Find A Designated Service Provider In The Nammed Network
For Basic Option members, the healthcare providers listed here are our Designated Service Providers (DSPs)—available at a reduced co-payment and contracted rates. Members on Trauma, Active, Essential, Standard, and Comprehensive options are not restricted to this list; they may visit any registered healthcare provider of their choice. Search for a designated healthcare provider from the Nammed network in your area.
Healthcare Providers Claiming List
At Nammed, we want you to have all the facts you need to make informed healthcare choices and avoid unexpected costs. One area that often raises questions is co-payments — what they are, why they happen, and how you can minimise them.
What Is a Co-Payment?
A co-payment is the portion of a
healthcare bill that you, as the member, pay when a provider’s fee is higher
than what Nammed reimburses according to your benefit option and NAMAF Tarriff.
For example:
- In-hospital procedures by general
practitioners and specialists are covered at 150% of the NAMAF Tariff.
- Other services are covered at 100% of the NAMAF Tariff,
unless otherwise stated in your benefit option.
When a healthcare practitioner charges more
than these limits, the difference is payable directly by you.
The Different Types of Co-Payments You May Encounter
While some healthcare practitioners do
charge above the Fund’s tariff (resulting in a co-payment), there are also
situations where billing practices make things appear differently:
- Split Billing
- The provider sends one bill to Nammed for the portion the Fund
will pay and a separate bill to you for the balance above the
tariff.
- In this case the fund data
will show that the healthcare practitioner charges in line with the Namaf
tariffs because the Fund will not know about the separate bill.
- This can make it appear that the healthcare practitioner is
charging within the Namaf tariff limits and will be listed when
in fact the combined amount billed to both you and the Fund is
above the tariff.
- Although split billing is not against the law it is regarded
as an unethical practice. Members are encouraged to report this to the
Principal Officer of Nammed in cases where healthcare practitioners do
split billing.
- Balanced billing
The healthcare practitioner charged above the
Namaf tariff and sends the full amount charged to the Fund. The Fund settles
the bill in line with the Namaf tariff, and you are responsible for the balance,
which the Fund does not cover. In such a case the provider will not be listed
as the full amount is captured in the fund’s data basis.
Balance billing is an acceptable practice and
not regarded as unethical.
- Write-Offs
- Some healthcare practitioners submit a claim above the Namaf tariff
but then write off the unpaid balance
instead of expecting the Member to cover the balance.
- In these cases, it may look as if you should have a
co-payment, but you won’t be asked to cover that portion.
- Again, in these cases, the
provider will not be listed as the full amount is captured, but the fund
will not know that the balance is not charged to the member.
Because billing practices vary, a healthcare
practitioner appearing on the list may still charge you a co-payment and some healthcare
practitioners not on the list may not charge you a co-payment. It is therefore
important to always confirm the actual charges with the healthcare practitioner before treatment commences.
How Nammed Is Supporting You
To help you plan and reduce the risk of
co-payments:
1. Healthcare Practitioner List of those
practices charging at or below 150% for in-hospital procedures
- Compiled by our actuaries based on claims data over the period January–March
2025.
- Shows healthcare practitioners whose claiming patterns are
generally within the Fund’s benefit limits. (Calculated on averages)
- Updated on a quarterly basis.
Members on the Trauma, Active,
Essential, Standard, and Comprehensive options may visit any registered healthcare
practitioner, and the Fund will cover those healthcare costs according to the Fund
Rules.
The Methodology Used to populate the list
- Only in-hospital claims are considered
- Claims where a NAPPI code is present are
excluded since this does not relate to services provided, but rather
consumables
- The Basic option is excluded since this is
only remunerated at 100% of the NAMAF benchmark tariff, which could impact
the claiming behaviour of some providers
- Only claims from specialists and GPs are
considered
- A margin of 2% was given for the inclusion
of providers. That is to say if their average claimed amount was 152% of
the tariff amount, then we would include them in the list.
Final Tip
This list is intended to empower you as
a member with information, not to judge the quality of any provider.
We recommend that you:
- Review the lists before making appointments,
- Discuss fees with your healthcare practitioner upfront, and
- Contact Nammed if you need any advice or clarity about your
benefits.
We’re here to help you navigate your
healthcare expenditure with confidence.
Map
Find a Branch
Search for a Designated Service Provider:
| Designated Service Providers |
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