What must I do if I need to see a specialist?

If you need to see a specialist, your GP must complete the KeyCare GP to specialist referral form and submit it to the Scheme on your behalf.  Your GP can only ask for a referral to a specialist if it is clinically appropriate.  Please only make the appointment with the specialist once you have received the specialist authorisation number from your GP and/or the Scheme.

It is important to note that your chosen GP must do your routine check-ups, not a specialist.  Your chosen GP must follow the GP-to-specialist referral process for any check-ups you may need at a specialist.

If you need to see the specialist the same day you saw the GP, your GP must contact us on 0860 123 077 to get an urgent specialist authorisation or send you to a casualty unit at a Scheme network hospital.

How is the specialist paid?

If you visit a specialist without an approved specialist authorisation, you will have to pay all costs for the visit.

If you use a specialist in the KeyCare Specialist Network, we cover your claim in full up to your available Specialist Benefit limit. If the specialist is not on the network, we may not cover the full claim if the specialist charges more than the Scheme Rate. Find a network specialist on our Find a healthcare professional tool on www.tfgmedicalaidscheme.co.za, or call us on 0860 123 077.

We pay your specialist claims up to 100% of the Scheme Rate, subject to a limit of R3 860 for each dependant each year.

What happens if the specialist sends me to hospital?

If you need to go to hospital after your approved visit to the specialist, you must phone us before you are admitted to get a hospital authorisation number. Call us on 0860 12 30 77 to get hospital preauthorisation.

For planned admissions, only a specialist with an approved specialist authorisation can admit you to hospital.

If you had surgery done in hospital and you need a follow-up visit with the specialist, you do not need to get another authorisation number - as long as the visit is within 30 days after your first day of admission. For any other treatment, or when the follow-up consultation date falls outside this 30‑day period, you must visit your chosen KeyCare GP.