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KeyCare Core (8 551 – 13 800)

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Medical Aid Year: 
Day to day Benefits: 

Specialists are covered up to R4 400 per person per
year. This plan does not offer any additional day-today

In Hospital Benefits
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)

Hospital accounts are covered in full at the rate agreed upon with the hospital group.
No overall annual limit applies.
Provider - Any hospital, Ingwe Network hospitals or State hospitals

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...
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...
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.
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...
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 or KeyCare Start
GP network, depending on the plan you choose. You must go to your chosen GP for us to cover your consultations, ...

Specialist consultations: 

Specialist cover up to R4 400 per person per year.

Acute medicine: 

You need to get your approved chronic medicine
that is on the KeyCare medicine list from one
of our network pharmacies or from your chosen
KeyCare GP (if he or she dispenses medicine).
If you get your medicine from anywhere else,
you will have to pay...

Optometry benefits: 
We cover one eye test for each person, but you must go to an optometrist in the KeyCare Optometry Networks. The optometrist will have a specific range of glasses which you can choose from. You can get a set of contact lenses instead of glasses if you...
Basic dentistry: 
We cover consultations, fillings and tooth removals at a dentist in our dentist network. Certain rules and limits may apply.
MRI and CT Scans (Out of Hospital): 
Out-of-hospital MRI and CT scans are paid up to the Specialist Benefit limit
Radiology and Pathology: 
The Discovery Health Rate (100%)
Chronic Conditions
You have access to treatment for a list of medical conditions under the Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List (CDL). Our plans offer benefits that are richer than PMBs. To access PMBs...
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...

Total Contributions
Total Contribution Main Member: 
Total Contribution Adult: 
Total Contribution Child*: 
KeyCare Core
Risk Contributions
Risk Contribution Main Member: 
Risk Contribution Child: