Choosing a plan
Network vs traditional plans explained
By Naledi Mokoena · 6 min read · Updated 24 June 2026
A network plan is cheaper because you agree to use a defined list of hospitals and doctors, while a traditional plan lets you use any private hospital and provider for a higher contribution. The choice comes down to how much you value freedom of choice versus a lower premium.
Network plans like Discovery KeyCare or income-based options keep costs down, but going out of network can mean a co-payment or no cover. Traditional plans remove that restriction.
This guide explains how networks work, what they cost you in flexibility and who each suits.
How network plans work
On a network plan, the scheme negotiates rates with a defined set of hospitals and doctors and passes the saving to you as a lower contribution. In return, you must use those network providers for non-emergency care. Use a hospital outside the network for a planned procedure and you can face a significant co-payment, or the claim may not be covered at all. Emergencies and PMBs have separate rules.
Network vs traditional compared
| Feature | Network plan | Traditional plan |
|---|---|---|
| Hospital choice | Defined network | Any private hospital |
| Doctor choice | Network providers | Any provider (at scheme rate) |
| Contribution | Lower | Higher |
| Out-of-network care | Co-payment or no cover | Covered at scheme rate |
| Best for | Budget-focused, near a network hospital | Want full freedom of choice |
What you give up on a network plan
You give up freedom of choice. If your preferred specialist or the nearest good hospital is not in the network, a network plan can be inconvenient or costly. Before choosing one, check that there is a network hospital near you and that the doctors you want to use are in network. For people in smaller towns, network coverage can be thinner.
Who each suits
Choose a network plan if you want the lowest contribution, live near a network hospital and are comfortable using network providers. Choose a traditional plan if you want to use any private hospital and specialist, value choice over price, or live where network coverage is limited.
Emergencies, PMBs and your rights
In a genuine emergency you should go to the nearest hospital, and PMB emergency rules still apply even on a network plan, though you may need to transfer to a network hospital once stable. Confirm the detail with your scheme. If a scheme does not resolve a complaint, you can escalate to the Council for Medical Schemes (CMS) at medicalschemes.co.za, the statutory regulator for all registered medical schemes in South Africa.
Frequently asked questions
What is a network medical aid plan?
A network plan is one where you agree to use a defined list of hospitals and doctors in exchange for a lower contribution. Using providers outside the network for planned care can mean a co-payment or no cover. Emergencies have separate rules.
What is the difference between network and traditional plans?
Network plans restrict you to defined hospitals and doctors for a lower price. Traditional plans let you use any private hospital and provider at the scheme rate for a higher contribution. The trade-off is price versus freedom of choice.
Do I get charged for using a non-network hospital?
On a network plan, yes, usually. A planned procedure at a non-network hospital can attract a significant co-payment, or the claim may not be covered. Always check the network and pre-authorise admissions to avoid surprises.
Are network plans worth it?
They are worth it if you live near a network hospital, are comfortable using network providers and want the lowest contribution. If your preferred specialist or hospital is outside the network, a traditional plan may suit you better.
What happens in an emergency on a network plan?
Go to the nearest hospital in a genuine emergency. PMB emergency rules still apply on a network plan, though you may need to transfer to a network hospital once stable. Confirm your scheme's exact emergency rules in advance.
Can I switch from a network to a traditional plan?
Yes, usually at the scheme's annual plan-change window, by upgrading to a traditional plan. The contribution will be higher. Check whether any waiting periods reapply when you change plans within the same scheme.
