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DISCOVERY HEALTH KEYCARE CORE 13 051+ 2019

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2019
Day to day Benefits: 

You have unlimited cover for medically appropriate GP consultations. We pay for a list of blood, urine and other fluid and tissue tests from a network provider. Your chosen GP must ask for these tests by filling in a KeyCare pathology form.We pay for medicine from our medicine list if they are prescribed and/or dispensed by your chosen KeyCare Network GP or chosen KeyCare Start network GP, depending on the plan you choose. We pay for a list of basic X-rays at a network provider. We cover consultations, fillings and tooth removals at a dentist in our dentist network. Certain rules and limits may apply.

In Hospital Benefits
Hospital Rate of Payment: 
We cover you in full at the rate agreed with the hospital.
Hospitals: 

KeyCare Hospital Network

Upfront Payments to hospitals: 

We pay up to a maximum of 70% of the hospital account and you must pay the balance of the account. If the admission is a Prescribed Minimum Benefit, we will pay 80% of the Discovery Health Rate (DHR).

Casualty / Emergency Visits: 
Casualty visits are not covered
Specialists: 
in our network, full cover. Not in our network 100% of the Discovery Health Rate. If they charge above the Discovery Health Rate you must pay the balance of the account.
Radiology and pathology: 
100% of the DHR
Dialysis: 
Once you are registered, we will allocate you to a network provider or you can go to a state facility. If you go elsewhere, we will pay up to 80% of the Discovery Health Rate (DHR)
Organ Transplants: 
As per scheme protocols
Oncology / Cancer: 
We cover treatment only if it is a Prescribed Minimum Benefit. We will allocate you to a network provider
Neck and Back Operations: 
No Benefit except for Prescribed Minimum Benefits
Joint Replacements: 
No Benefit except for Prescribed Minimum Benefits
Prosthesis: 

No Benefit except for Prescribed Minimum Benefits

Maternity Confinements: 
100 % of Discovery Health Rate.
In Hospital Dentistry: 
No Benefit
Rehabilitation, Hospice and Step-down facilities: 
21 days for each person
Treatment for Mental Health: 
21 days for admissions or up to 15 out- of-hospital consultations for each person for major affective disorders, anorexia and bulimia, and up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma.
HIV / AIDS: 
When you register for our HIVCare Programme, you are covered for the care you need, which includes additional cover for social workers. Be assured of confidentiality at all times. You need to get your medicine from a DSP to avoid a 20 % co-payment.
International Travel Benefit: 
No Benefit.
Day-to-day benefits
GP consultations: 

You must go to your chosen GP for us to cover your consultations and some minor procedures. Preauthorisation is required after your 15th GP visit.

Specialist consultations: 

Specialist cover up to R4 050

Optometry benefits: 
one eye test for each person, but you must go to an optometrist in the KeyCare Optometry Networks.
Basic dentistry: 
We cover consultations, fillings and tooth removals at a dentist in our dentist network. Certain rules and limits may apply.
Specialised Dentistry: 
No Benefit.
Orthodontics: 

No Benefit.

Pregnancy benefits: 
You are covered for eight consultations at your gynaecologist, chosen GP or midwife. Two 2D ultrasound scans. A defined basket of blood tests per pregnancy. You are covered for one flu vaccination during your pregnancy.
Chronic Conditions
Provider: 
Designated Service Provider or chosen GP
Chronic Conditions: 

Addison’s disease, asthma, Bipolar mood disorder, bronchiectasis, Cardiac failure, cardiomyopathy, chronic obstructive pulmonary disease, chronic renal disease, coronary artery disease, Crohn’s disease, Diabetes insipidus, diabetes Type 1, diabetes Type 2, dysrhythmia, Epilepsy, Glaucoma, Haemophilia, HIV, hyperlipidaemia, hypertension, hypothyroidism, Multiple sclerosis, Parkinson’s disease, Rheumatoid arthritis, Schizophrenia, systemic lupus erythematosus, Ulcerative colitis

Additional Chronic Conditions: 
No Benefits
Preventative Care Benefits
Preventative Benefits: 

Covers certain tests at one of our wellness network providers, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram every 2 years, Pap smear every 3 years, PSA (a prostate screening test) once a year and HIV screening tests. Seasonal flu vaccine during pregnancy, or for members 65 years or older and/or registered for certain chronic conditions. Additional, and/or more frequent screening is available for those who meet our clinical criteria. Kids screening covers growth assessment and health and milestone tracking at any one of our wellness network providers.

Total Contributions
Total Contribution Main Member: 
1661.00
Total Contribution Adult: 
1661.00
Total Contribution Child*: 
376.00
KeyCare Core 13 051 +
Risk Contributions
Risk Contribution Main Member: 
1661.00
Risk Contribution Adult: 
1661.00
Risk Contribution Child: 
376.00
Medical Aid Plan Name Term: 
Any