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KeyCare Plus R0-R8550

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2020
Income Level: 
0 - 8 550
Day to day Benefits: 

Basic cover through your chosen KeyCare Network GP. Specialist Benefit up to R4 400 per person per annum on referral from your KeyCare Network GP. All benefits through KeyCare Network providers

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, and 80% if the admission is a PMB
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 if it is a PMB

Casualty / Emergency Visits: 
One visit per person per year to the unit at a hospital in the KeyCare Hospital Network. You pay the first R390
Specialists: 
Full cover
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 the 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 not a member of DH
Oncology / Cancer: 
Subject to registration on the Oncology Care Programme. PMB's covered in full in the network. If you choose any other provider, covered up to 80% of DHR
Neck and Back Operations: 
PMB's only
Joint Replacements: 
PMB's only
Prosthesis: 

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 the DHR at a non-network facility. 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
GP consultations: 

Unlimited consultations and minor procedures at your chosen KeyCare Network GP. Pre-authorisation required after the 15th visit. 4 out-of-network GP visits covered at DHR

Specialist consultations: 

On referral from your KeyCare Network GP and a reference number up to R4 400 pppa

Acute medicine: 

From a medicine list and dispensed by your KeyCare Network GP

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
From an optometrist in the KeyCare Optometry network. One eye test and a specific range of glasses and a frame or contact lenses, per person
Basic dentistry: 
Consultations, fillings and tooth extractions at a Keycare dentist
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
Paid from Specialist Benefit up to R4 400 pppa
Radiology and Pathology: 
On referral from your KeyCare Network GP. Basic X-rays at a network provider
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 birthst
Physiotherapy and Occupational Therapy day to day: 
No benefit.
Chronic Conditions
Provider: 
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: 
None
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: 
1207.00
Total Contribution Adult: 
1207.00
Total Contribution Child*: 
439.00
Plus
Risk Contributions
Risk Contribution Main Member: 
1207.00
Risk Contribution Adult: 
1207.00
Risk Contribution Child: 
439.00
How much do you spend on Chronic medication per annum?: 
0
Medical Aid Plan Name Term: 
KeyCare Plus