What is a Network option?
It is an option where, for the purpose of containing costs, the scheme has negotiated rates to be charged with certain providers (DSPs) on behalf of members who are on the network options. These providers form the network, to which members of these options are restricted. Members on these network options get discounted contribution rates, which are directly linked to the discounts received from negotiating with the designated service providers.
Networks apply to hospitalisation benefits, optical benefits and GP consultations. A 20% co-payment is applicable for utilising a non-network hospital provider. This does not apply in emergencies where a member is hospitalised. You will be stabilised and transferred to a network hospital once the emergency has been resolved.
Understanding CAMAF Network Options
|ALLIANCE NETWORK||DOUBLE NETWORK||VITAL NETWORK||ESSENTIAL NETWORK||NETWORK CHOICE|
|Hospitalisation||Life Healthcare & Netcare hospital groups||Life Healthcare & Netcare hospital groups||Life Healthcare & Netcare hospital groups||Life Healthcare & Netcare hospital groups||Netcare hospital group|
Find a PPN optometrist here
|PPN optometrist||PPN optometrist||Any optometrist||Any optometrist||PPN optometrist|
Click here to view a list of our network GP’s
|Nominated CAMAF Network GP||Nominated CAMAF Network GP||Any GP||Any GP||Nominated CAMAF Network GP|
|Nomination of a Network GP||Compulsory for each beneficiary to nominate their GP (main and alternate) from the CAMAF GP network each year and use that GP only.||Compulsory for each beneficiary to nominate their GP (main and alternate) from the CAMAF GP network each year and use that GP only.||No nomination required||No nomination required||Compulsory for each beneficiary to nominate their GP (main and alternate) from the CAMAF GP network each year and use that GP only.|
|Specialist visits||Referral from a Nominated CAMAF Network GP is required||Referral from a Nominated CAMAF Network GP is required||No referral is required||No referral is required||Referral from a Nominated CAMAF Network GP is required|
Please consult the benefits brochure for more information on benefits and limits.
Why do I have to nominate a GP?
The nominated GP acts as the custodian of your coordinated healthcare. We believe that this will improve the healthcare outcomes.
What if I need to change my nominated GP?
You are allowed to change your GP once a year.
Should you change your nominated GP during the year, please note the following:
- A new chronic script will be required for your chronic medication, as your old script will have the old nominated GP information
- If you are pregnant, you will need a new referral to your gynaecologist from your new nominated GP
- If you are seeing a specialist regularly, you will need a new referral from your new nominated GP.
What if my nominated GP is not available?
One alternate GP is allowed should your nominated GP not be available. One out of network or one non-nominated GP visit per year is also allowed should you be away and be unable to get to your nominated GP.
Can I use my MSA to pay for my non-nominated GP visits?
Yes, if your benefit option has a savings account, you will be able to use your savings for co-payments for non-DSP visits.
What if I decide to move to the Network option, but my current treating GP is not in the CAMAF network?
You will have to change your current GP and nominate a new GP who is in the CAMAF network. You can also ask your current GP to register in the CAMAF network.
I am currently receiving Oncology treatment, what do I need to consider if I want to change to the network option?
You will not be permitted to use non-ICON doctors if you are on the network option.
If you are currently seeing an oncologist outside of the ICON network, your oncologist will have to change to an ICON doctor for your treatment and procedures to be reimbursed.
Referrals required for Network options
What must I do to see a specialist?
You must be referred by your nominated network GP. Please ensure that your referring GP’s name and practice number appear on the specialist account or it will be rejected.
Do I need to obtain another GP referral for subsequent or follow-up visit(s) to the same specialist for the same condition?
No, you only need to obtain a nominated network GP referral to see a specialist for the first visit. For any subsequent or follow-up visits relating to the same condition, the specialist claim should simply reflect the initial referral GP name and practice number.
What is the time limitation for a referral?
There is no time limitation for a referral if you are treated for the same condition. If your condition requires extended treatment with repeat or follow-up visits, your initial referral will remain valid throughout your treatment period.
What if my treatment extends to the next benefit year?
The referral from your nominated network GP can be carried over from one benefit year to the next, if the same condition requires extended treatment with repeat or follow-up visits. Please check that your nominated network GP is still on the network for the new year.
What if I visit the same specialist for a new condition?
You must obtain a new referral from your nominated network GP for other visits to the same specialist for treatment of a new condition.
How often do I need to obtain a referral to a gynaecologist when I’m pregnant?
You only need to obtain a referral to see a gynaecologist for the first visit. For any subsequent follow-up visits to the same gynaecologist relating to that pregnancy, the claim must simply reflect the initial referral GP name and practice number.
What if I decide to change my gynaecologist during my pregnancy?
Your claim for your new gynaecologist must have your nominated GP referral.