User login

You are here

Home

Discovery Health KeyCare Plus R8 551-R12 200 2018

Add to compare
Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2018
Income Level: 
R8 551-R12 200
Day to day Benefits: 

Primary care cover through your chosen GP and day-to-day medicine from our medicine list. Unlimited cover for medically appropriate GP consultations, blood tests, X-rays , basic dentistry, eye care and medicine in our KeyCare network.

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Network Hospitals.

Upfront Payments to hospitals: 

If you use a hospital in the Partial Cover Network, we pay up to 70% of the Discovery Health Rate. Non-network hospitals We will not pay the hospital and related accounts if you are admitted to a non-network hospital for a planned admission. If the admission is a Prescribed Minimum Benefit, we will pay 80% of the Discovery Health Rate.

Casualty / Emergency Visits: 
On KeyCare Plus you can go to any casualty unit at one of the KeyCare network hospitals. You have to pay the first R325 of the consultation.
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.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
In our network, full cover. Not in our network 100% of the Discovery Health Rate. If they charge above the DHR you must pay the balance of the account.
Radiology and pathology: 
100 % of Discovery Health Rate.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
We cover scopes at our day-surgery network.
MRI and CT scans: 
If done as part of an approved admission, we will pay up to 100% of the Discovery Health Rate from the Hospital Benefit. If not related to your admission, we pay it from the Specialist Benefit up to a limit of R3 860 each person each year.
ICU and High Care: 
100 % of Discovery Health Rate.
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.
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.

Medical and Surgical Appliances: 
We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. Overall limit of R5 400 for each family.
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 15 out-of-hospital consultations for each person for major affective disorders, anorexia and bulimia, & 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.
Ambulance Service: 
Netcare 911
International Travel Benefit: 
No Benefit.
Day-to-day benefits
GP consultations: 

You have unlimited cover for medically appropriate GP consultations. When joining, you must choose a GP from the KeyCare GP Network. You must go to your chosen GP for us to cover your consultations and some minor procedures. Pre-authorisation is required after your 15th GP visit. If you need to see a doctor and your chosen GP from our network is not available for you to see, each person on your plan can go to any GP with a limit of four out-of-network GP visits each year, covered up to the Discovery Health Rate. We will cover the GP visit, with selected blood tests and X-rays and medicine on our medicine list.

Specialist consultations: 

Specialist cover-up to R3 860 per person per year. Your GP must refer you to a specialist and you need a reference number from us before your consultation with the specialist. If you need to see a maxillo-facial surgeon, periodontist, ophthalmologist or a specialist for maternity care, you do not need a referral from your GP or a reference number from us.

Acute medicine: 

We pay for medicine from our medicine list if they are prescribed by your chosen KeyCare network GP.

Over-the-counter (OTC) Medicine: 

No Benefit.

Optometry benefits: 
One eye test for each person every 24 months, use an optometrist in the KeyCare Optometry Network. A specific range of glasses you can choose from. Contact lenses instead of glasses if you choose to.
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.

MRI and CT Scans (Out of Hospital): 
MRI and CT scans are paid from the Specialist Benefit up to a limit of R3 860 each person each year.
Radiology and Pathology: 
We pay for a list of basic X-rays at a network provider. Your chosen GP must ask for the X-rays to be done.We pay for a list of blood, urine and other fluid and tissue tests. Your chosen GP must ask for these tests by filling in a KeyCare pathology form.
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.
Physiotherapy and Occupational Therapy day to day: 
We do not cover other types of healthcare professionals, such as physiotherapists, psychologists, speech therapists, audiologists, homeopaths or chiropractors.
Chronic Conditions
Provider: 
Designated Service Provider or chosen GP
Chronic Conditions: 

Chronic Disease List: 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 Benefit.
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: 
1386.00
Total Contribution Adult: 
1386.00
Total Contribution Child*: 
389.00
KeyCare Plus R8 551-R12 200 2018
Risk Contributions
Risk Contribution Main Member: 
1386.00
Risk Contribution Adult: 
1386.00
Risk Contribution Child: 
389.00
How many times per annum do you and your dependants visit a doctor?: 
50
How much do you spend on Acute medication per annum?: 
R1000 - R4999
How much do you spend on Chronic medication per annum?: 
R1000 - R4999
Will you or any of your dependants require specialised Dentistry: 
No