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2018 Keyhealth Origin

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Type of Medical Aid Plan: 
Hybrid
Medical Aid Year: 
2018
In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

100% of the KeyhealthTariff.

Unlimited.

Any hospital.

Subject to pre-authorisation, protocols and case management.

Upfront Payments to hospitals: 

MRI & CT scans co-payment in and out of hospital

Sigmoidoscopy and cystoscopy; R2 100 co-payment per scope

(in-hospital). Hysteroscopy; R2 950 co-payment per scope (in-hospital).
Arthroscopy and laparoscopy (diagnostic): R3 700 co-payment per scope
(in-hospital).

Casualty / Emergency Visits: 
Full ER cover
Specialists: 
100% of the scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of the scheme rate
Radiology and pathology: 
100% of the scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
100% of the scheme rate
MRI and CT scans: 
100% of the scheme rate
ICU and High Care: 
100% of the scheme rate
Dialysis: 
Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
Organ Transplants: 
Pre-authorisation compulsory and subject to Case Management. PMB entitlement in DSP hospitals only.
Oncology / Cancer: 
Per family per annum. Pre-authorisation compulsory and subject to Case Management and Scheme Protocols.
Neck and Back Operations: 
PMB only
Joint Replacements: 
PMB only
Prosthesis: 

Subject to pre-authorisation and Scheme Protocols. PMB entitlement only

Medical and Surgical Appliances: 
Combined in- and out-of-hospital benefit, subject to quantities and protocols. No pre-authorisation required.
Maternity Confinements: 
Private ward for 3 days for natural birth.
In Hospital Dentistry: 
No benefit
Rehabilitation, Hospice and Step-down facilities: 
Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
Treatment for Mental Health: 
R17 700 Per family per annum. Pre-authorisation compulsory and subject to Case Management. In-hospital benefit only. Out-of-hospital: PMB entitlement
HIV / AIDS: 
Unlimited. Chronic Disease Programme applicable.
Ambulance Service: 
DSP - NETCARE 911. Unlimited, subject to use of DSP and protocols. (40% co-payment at non-DSP service provider.)
Day-to-day benefits
GP consultations: 

Principal member: R2 325 p.a.
Adult dependant: R1 358 p.a.
Child depedant: R710 p.a.

Specialist consultations: 

Subject to available Medical savings account

Acute medicine: 

Principal member: R2 325 p.a.
Adult dependant: R1 358 p.a.
Child depedant: R710 p.a.

Over-the-counter (OTC) Medicine: 

Principal member: R2 325 p.a.
Adult dependant: R1 358 p.a.
Child depedant: R710 p.a.

Optometry benefits: 
Subject to available medical savings account
Basic dentistry: 
Subject to day-to-day benefit. Scheme Rules and protocols apply. Consultations 100% 1 check-up pbpa. 3 specific (emergency) consultations pbpa.
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit