Benefit from our Networks
If you are diagnosed and need to be admitted to hospital, remember that it will be to your advantage if the admitting practitioner is part of the Nedgroup GP and Specialist Network, as you will obtain cover of up to 2 x Medical Scheme Rate. In addition, you will NOT be required to make a co-payment on the hospital claim.
If your treating practitioner is not part of the Nedgroup GP and Specialist Network, all accounts will be covered at Medical Scheme Rate. In addition, you will be required to make a co-payment on the hospital claim (unless it was an emergency case). There will be no co-payment on the Platinum Plan, but payment will be limited to the Medical Scheme Rate.
If you are referred to a specialist, you should check whether the specialist is part of the Nedgroup specialist network, as you will probably not be in a position to change your specialist at the time of requesting pre-authorisation or admission.
To check whether a specialist is on the Network, or if you would like to find a Network specialist close to you, contact the Scheme on 0860 100 080 or at firstname.lastname@example.org
WHY WOULD A SPECIALIST NOT JOIN A NETWORK?
Members sometimes receive the impression that a network offers lower quality care, especially if their preferred specialist is not on the network. The reality is that specialists (and especially anaesthetists) are sometimes reluctant to join any network, as they do not want to lower their fees. Not being part of a network would also allow them to charge excessive tariffs for PMB, as they are able to argue that it is involuntary use of a non-DSP.
Please remember that all members except those on the Platinum Plan will in future have a 30% co-payment for consultations with specialists if they were not referred by their GP. See more information here.