#AlwaysThereForYou
Medical Aid Network Plans
How network plans lower your contribution, and what going out of network costs.
By Roxanne Hurter-Ehlers, Director of People and Governance
Medical Aid Network Plans in South Africa (2026)
A network plan, sometimes called an efficiency-discounted plan, offers lower monthly contributions in exchange for using the scheme's chosen network of providers. This guide explains how network plans work, what happens if you go outside the network, and who they suit. Network details vary by scheme and change each year, so always check the specific plan.
How network plans work
The scheme contracts a network of providers, known as Designated Service Providers, and negotiates rates with them. In return for agreeing to use those providers, you pay a lower monthly contribution. Using the network gives you full cover for the benefits on your plan.
Going outside the network
If you voluntarily use a provider outside the network when a network provider was reasonably available, the scheme may pay only up to its tariff and leave you with a co-payment. This can apply even to Prescribed Minimum Benefits, under Regulation 8 of the Medical Schemes Act regulations. The exceptions are a genuine emergency, or a situation where no network provider was reasonably available, in which case PMB care must be covered in full at any provider.
Who network plans suit
- People who want a lower contribution and are comfortable using the scheme's providers.
- People who live or work near network facilities, so out-of-network costs rarely arise.
- Less suitable for those who want freedom to use any provider, or who rely on a specific doctor or hospital outside the network.
What is set by the scheme
Which providers are in the network, which plans are network plans, the size of any co-payment, and how much the network discount lowers the contribution are all decided by each scheme and reviewed every year. Confirm the current rules of the specific plan before joining. The right to require network use for PMBs, and the emergency exceptions, come from the regulations and are stable.
Related guides
How a broker helps
A registered broker conducts a needs analysis (required under the FAIS Act) covering your health needs, chronic conditions, family composition, hospital preferences and budget, then maps those needs to the right plan across the open schemes. Curemed is FSP 44098 and accredited by the Council for Medical Schemes as ORG 163. See our credentials.
Frequently asked questions
What is a network or efficiency-discounted plan?
A medical scheme option with lower contributions in return for using the scheme's contracted network of providers.
What happens if I use a doctor or hospital outside the network?
If you do so voluntarily when a network provider was available, the scheme may pay only its tariff and leave you with a co-payment, even for PMBs.
Are there situations where out-of-network is still fully covered?
Yes. In a genuine emergency, or where no network provider was reasonably available, the scheme must cover PMB treatment in full at any provider.
Who should consider a network plan?
People who want a lower contribution and are happy to use the scheme providers, especially if those providers are conveniently located.
Is the network the same on every plan?
No. Networks, co-payment rules and discounts differ by scheme and plan and are reviewed each year, so always check the current rules of the specific plan.
What is a Designated Service Provider?
A provider the scheme has chosen for full-cover treatment, especially for PMBs. A network plan is built around using these providers to avoid co-payments.
Speak to an independent broker
Get a no-obligation needs analysis and a plan recommendation matched to your situation.
Speak to a broker
Roxanne Hurter-Ehlers
Director of People and Governance | Admitted Attorney, Founder and MD of RH Attorneys, FAIS Key Individual
More about Roxanne