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Necesse Network in 2021


This comprehensive product provides quality cover through an extensive network of private hospitals and healthcare providers for medical expenses incurred in and out of hospital. With a special student rate, Necesse is also the ideal healthcare solution for full-time students.
Medical aid plan networks

View a summary of Necesse’s monthly contributions and benefits

 Full-time students
R0 - R600
R601 - R11 000 R11 001 and more
Principal memberPrincipal memberR636R2 334
R2 724
DependantDependantR636R1 824
R2 130
Child dependant < 21 yearsChild dependantR636R1 026
R1 182
The monthly contribution does not take any employer subsidy into account.

These benefits are provided in addition to other insured benefits and are available annually, unless otherwise indicated. Benefits for certain services may be limited to specific item codes and protocols may apply.  A GP network and referrals to a specialist also apply. Network information is available on the provider search page . Register for HealthPrint, Medihelp’s free online health and wellness programme, to activate these benefits.

Routine screening and immunisation
Available at network pharmacy clinics per person:
  • A combo test (blood glucose, cholesterol, BMI & blood pressure measurement)/ individual test (blood glucose or cholesterol)
  • HIV testing, counselling & support
  • A tetanus vaccine
  • A flu vaccination
  • Two HPV vaccinations for girls and boys between 10-14 years or three between 15-26 years
Women's health
  • A mammogram requested by a medical doctor per 2-year cycle (women 40-75 years)
  • A Pap smear requested by a medical doctor per 3-year cycle (women over 21 years)
  • Contraceptives:
    • Oral/ injectable/ implantable contraceptives (women up to 50 years) –
      R125 per beneficiary per month, up to R1 500 per year
    • Intra-uterine device every 60 months –
      R2 000 per beneficiary
Supporting wellness
  • Back treatment as an alternative to surgery at a Document Based Care facility for eligible patients, and the treatment is also a prerequisite for spinal surgery
  • Chronic Care programme
  • One dietician consultation if a BMI measurement indicates a BMI higher than 30
  • Early Detection programme
  • Bipolar programme (from 1 April 2021)
Men's health
  • A prostate test (PSA level) requested by a medical doctor (men 40 years and older)
Enhanced maternity benefits
Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
  • 10 antenatal and post-natal consultations with a midwife/ GP/ gynaecologist
  • 2 antenatal and post-natal consultations at a dietician/ breastfeeding specialist/ antenatal classes
  • Two 2D ultrasound scans
Child benefits
  • Babies under 2 years receive 2 additional visits to a GP, paediatrician or ear, nose and throat specialist
  • Standard child immunisations for children up to 7 years at network pharmacy clinics
Over 50s
  • One bone mineral density test requested by a medical doctor (women >50 years)
  • A Pneumovax vaccine in a 5-year cycle per person older than 55 years (if registered for asthma or COPD)
  • An FOBT test for people over 50 years
HealthPrint

Medihelp members get free access to this online health and wellness programme designed to add value based on their health profile through programmes such as the Maternity and Baby programme.

 

Hospitalisation
100% of the MT– unlimited

Hospital network: 134 private hospitals

Day surgery network: 134 day surgeries for certain procedures

Emergency transport
Netcare 911
Transport by road or air within South Africa
100% of the MT – unlimited
Emergency unit services and non-network consultations
80% of the MT
  • Member = R1 150 | Member+ = R2 350
    Outpatient emergency unit services, non-network visits, medicine and services rendered by a non-network medical doctor and radiology requested by a non-network medical doctor
100% of the MT
  • Pathology at Lancet and ParthCare
Standard radiology, pathology and medical technologist services
In hospital – 100% of the MT
R31 700 per family per year
    Specialised radiology
    In and out of hospital
    Services requested by a specialist on referral by a network GP
    • MRI and CT imaging (subject to pre-authorisation) and angiography
      100% of the MT – R17 100 per family per year
    Clinical technologist services
    In hospital – R23 100 per family per year
    Oncology
    PMB – 100% of the MT
    Chronic illness/ PMB
    • 100% of the cost for 270 PMB and 26 chronic conditions (DSPs, specialist network, protocols and pre-authorisation apply)
    • Unlimited cover for trauma that necessitates hospitalisation

