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KeyCare Core R13 801 +

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2020
Income Level: 
13800 +
In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
Unlimited at 100% of Discovery Health Rate (DHR). If you use a Partial Cover Hospital Discovery pays 70% of cost. If the admission is a PMB, Discovery pays 80% of cost. No cover if you use a hospital outside of the KeyCare Network
Hospitals: 

KeyCare Network Hospital or KeyCare Partial Cover Hospital. A defined list of procedures are covered in the KeyCare Day Surgery Network

Upfront Payments to hospitals: 

If you use a KeyCare Partial Cover Hospital, you will have to pay 30% of the cost for a planned admission and 20% of the cost for a PMB admission

Casualty / Emergency Visits: 
No benefit
Specialists: 
Full cover for network specialists. 100% of DHR if not in the network
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of DHR
Radiology and pathology: 
100% of DHR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
PMB only in KeyCare Day Surgery Network. Authorised scopes done in dr's rooms will be covered from the hospital benefit
MRI and CT scans: 
If part of an approved admission 100% of DHR. If not related to admission or for back and neck treatment, paid from the Specialist Benefit up to the limit of R4 400 pppa
ICU and High Care: 
100% of DHR
Dialysis: 
When registered, a network provider will be allocated to you or you can go to a state facility. if you go elsewhere Discovery will pay up to 80% of DHR
Organ Transplants: 
Cover for transplant surgery explained on authorisation request. Discovery pay for appropriate, approved work-up costs for recipient, procurement of organ and necessary tests done on donor before harvesting organ, even if donor is not a member of DH
Oncology / Cancer: 
Subject to registration on the Oncology Care Programme and treatment in the network. Cover is for a 12 month cycle from date of diagnosis. PMB's covered in full in the network. If you choose any other provider, you are covered up to 80% of DHR
Neck and Back Operations: 
PMB's only
Joint Replacements: 
PMB's only
Medical and Surgical Appliances: 
No benefit
Maternity Confinements: 
Subject to pre-authorisation. Unlimited at 100% of DHR
In Hospital Dentistry: 
No benefit
Take home Medicine: 
No benefit
Rehabilitation, Hospice and Step-down facilities: 
21 days of rehabilitation per person per annum. 3 days per approved admission per person for detoxification
Treatment for Mental Health: 
Covered in full at a network facility, or up to 80% of DHR at non-network facilities. Protocols apply. Up to 21 days for admissions or up to 15 out-of-hospital consultations pp
HIV / AIDS: 
Subject to registration on the HIV programme. Choose a KeyCare and Premier Plus HIV Network GP and Specialist to manage your condition to avoid a 20% co-payment
Ambulance Service: 
Netcare 911
International Travel Benefit: 
No benefit
Day-to-day benefits
Optometry benefits: 
No benefit
Basic dentistry: 
No benefit
Specialised Dentistry: 
No benefit
MRI and CT Scans (Out of Hospital): 
Paid from Specialist Benefit up to R4 400 pppa
Radiology and Pathology: 
No benefit
Pregnancy benefits: 
8 antenatal consultations, 2 x 2D scans, including 1 x nuchal translucency test. A defined basket of blood tests. 5 x antenatal or postnatal classes or consultations with a registered nurse up until 2 years after giving birth
Physiotherapy and Occupational Therapy day to day: 
No benefit
Chronic Conditions
Provider: 
Chosen KeyCare GP or network pharmacy
Additional Chronic Conditions: 
None
Total Contributions
Total Contribution Main Member: 
1809.00
Total Contribution Adult: 
1809.00
Total Contribution Child*: 
410.00
Core R13 800 +
Risk Contributions
Risk Contribution Main Member: 
1809.00
Risk Contribution Adult: 
1809.00
Risk Contribution Child: 
410.00