Network or capitation medical aid options provide the most cost effective health care cover at a prescribed network of service providers.
Each medical aid scheme negotiates an applicable rate with a chosen network of hospitals, clinics, GPs, specialists and pharmacies. In some cases, state hospitals are amongst the designated service providers or DSPs.
These capitated products, which are becoming more and more popular due to soaring annual medical aid inflation, are generally income-based, ensuring low income earners are able to enjoy adequate health care cover regardless of their medical aid budget.
It is worth remembering, however, that certain procedures are only covered at network day clinics; demand a co-payment from the member or are excluded altogether.
Benefits of Network Options
- Network options are the most cost-effective medical aid alternatives on the market today, providing adequate cover for under R1000 per month for the entire family on the lowest income bracket.
- Monthly premiums are set according to the member’s salary.
- There is no overall annual limit to in-hospital benefits depending on the plan selected.
- All capitation or network plans provide chronic medication cover for 25 PMB chronic conditions.
- All medical aid schemes typically offer access to network GPs, limited access to specialists and additional cover for conservative dentistry.
- Some schemes make allowances for additional in-hospital benefits to cover mental health, terminal care, alcohol and drug rehabilitation and health care emergencies.
Who Should Apply for Network Options?
Network or capitation medical aid plans have been specifically designed with the low income groups in mind. Monthly contributions depend entirely upon a prescribed salary scale, so the more you earn, the higher your monthly premium will be.
Network options are also ideal for entry-level clients or young couples with a growing family who have a limited medical aid budget to work with.
Popular Network Options in South Africa
Medical aid schemes offering network options or capitation plans for low income earners include:
