Hospital Rate of Payment:
We pay up to the Discovery Health Rate (100%).We pay up to 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)
Upfront Payments to hospitals:
We pay for planned hospital stays
from your Hospital Benefit. We pay
for services related to your hospital
stay, including all healthcare professionals,
services, medicines authorised by the
Scheme for your hospital stay.
Casualty / Emergency Visits:
We pay for all of the following medical services
that you may receive in an emergency:
the ambulance (or other medical transport)
the account from the hospital
the accounts from the doctor who admitted
you to the hospital
the anaesthetist
any other h...
Specialists:
If you use
doctors, specialists and other healthcare
professionals that we have an agreement
with, we will pay for these services in full.
We pay up to the Discovery Health Rate
(DHR) for other healthcare professionals.
Other healthcare professionals eg. Physio, Occupational, Dietician:
The Discovery Health Rate (DHR). If they charge more, you must pay
the balance of the account
Radiology and pathology:
The Discovery Health Rate (100%)
ICU and High Care:
Prescribed Minimum Benefit (PMB) conditions in terms of
the Medical Schemes Act 131 of 1998 and its Regulations,
all medical schemes have to cover the costs related to the
diagnosis, treatment and care of:
An emergency medical condition
A defined lis...
Dialysis:
You must use a network provider once you are registered, or you can go to a state facility.
If you go elsewhere we will pay 80% of the Discovery Health Rate (DHR)
You are covered at a provider in a state facility
Oncology / Cancer:
If you are diagnosed with cancer
and once we have approved your
cancer treatment, you are covered
by the Oncology Care Programme.
We cover your approved cancer
treatment over a 12-month cycle.
All cancer-related healthcare
services are covered up to ...
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. There is an overall limit of R5 400 f...
Take home Medicine:
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.
Rehabilitation, Hospice and Step-down facilities:
We pay for 21 days of rehabilitation per person per year. Three days per approved admission per person for detoxification.
Treatment for Mental Health:
21 days for all other mental
health admissions.
All mental health admissions are covered
in full at a network facility. If you go
elsewhere, we will pay up to 80% of
the Discovery Health Rate (DHR)
for the hospital account.
HIV / AIDS:
If you are registered on the HIV programme, you
are covered for the care you need, which includes
additional cover for social workers. You can be
assured of confidentiality at all times. You have to
see a Premier Plus GP to avoid a 20% co-payment.
Yo...
