How it works
Network plans explained
By Naledi Mokoena · 5 min read · Updated 24 June 2026
A network plan is a cheaper version of a medical aid that requires you to use a defined network of hospitals, GPs or pharmacies, in exchange for a lower contribution. You agree to use the scheme's chosen providers, and the scheme passes the saving on to you as a lower premium.
Network plans are one of the main ways schemes keep costs down. They can be excellent value if the network suits where you live and who you see, but they catch people out who go out of network. This guide explains the trade-offs.
How network plans save you money
Schemes negotiate set rates with a network of hospitals, doctors or pharmacies. In return for steering members to those providers, the network gives the scheme a better price, and the scheme offers you a lower contribution. The same scheme often sells a network and a non-network version of a plan, with the network version costing noticeably less.
What happens out of network
If you use a provider outside the network on a network plan, you usually face one of these:
- A percentage co-payment on a hospital admission (often a fixed rand amount or a percentage)
- Reduced or no cover for a non-network GP visit
In a genuine emergency, you can use the nearest facility and the scheme must still cover PMB emergency care.
Network GPs and nominated doctors
Some network plans ask you to nominate a network GP as your main doctor. Visits to that GP are covered, while visits to a non-network GP may not be. If you move or your GP leaves the network, update your nomination so your day-to-day cover keeps working. Network pharmacies work the same way for chronic and acute medicine.
Is a network plan right for you
A network plan is good value if:
- There is a network hospital and GP near you
- You are happy to use the scheme's chosen providers
- You want a lower contribution
It suits you less if you live far from network providers, travel a lot, or have a specialist you are unwilling to change. Check the network list for your area before you join.
Frequently asked questions
What is a network plan?
A network plan is a medical aid that requires you to use a defined network of hospitals, GPs or pharmacies in exchange for a lower contribution. Using the network keeps your cover full and your premium low.
What happens if I go out of network?
You usually face a co-payment on a hospital admission or reduced cover for an out-of-network GP visit. In a true emergency, the scheme must still cover PMB emergency care at the nearest facility.
Are network plans cheaper?
Yes. Network plans typically cost less than the non-network version of the same plan, because the scheme negotiates better rates with its chosen providers and passes the saving to you.
Can I choose my own GP on a network plan?
Often you nominate a network GP as your main doctor. Visits to that GP are covered; non-network GP visits may not be. You can usually change your nominated GP if you move.
Do network plans still cover emergencies anywhere?
Yes. Emergencies are PMBs, so you can use the nearest facility in a true emergency even on a network plan. Notify the scheme as soon as possible after the event.
Is a network plan a good idea?
It is good value if there are network providers near you and you are happy to use them. It suits you less if you live far from the network or refuse to change your specialist.
