Designated Service Providers

When you use the services of a designated service provider, all claims, including Prescribed Minimum Benefits, are paid in full. This means you will not have to make out-of-pocket payments at these providers.

These designated service providers are specific providers of healthcare services, for example General Practitioners and Specialists, who have agreed to provide services according to certain agreed rules. The Scheme pays these providers directly.

In certain instances you must use the services of the designated service providers.  If you do not use these services you may have to pay deductibles or make co-payments.

In certain instance you will not have to pay co-payments or deductibles

The Scheme will still pay the Prescribed Minimum Benefit claims in full if you have involuntarily obtained the services from a provider other than a designated service provider, if:

  • it is an emergency, for hospital admissions
  • the service was not available from the designated service provider or would not have been provided without unreasonable delay; or
  • there was no designated service providers within a reasonable distance from your place of business or residence.

The Scheme’s designated service providers for the diagnosis, treatment and care costs (which may include medicine) for Prescribed Minimum Benefit (PMB) conditions are:

Hospital NetworkKeyCare Hospital Network for all in-hospital services on the LA KeyPlus Option
LA Focus Hospital NetworkHospitals in coastal provinces:  KwaZulu-Natal, Eastern, Western and Northern Cape; and specific hospitals in other provinces
Specialist ServicesThe Premier Rate Specialist Network or KeyCare Specialist Network (for LA KeyPlus)
General Practitioners’ ServicesThe Discovery GP Network or the KeyCare GP Network (for LA KeyPlus)
Chronic MedicineAny pharmacy willing to charge dispensing fees at the Scheme’s Medicine Rate.
Drug and alcohol rehabilitationSANCA, Nishtara or RAMOT
Renal care, including dialysisNational Renal Care
Oncology (LA KeyPlus)When you authorise your Oncology treatment, the Scheme will advise you about its registered DSP providers
Oxygen rentalVitalAire

       

It is likely that the Scheme will contract with, and appoint more designated service providers, particularly provider networks, in its ongoing efforts to control and reduce costs for members.

Other Designated Service Providers to the Scheme

PET ScansCentres of Excellence identified by the Scheme
Stem cell transplantsCentres of Excellence identified by the Scheme

In the case of either of these two benefits, we will tell you about the nearest DSP in your area when you call us to pre-authorise the procedure.