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KeyCare Start R13 801+

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2020
Income Level: 
13801 +
Day to day Benefits: 

Unlimited cover for medically appropriate GP consultations at your chosen KeyCare Start 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?: 
Yes
Hospital Rate of Payment: 
Unlimited at 100% of Discovery Health Rate (DHR) at your chosen KeyCare Start Network Hospital. No cover if you use a hospital outside of the KeyCare Start Network
Hospitals: 

KeyCare Start Network hospital. A defined list of procedures are covered in the KeyCare Start Day Surgery Network

Casualty / Emergency Visits: 
Use your KeyCare Start Network GP for after-hours care
Specialists: 
Full cover for network specialists in a KeyCare Start Network Hospital. 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 Start 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 R2 200 pppa
ICU and High Care: 
100% of DHR
Dialysis: 
Cover at a provider in a state facility
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 a state facility. Cover is for a 12 month cycle from date of diagnosis. PMB's covered in full in a state facility. 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
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 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 Start 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 Start 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 R2 200 pppa, on referral by your KeyCare Start Network GP

Acute medicine: 

Medicine from the medicine list, if prescribed and/or dispensed by your KeyCare Start 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
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
Paid from the Specialist Benefit up to R2 200 pppa
Radiology and Pathology: 
Basic x-rays, blood, urine and tissue tests from a network provider, on referral from your KeyCare Start 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
Provider: 
Discovery cover it in a State facility
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: 
2394.00
Total Contribution Adult: 
2394.00
Total Contribution Child*: 
650.00
Start R13 801 +
Risk Contributions
Risk Contribution Main Member: 
2394.00
Risk Contribution Adult: 
2394.00
Risk Contribution Child: 
650.00
Medical Aid Plan Name Term: 
KeyCare