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.
View a summary of Necesse’s monthly contributions and benefits
| Full-time students
R0 - R600 | R601 - R11 000 | R11 001 and more | ||
| Principal member |  | R636 | R2 334
| R2 724
|
| Dependant | | R636 | R1 824
| R2 130
|
| Child dependant < 21 years |  | R636 | R1 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 benefits as indicated.
| Routine screening and immunisation
Available at network pharmacy clinics per person:
| Women's health
|
Supporting wellness
| Men's health
|
| Enhanced maternity benefits
Registration on HealthPrint’s Maternity and Baby programme will activate these additional benefits:
| Child benefits
|
Over 50s
| 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
Hospital network: 123 private hospitals Day procedure network: 240 day procedure 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
| 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
| |
| Clinical technologist services
In hospital – R23 100 per family per year | Oncology
PMB – 100% of the MT |
Chronic illness/ PMB
| Confinement (childbirth)
|
| 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
| Optometry
PPN network and benefits per beneficiary per 24-month cycle apply
|
| Standard radiology and pathology
100% of the MT
| 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 |
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 (non-surgical back treatment at a DBC clinic is a prerequisite)
- All endoscopic procedures (in hospital/ day clinic) – R4 500 (services should be rendered in a day procedure 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
Day procedure network
Specialist network