Network

What is a network plan?

On a network medical aid plan, you need to use specific doctors, providers, or hospitals to get full cover. These providers meet Medihelp’s standards and have agreed to set rates – which is how your monthly contribution stays lower.

You can save up to 25% with a network plan. Medihelp’s network plans include MedMove!, MedVital Elect, MedAdd Elect, MedReach, and MedPrime Elect.

What is a network provider?

A network provider is a doctor, specialist, healthcare facility, pharmacy, or other provider that has been vetted and approved by Medihelp to be part of its network. Some network providers have agreed tariffs with Medihelp – you can check this on the Medihelp provider search.

Must a GP refer me before I can see a specialist?

Members of Medihelp’s MedMove! plan need a referral from a network GP to see a specialist. Without one, your claim may not be fully covered.

If you’re on one of our other plans, you don’t need a referral.

What happens if I use a doctor that is not part of the network?

If you’re on a network plan and use a doctor who is not part of the network, you might need to pay a co-payment. To avoid this, use the provider search tool to find a network provider.

What is the difference between a network and non-network medical aid plan?

A network plan gives you access to Medihelp’s approved private healthcare providers. Some of these providers have agreed tariffs with Medihelp, which means lower out-of-pocket costs for you. You can check your provider’s status on the Medihelp provider search.

With a network plan, you can save up to 25% on your monthly contribution.

A non-network plan allows you to visit any healthcare provider of your choice.

Note: Regardless of your plan, certain services – such as cancer treatment and eye care – must be obtained through Medihelp’s healthcare partners.

What is a day procedure?

A day procedure is a medical treatment or surgery where you go to hospital but don’t need to stay overnight. You’re admitted, treated, and go home on the same day.

Does Medihelp have a day procedure network?

Yes. Medihelp covers a list of day procedures that should be performed in a day procedure facility or in Medihelp’s day procedure network (for members on the network plans). These procedures are:

• Ophthalmological procedures;
• Ear, nose, and throat procedures;
• Endoscopic procedures;
• Removal of skin lesions;
• Circumcisions; and
• Dental services.

How do I find a doctor or hospital in my network?

You can search for network providers using our provider search function.