Select a scheme and option
View the benefits, health management programmes and chronic conditions covered by your patient’s medical scheme and option.
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| Search a network | |
|---|---|
| General practitioner network | |
| Dentist network | |
| Pharmacy network | |
| Optometrist network | |
| Network management | |
|---|---|
| General Practitioners - Primary Care Network | By joining our primary care network, we would like you to be the primary caregiver to the members of the schemes within this network. In return we have a seamless integration of benefits, regardless of the member’s option thereby reducing the administration burden on your practice. You will receive weekly payments for all valid claims correctly submitted within 4 months of date of service. Kindly note that dispensing practices’ reimbursement is inclusive of medication and therefore cannot give members a prescription to take to the pharmacy, as these prescriptions will reject. |
| General Practitioners - group practices | If you are part of a group practice, you need to supply us with the practice numbers of all the group practice members, in order for us to capture the necessary detail on system. This will enable these practitioners to use their practice number as a referring practice number. It must be noted that billing must be done under the group practice number. We would also like to encourage you to make use of our specialist network when you need to refer members. In so doing, members will not experience out-of pocket expenses as network specialists have agreed to charge contract rates. We will send you regular statements, showing your payments. |
| Dental Practitioners | The dental network is managed by Momentum Health Solutions . As a designated service provider you need to adhere to certain protocols, i.e. rates, list of tariffs, and explaining to a patient if certain codes are not covered before procedures are performed. The objective is to direct members to compliant providers to prevent any out-of-pocket expenses for members. |
| Optometrists | The optometry network is managed by Opticlear. Their contact number is 011 461 6337. As a designated service provider you need to adhere to certain protocols, i.e. rates, list of tariffs, and explaining to a patient if certain codes are not covered before procedures are performed. The objective is to direct members to compliant providers to prevent any out-of-pocket expenses for members. Contact Opticlear for any optical benefit queries. Contact details: Phone no: 011 461 6337. |
| Specialist visits | Specialists on our networks have agreed to charge contract rates thereby ensuring that members do not experience out-of-pocket expenses. Members in need of a specialist visit should be referred to the relevant scheme in order to obtain an authorisation. |
| Pharmacy network | Members to access network pharmacies to ensure medication is dispensed according to the applicable formularies. |