Specialists

A specialty in medicine is a branch of medical science.  After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency. Medical practitioners who engage in a medical specialty are known as medical specialists.

Any participating specialist in the Discovery Premier Rate Network is one of the Scheme’s DSP specialists on the LA Focus, LA Active, LA Core and LA Comprehensive Options.  If you make use of their services for in- or out-of-hospital care, you will not have to make any ‘above the Scheme Rate’ co-payments as the provider will only charge at the Scheme Rate. LA Health will pay these claims in full, directly to the Premier Rate Specialist.

You can make sure that you are using a Network Specialist by following this link or find out more by calling 0860 103 933.

If you do not use the services of a network specialist, you may have co-payments.  We will pay these claims at the Scheme Rate only and always pay you directly if the amount claimed is above the Scheme Rate.  You will have to settle the claim in full.

On the LAKeyPlus Option, the Scheme’s Designated Service Provider Specialists are Specialists on the KeyCare Specialist network.  If the services of any other Specialist are used in-hospital, you will have to pay for the services from your own pocket.

Out-of-hospital Specialist services on the LA KeyPlus Option are only available on referral from the member’s chosen KeyCare GP.  If the member bypasses this process and consults a Specialist without referral from a network GP, no benefit will be payable by the Scheme.

Cover for Specialists, and the specific limits that may apply, is dependent on your Benefit Option.

 

 In hospitalOut of hospital
LA Comprehensive

Consultations are covered in full at the Scheme’s network providers.

Consultations at non-network specialists will be covered up to the Scheme Rate.

Consultations are covered in full from available funds in MSA or Above Threshold benefit at the Scheme’s network providers.  

Consultations at non-network specialists will be covered up to the Scheme Rate.

 

LA Core

Consultations are covered in full at the Scheme’s network providers.

Consultations at non-network specialists will be covered up to the Scheme Rate.

Consultations are covered in full from available funds in MSA or Extended Day-to-Day Benefit at the Scheme’s network providers.  

Consultations at non-network specialists will be covered up to the Scheme Rate.

 

LA Active

Consultations are covered in full at the Scheme’s network providers.

Consultations at non-network specialists will be covered up to the Scheme Rate.

Consultations are covered in full from available funds in MSA or Extended Day-to-Day Benefit at the Scheme’s network providers.  

Consultations at non-network specialists will be covered up to the Scheme Rate

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LA Focus

Consultations are covered in full at the Scheme’s network providers.

Consultations at non-network specialists are covered up to 100% of the Scheme Rate.

Consultations are covered in full from available funds in MSA at the Scheme’s network providers.

Consultations at non-network specialist will be covered up to the Scheme Rate.

 

LA KeyPlus

Consultations are covered in full at a specialist within the KeyCare Hospital Network.

Consultations at non-network specialists will be for the member's own account.

To obtain the services of a Specialist out-of-hospital, members must be referred by one of the KeyCare GPs.

If the necessary referral process is used, the benefit is paid in full subject to a limit of R3 000 per person for the year.