Affinity GP List: How to choose a network GP

Affinity Health has a pre-screened, vetted group of doctors that are at your disposal. This list is called the Affinity Health GP List. When choosing a doctor, it is important to find one on this list who is closest to your home address. This way, you know that Affinity will cover the cost of the consultation. 

However, it is still important to get authorisation. 

How do I know if the GP I need is on the Affinity GP List?

Affinity Health has made it very easy for you to check whether or not your desired physician is on the network. 

Finding your nearest network GP is as easy as going to Affinity Health’s website and clicking on the Find a Doctor or Dentist tab. You should find this tab under resources. Then, type in your city or town. 

And just like that, you will have access to the Affinity’s list of network GPs listing their names, addresses and contact details. 

Affinity Health members can contact us on 0861 11 00 33 to consult with an Affinity Health primary healthcare professional, who will assess your symptoms and give you medical advice before issuing you with a script for medication or referring you to consult with an Affinity Health network GP.

Network doctors claim directly from Affinity Health. However, additional administration fees may be charged separately by the practice and cannot be recovered from Affinity Health. These will be solely at members’ expense.

What if there are no Affinity GP’s near me?

You will receive partial cover for out-of-network consultations. Should you need to visit a GP who is not on our network, Affinity Health will pay a portion of the costs, but important information applies:

The full consultation fee will have to be paid upfront by the member. Up to R250 can be claimed back from Affinity Health. 

For assistance with reimbursement, please email the detailed account and a signed Affinity Health reimbursement form to claims@affinityhealth.co.za. Out-of-network GPs are unfamiliar with cover rules, and this means that they are unaware of exactly which medications are covered. Using an out-of-network GP may increase the chance of having to pay for medication.

What is pre-authorisation?

Receiving pre-authorisation essentially means that you are getting the go-ahead from your health insurance provider. This is regardless of whether the GP you choose is on the affinity network or not. These two factors go hand in hand to ensure that your claim is paid.

To get pre-authorisation from Affinity Health, members can call 0861 11 00 33 to check the status of their policy and receive authorisation before visiting a GP.

The same needs to be done before admission to a hospital. 

According to the Policy Document, members must notify Affinity Health’s Pre-authorisation Department at least 48 hours before being hospitalised. This can be done by contacting the department on 0861 11 00 33 and providing full particulars of the hospitalisation.

Failure to do so may result in the non-payment of claims. Where it is not possible to notify Affinity Health’s Pre-authorisation Department prior to hospitalisation, this condition will not apply, subject to Affinity Health’s Pre-authorisation Department being notified within 48 hours of admission provided that the Insured Person is physically able to do so.