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DISCOVERY HEALTH KEYCARE PLUS R8 551 -R13 050 2019

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2019
Income Level: 
R8 551 -R13 050
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
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
We cover you in full at the rate agreed with the hospital.
Hospitals: 

Keycare Network hospitals: Full cover in hospital for specialists on Ketcare network, up to 100% of Discovery Health rate for other healhtcare professionals. 

Upfront Payments to hospitals: 

Partial cover Hospital Network: 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: 
Cover in any casualty unit at one of the KeyCare network hospitals. You have to pay the first R355 of the consultation. Subject to pre-authorisation
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 Discovery Health Rate you must pay the balance of the account.
Radiology and pathology: 
100 % of Discovery Health Rate.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
As per scheme protocols
MRI and CT scans: 
As per scheme protocols
ICU and High Care: 
As per scheme protocols
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.
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
Take home Medicine: 
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: 

On KeyCare Plus, if you need to see a doctor and your chosen GP is not available, each person on your plan can go to any Keycare GP for an out-of-network visit. On KeyCare Start you can go to any KeyCare Network GP for an out-of-nework visit. Out-of-network GP visits are limited to four visits per person on KeyCare Plus and two per person on KeyCare Start each year, covered up to the DHR, depending on the plan you choose. We will cover the GP visit, selected blood tests and X-rays, and medicine on our medicine list.

Specialist consultations: 

Specialist cover up to R4 050 on KeyCare Plus and KeyCare Core, and up to two visits up to R2 000 on KeyCare Start per person per year. Your chosen GP must refer you to a specialist and you need a reference number from us before your consultation with the specialist. On KeyCare Plus, 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: 

You can get your approved medicine from network GP

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
We cover one eye test for each person, but you must go to an optometrist in the KeyCare Optometry Network.
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.

Radiology and Pathology: 
A defined list of tests are covered.
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: 
No benefit.
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 benefit.
Preventative Care Benefits
Preventative Benefits: 

No benefit.

Total Contributions
Total Contribution Main Member: 
1523.00
Total Contribution Adult: 
1523.00
Total Contribution Child*: 
429.00
KeyCare Plus R8 550 - R13 050
Risk Contributions
Risk Contribution Main Member: 
1523.00
Risk Contribution Adult: 
1523.00
Risk Contribution Child: 
429.00
Medical Aid Plan Name Term: 
Any