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Medical Aid Company news South Africa

Unlocking in-network healthcare: Tips and perks from Medshield

Imagine being recently enrolled on a new medical scheme plan, eager for the comprehensive healthcare coverage it promises, but you are not entirely sure which doctors, dentists or hospitals are covered on your chosen benefit option/plan. Maintaining good health requires more than just eating right and working out. It also requires access to quality medical care when necessary. Medical scheme coverage is a lifeline that helps pay medical bills. However, navigating the complexities of network coverage and locating in-network healthcare providers can often seem like a complex puzzle. It is critical to understand your network cover and know where to find relevant in-network healthcare providers covered by your medical scheme.
Unlocking in-network healthcare: Tips and perks from Medshield

The perks of staying in-network

The concept of network cover is simple, as it refers to the list of healthcare professionals, facilities, and services contracted with your medical scheme plan or option. Medical schemes, like Medshield, typically negotiate discounted rates with specific healthcare providers, forming a network.

When you visit an in-network provider, your medical scheme covers all, or a significant portion of the costs, ensuring you pay less out of pocket. However, if you opt for an out-of-network provider, you may be responsible for a larger share of the medical expenses incurred.

Choosing an in-network healthcare provider is not just about saving money; it also guarantees quality care and convenience. In-network providers often know your plan's procedures, making healthcare administration smoother.

Most importantly, medical scheme plans monitor in-network providers for high standards of care, ensuring you receive quality and expertise from healthcare professionals.

Tips for finding in-network providers

  1. Review your benefit plan documents – To make informed decisions about your healthcare, check your specific benefit option/plan's benefit guide or visit the website page for your plan. Focus on the network cover section, which details the healthcare providers and facilities included in your plan's network. Knowing which providers are in-network empowers you to navigate your healthcare options effectively.

  2. Use online tools – Medical schemes like Medshield offer convenient online tools and a mobile app to help members find in-network healthcare providers easily. These resources allow users to search for doctors, specialists, hospitals, and other facilities within their network, filtering by location, speciality, and preferences. Medshield members can visit for a comprehensive list of all network providers under every plan.

  3. Verify network participation – Confirming a healthcare provider's network participation status before booking an appointment is crucial to avoid unexpected costs. Even if a provider was previously in-network, it's wise to double-check with your scheme or the provider's office. By taking this proactive step, you can ensure that you stay within your plan's network and avoid unexpected out-of-pocket expenses.

  4. Consider telemedicine options – Telemedicine, also known as virtual healthcare visits, gained popularity, especially during the Covid-19 pandemic. Medshield's Virtual GP Consultations and SmartCare are included in all benefit packages, enabling members to consult with healthcare providers remotely or via a clinic nurse before opting for in-person care. It is a convenient and cost-effective option, providing easy access to care from the comfort of your home. As an added positive, it also stretches your benefits to last the entire year.

  5. Plan for specialised care – Plan and ensure that your preferred specialist providers are in-network, especially if you require specialised care or treatments like surgery or chronic disease management. These services usually involve multiple healthcare professionals or facilities, so ensuring each part is covered by the network is crucial to avoid extra costs.


Navigating your medical scheme network and finding in-network healthcare providers may seem overwhelming, but it's manageable with the right approach. Understanding the significance of network cover, using online tools, reaching out to your medical scheme for guidance, and verifying network participation are critical steps towards informed healthcare decisions and maximising your benefits. Remember, your medical scheme supports your health journey, so don't hesitate to ask for help when needed. Stay positive and proactive in managing your healthcare needs!

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