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.
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 Prime plan may use any doctor or service provider of their choice.
Cataract surgery
The Ophthalmology Management Group Limited (OMG) is a network of ophthalmologists that is contracted to provide cataract surgery on all plans.
-
Ophthalmology Management Group (OMG)
- link https://www.omg-ltd.co.za
- call 011 340 9000
- email [email protected]
Optical
Preferred Provider Negotiators is contracted to manage all optical benefits, including optical claims processing, on the Select and Guardian plans.
-
Preferred Provider Negotiators (PPN)
- link http://www.ppn.co.za
- call 0861 103 529
- email [email protected]
Dental
Dental Information Systems (DENIS) is contracted to manage all dental benefits on the Select and Guardian plans
-
Dental Information Systems (DENIS)
- link http://www.denis.co.za/
- call 0860 104 941
- email [email protected]
Oncology
The Independent Clinical Oncology Network (ICON) is a network of oncologists that is contracted for cancer treatment
-
Icon
- http://iconsa.co.za
- call021 944 3750
- mail_outline[email protected]
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.
-
Improved Clinical Pathway Services
- http://www.icpservices.co.za/
Link plan
Please contact Universal Healthcare to locate a GP, specialist, dentist or optometrist within your area.
-
Universal Healthcare
- http://www.universal.co.za/Healthcare/Default.aspx
- mail_outline[email protected]
- call0861 686 278
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.