level Plan
👉 This plan offers basic day-to-day benefits and hospital cover when using the set network of doctors, hospitals and providers. Read more about BonCap Income plan
4. BestMed Medical Scheme
👉 South Africans have received medical assistance from BestMed for more than half a century. About two hundred and fifty thousand people benefit from the medical aid, which is self-administered. This means that more of the money you spend on contributions goes towards benefits rather than administrators.
👉 BestMed does not have any self-payment gaps, and the company claims to have fewer co-payments than other medical aid programmes.
👉 They also tailor-make corporate solutions, which is a benefit, because they understand that every business group has different requirements and may desire a bespoke alternative.
👉 BestMed has 11 plans across 3 different schemes, of which the following network options offer healthcare services and private hospital cover at designated service providers (DSPs).
Rhythm1 Option Plan
👉 The Rhythm 1 network choice give you unlimited coverage while you are in the hospital and either limited essential day-to-day benefits or big savings when you see GPs in the specified network.
👉 Your monthly payment will be based on whichever of the main member and spouse/partner on the membership application has a bigger gross monthly income. When you register for a Bestmed membership, you will need to show proof of income for the past three months, and every year, you will need to show proof of income to figure out which income category you belong in. If you cannot give the information asked for, the highest income level will be used.
👉 Day-to-Day Family Practitioner (FP) consultations are all covered unlimited but subject to the Bestmed Rhythm FP network and pre-authorisation after the 10th visit.
👉 Pharmacy clinic nurse consultations are covered at 100% of the scheme tariff/cost for unlimited primary care nurse consultations at network pharmacies and diabetes primary care consultations at 100% of scheme tariff, subject to registration with Halocare and 2 primary care consultations at Dis-Chem Pharmacies are covered.
👉 Specialist consultations are covered if it was referred by a Rhythm Network Provider, and is limited to a maximum of R2 325 per family per year.
Rhythm2 Option Plan
👉 The Rhythm 2 network option is income-level dependant and offers you unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for your consultations with designated healthcare providers.
👉 You pay for a maximum of three children. Additional children join as beneficiaries of the scheme at no additional cost.
👉 Hospital & Emergencies (hospital stay and theatre fees) are covered at 100% scheme tariff at a designated service provider (DSP) hospital.
👉 Consultations and procedures are covered at 100% of scheme tariff, subject to pre-authorisation and treatment in the DSP network.
👉 Functional nasal surgery, surgery for medical conditions, e.g. Epilepsy, Parkinson’s disease, etc., and procedures where stimulators are used, are excluded from benefits.
READ more about the Top 10 Best Hospital Plans in South Africa revealed.
5. Medihelp Medical Scheme
👉 Medihelp is a reliable and consistent self-administered medical aid company that takes care of its users and meet their needs for medical services.
👉 You should feel at home at Medihelp whether you are a student, just got a new job and want to join a medical aid for the first time, are self-employed and looking for a reliable healthcare option for your employees or are taking care of a family with growing needs.
👉 Medihelp is still one of the top five choices for medical aids in South Africa because it can adapt to changing needs and improve the way it does business by using cutting-edge technology.
👉 Medihelp offers the following network option plans:
MedElect Option (for students)
👉 The MedElect option makes use of a quality network of service providers to provide comprehensive cover at an affordable premium for those who still have to concentrate on their studies. Among its benefits are extensive in-hospital cover, screenings and additional benefits.
👉 Medmove provides health essentials cover such as private hospitalisation and emergency medical services through a quality network to members. They also have access to virtual and in-person doctors’ consultations and medicine, as well as a selection of other medical services in the network.
MedAdd Elect Option
👉 MedAdd Elect offers comprehensive care at a premium quality network of providers at an affordable rate.
Frequently Asked Questions
What is meant by GP network options for a medical aid?
A GP network refers to a predetermined network of service providers. A medical aid system negotiates a lower fee with a pre-selected network of hospitals, clinics, GPs, specialists, and pharmacies.
How does a GP network plan work?
Members of a GP network plan must visit GPs within the approved network for routine consultations and basic healthcare requirements.
What are the advantages of a GP network plan?
The costs of a GP Network plan are generally lower as opposed to plans that offer unrestricted GP choices.
Can I still see a specialist with a GP network plan?
Yes, GP network plans normally allow patients to consult specialists, although coverage may be contingent on a referral from your GP inside the network.
How do I find GPs within the network?
Medical aid companies often provide a list or directory of GPs in their network, which can be accessible online or through their customer service channels.