Going to see a healthcare professional

We recognise that health professionals play a critical role in helping you improve your health and wellbeing by sharing their expert knowledge. We believe that we have a responsibility to you, our member and our industry to use our experience, and expertise to help keep private healthcare affordable.

This is why we have entered into arrangements with specialists and GPs which offer them a higher rate of reimbursement while ensuring you have limited co-payments.

Our arrangements benefit you

You can benefit by using a healthcare professional who we have an arrangement with because we will cover their approved consultations and procedures in full.  We pay claims directly to the healthcare professional when we have an arrangement with them.

What is my cover for specialists and GPs?

In the Fund's efforts to improve the management of costs while ensuring that members receive PMBs, the Fund utilises a preferred GP and specialist designated service provider (DSP) network.

The Fund has negotiated specific rates with all GPs and specialists in the network of service providers, who provide members with diagnosis, treatment and medication for any of the PBM conditions at an agreed-upon, more affordable rate.

Preferred GP and specialist designated service provider (DSP) network search facilities.

To search for a service provider that is in our networks and closest to you, click here.

What is my cover for the dentist?

Dentistry is paid from your Insured Benefit and is subject to a limit per family when done both in- and out-of-hospital.

Click here for your guide to visiting your doctor.

Going to hospital

The reimbursement rate for all members is 100% of the Fund rate, subject to pre-authorisation. If you make use of our Designated Service Providers then we will cover you at the full contracted rate.

Click here for your guide when visiting a hospital.

Log in