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KeyCare Plus R0 - R8 550

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Type of Medical Aid Plan: 
Medical Aid Year: 
Income Level: 
0 - 8550
Day to day Benefits: 

Unlimited cover for medically appropriate GP consultations at your chosen KeyCare Network GP. Referral from the network GP through KeyCare network providers for medication, specialist consultations, basic blood tests and X-rays. Dental consultations for fillings and tooth removals and basic optometry through KeyCare network providers

In Hospital Benefits
Are you prepared to use designated hospitals?: 
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

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: 
Approval required for one casualty visit pppa at a casualty unit at a KeyCare Network Hospital. You pay the first R390
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
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

PMB's only

Medical and Surgical Appliances: 
Cover for wheelchairs, their batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if they are from a network provider. There is an overall limit of R5 400 per family
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
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
GP consultations: 

You must choose a GP from the KeyCare GP Network. You have unlimited cover for medically appropriate GP consultations, including some minor procedures. Pre-authorisation is required after the 15th GP visit

Specialist consultations: 

Cover from the Specialist Benefit up to R4 400 pppa, on referral by your KeyCare Network GP

Acute medicine: 

Medicine from the medicine list, if prescribed and/or dispensed by your KeyCare Network GP

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
Cover for one eye test pp every 24 months, at an optometrist in the KeyCare Optometry Network. There is a specific range of glasses to choose from. You can choose a set of contact lenses instead of glasses
Basic dentistry: 
Cover for consultations, fillings and extractions at a dentist in the KeyCare Dentist Network. Rules and limits may apply
Specialised Dentistry: 
No benefit

No benefit

MRI and CT Scans (Out of Hospital): 
Paid from the Specialist Benefit up to R4 400 pppa
Radiology and Pathology: 
Basic x-rays, blood, urine and tissue tests from a network provider, on referral from your KeyCare Network GP
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
Chosen KeyCare GP or network pharmacy
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes. Subject to approval by the Chronic Illness Benefit

Additional Chronic Conditions: 
Preventative Care Benefits
Preventative Benefits: 

Screening tests for adults and children at a wellness network provider. Age specific tests for: pap smear, mammogram, prostate and HIV screening tests. Flu vaccine during pregnancy and for members > 65 years. Bowel cancer screening tests for members 45-75 years

Total Contributions
Total Contribution Main Member: 
Total Contribution Adult: 
Total Contribution Child*: 
Plus R0 - R8 550
Risk Contributions
Risk Contribution Main Member: 
Risk Contribution Adult: 
Risk Contribution Child: