Healthcare providers

Visiting doctors, specialists and payments

Claims must be submitted to the Fund not later than the last day of the fourth month following the month in which the service was rendered.

How to submit a claim

Select plan and Guardian plan

Members on the Select plan and Guardian plan may use any doctor or service provider of their choice.

Link plan

Members on the Link plan should make use of their network providers.

Prime plan

Members on the Prime plan are encouraged to visit contracted service providers on the general practitioner and specialist networks to take advantage of agreed-upon rates with the Fund.

The GP and specialist networks are contracted to provide general practitioner and specialist services at a contracted rate.


Cataract surgery

The Ophthalmology Management Group Limited (OMG) is a network of ophthalmologists that is contracted to provide cataract surgery on all plans.

OMG

Optical

Preferred Provider Negotiators is contracted to manage all optical benefits, including optical claims processing, on the Select and Guardian plans.

PPN

Dental

Dental Information Systems (DENIS) is contracted to manage all dental benefits on the Select and Guardian plans

IsoLeso

Oncology

The Independent Clinical Oncology Network (ICON) is a network of oncologists that is contracted for cancer treatment


Pharmacies and dispensing of medication

Pharmacy Network for Prime, Select and Guardian plans

Clicks Directmedicines

Clicks
Pharmacies in Shoprite/Checkers stores

Medirite
Contracted independent pharmacies

Dis-Chem pharmacies

Dis-Chem

Joint replacement

Improved Clinical Pathway Services is a network of orthopaedic surgeons that is contracted for selected knee and hip replacements for members on the Guardian plan.

icps

Link plan

Please contact Universal Healthcare to locate a GP, specialist, dentist or optometrist within your area.


Hospital Networks

Guardian plan

The designated service provider is State facilities.

The Transmed Guardian plan private hospital network is the secondary service provider for cases where the required medical treatment cannot be rendered by a State facility. Use of these hospitals is strictly subject to pre-authorisation and a co-payment may apply if these facilities are used on a voluntary basis.


Select plan

The designated service provider is State facilities.

The Transmed Select plan private hospital network is the secondary service provider for cases where the required medical treatment cannot be rendered by a State facility. Use of these hospitals is strictly subject to pre-authorisation and a co-payment may apply if these facilities are used on a voluntary basis.

The Transmed Select plan private hospital network has also been contracted for selected procedures where members have direct access to private hospitals. Please consult the benefit guide for details of the procedures and admission types for which cover is provided via this hospital network. These admissions will be paid in full at network hospitals, subject to pre-authorisation.


Prime plan

The Transmed Prime plan private hospital network is the designated service provider for all admissions covered in terms of the Prime plan benefits. Please consult your benefit guide for details on these benefits.

Members are encouraged to visit these hospitals when admission is required, as members who use a non-network facility may be liable for a co-payment.

Admissions to network hospitals will be paid in full, subject to pre-authorisation.