    Confinement (childbirth)
    PMB – 100% of the MT
    Non-PMB – R27 300 per confinement for an elective caesarean section
    Home delivery – R13 500 per event

    Physiotherapy and occupational therapy
    In hospital – 100% of the MT
    On request of the attending medical doctor
    Sub-acute care and private nursing
    As an alternative to hospitalisation – R23 100 per family per year
    Palliative care
    100% of the MT
    R18 000 per family per year
    Organ transplants
    PMB only – 100% of the cost
    Cornea implants – R29 900 per implant per year
    GP services within the Necesse network
    9 consultations per beneficiary per year

     

    Specialist care
    Subject to referral by a Necesse network GP, clinical protocols and pre-authorisation, which includes one follow-up consultation
    Member = R3 300 per year
    Member + = R4 600 per year
    Medicine
    • Acute medicine and PMB chronic medicine (Necesse GP network, pharmacy network and formularies apply)
    • Self-medication obtained from a network pharmacy
      • 100% of the MMAP (R110 per event or R300 per beneficiary per year)
    Optometry
    PPN network and benefits per beneficiary per 24-month cycle apply
    • 1 composite examination
    • Spectacles or contact lense
      • Spectacles: R550 for a frame/ lens enhancements and 1 pair of standard clear Aquity lenses single vision or bifocal lenses (multifocal lenses are paid at the cost of bifocal lenses)
      • R750 for contact lenses
    Standard radiology and pathology
    100% of the MT
    • List of item codes and protocols apply
    • DSP for pathology is Lancet or PathCare
    Physiotherapy and occupational therapy
    On request of a Necesse network GP
    Member = R2 100 per year
    Member + = R3 300 per year
    Conservative dental benefits
    Subject to DRC managed care protocols and services rendered by a DRC network dentist
     

     

    Important:
    This is only a summary of the available benefits. Please consult the registered Medihelp Rules for more information and details of services that are excluded from benefits. In case of a dispute, the Rules of Medihelp will apply (subject to approval by the Council for Medical Schemes).
    The Necesse network GP must be the starting point for all services and must refer Necesse patients for radiology, pathology and treatment by specialists.
    • Certain added insured benefits are not available if you have been registered for a chronic/ PMB condition, as the treatment is no longer considered as preventive care.
      Some benefits may be linked to a specific age/ gender/ item code. Benefits are paid at 100% of the MT.
    • Doctors’ consultations are paid from the available day-to-day benefits.
    • Benefits may be subject to pre-authorisation and/ or protocols.

    Procedure-specific deductibles
    • Spinal column surgery – R15 000 per admission
    • All endoscopic procedures (in hospital/ day clinic) – R4 500 (services should be rendered in a day surgery network to avoid a further 35% deductible)
    • Hysterectomy and endometrial ablation – R6 700 per admission
    • Prostatectomy (conventional/ laparoscopic procedures only) – R6 700 per admission

    Abbreviations

    BMI-Body mass index | CDL-Chronic Diseases List | COPD-Chronic obstructive pulmonary disease | CT-Computerised tomography | DRC-Dental Risk Company | DSP-Designated service provider | EMS-Emergency medical services | FOBT-Faecal occult blood test | GP-General practitioner | HPV-Human papilloma virus | OAL-Overall annual limit | MRI-Magnetic resonance imaging | MT-Medihelp tariff paid by Medihelp for benefits which can include a contracted tariff or the single exit price | PMB-Prescribed minimum benefits | PPN-Preferred Provider Negotiators 

    Necesse hospital network

    Specialist network

    If you are interested in a medical aid, complete the form below and an accredited adviser will get in touch with you:

    To request pre-authorisation, view your benefits, and for other member services please log in to the Member Zone.


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