User login

You are here

Home

KEYHEALTH GOLD 2019

Add to compare
Type of Medical Aid Plan: 
Hybrid
Medical Aid Year: 
2019
Day to day Benefits: 

Routine medical expenses like, General practitioner and specialist consultations, radiology (incl. Nucleur Medicine Study and bone density scans). Prescribed and over-the-counter medicine. Optical and auxiliary services, e.g. physiotherapy, occupational therapy, contraceptive pills and biokinetics. This is a family benefit which means that one member of the family can use the total benefit allocation.

PM: R5 928 p.a.
AD: R4 008 p.a.
CD: R1 164 p.a.

Additional day-to-day benefits :

PM: R4 680 p.a.
AD: R3 490 p.a.
CD: R1 120 p.a.

In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Private hospitals Unlimited. 100% of Agreed Tariff, subject to use of DSP hospital
(Netcare or Life Healthcare). (30% co-payment at non-DSP hospital.)

Upfront Payments to hospitals: 

R1 560 co-payment per scan (in- or out of hospital).

Hospital Dentistry R1 560 per admission.

Specialists: 
100% Unlimited, subject to use of DSP provider.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of Scheme Rate
Radiology and pathology: 
100% Pre-authorisation: specialised radiology, including MRI, CT and PET scans. Hospitalisation not covered if radiology is for investigative purposes only. (MSA / day-to-day benefits will then apply.)
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Colonoscopy and/or gastroscopy. Pre-authorisation compulsory. No co-payment at DSP hospital, out-of-hospital and PMB. All other endoscopic procedures. No co-payment.
MRI and CT scans: 
R15 500 Pfpa. R1 560 co-payment per scan (in- or out-of-hospital), excluding confirmed PMBs.
Dialysis: 
100% Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
Organ Transplants: 
100% Pre-authorisation compulsory and subject to Case Management. PMB entitlement in DSP hospitals only.
Oncology / Cancer: 
R377 500 Pfpa. Pre-authorisation compulsory and subject to case management and Scheme Protocols.
Neck and Back Operations: 
Unlimited. 100% of Agreed Tariff.
Joint Replacements: 
Unlimited. 100% of Agreed Tariff.
Prosthesis: 

R44 100 Pfpa, combined benefit. Pre-authorisation compusory and subject to
Case Management, reference pricing, DSP and Scheme Protocols.

Medical and Surgical Appliances: 
R8 500 Pfpa. Combined in- and out-of-hospital benefit, subject to quantities and protocols. No pre-authorisation required.
Maternity Confinements: 
Private ward for 3 days for natural birth.
In Hospital Dentistry: 
R1 560 co-payment per hospital admission. DENIS pre-authorisation compulsory. Extensive dental treatment for very young Child Dependants. Removal of impacted wisdom teeth.
Take home Medicine: 
R500 Per admission.
Rehabilitation, Hospice and Step-down facilities: 
R38 000 Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. Pfpa. Wound care is included in this benefit up to an amount of R12 500. Combined in- and out-of-hospital benefit.
Treatment for Mental Health: 
R38 000 Pre-authorisation compulsory and subject to Case Management. Pfpa. Combined benefit; in- and out-of-hospital. Out-of-hospital treatment is limited to R15 500.
HIV / AIDS: 
Unlimited. Chronic Disease Programme, managed by Lifesense, applicable.
Ambulance Service: 
DSP – NETCARE 911. Unlimited, subject to use of DSP and protocols. (20% co-payment at non-DSP service provider.)
International Travel Benefit: 
No benefit.
Day-to-day benefits
GP consultations: 

Routine medical expenses like, General practitioner and specialist consultations, radiology (incl. Nucleur Medicine Study and bone density scans). Prescribed and over-the-counter medicine. Optical and auxiliary services, e.g. physiotherapy, occupational therapy, contraceptive pills and biokinetics. This is a family benefit which means that one member of the family can use the total benefit allocation.

PM: R5 928 p.a.
AD: R4 008 p.a.
CD: R1 164 p.a.

Additional day-to-day benefits :

PM: R4 680 p.a.
AD: R3 490 p.a.
CD: R1 120 p.a.

Specialist consultations: 

Routine medical expenses like, General practitioner and specialist consultations, radiology (incl. Nucleur Medicine Study and bone density scans). Prescribed and over-the-counter medicine. Optical and auxiliary services, e.g. physiotherapy, occupational therapy, contraceptive pills and biokinetics. This is a family benefit which means that one member of the family can use the total benefit allocation.

PM: R5 928 p.a.
AD: R4 008 p.a.
CD: R1 164 p.a.

Additional day-to-day benefits :

PM: R4 680 p.a.
AD: R3 490 p.a.
CD: R1 120 p.a.

Acute medicine: 

Subject to savings and day-to-day benefit.

Over-the-counter (OTC) Medicine: 

Over-the-counter medicine 100% R1 910 Pfpa sublimit. Subject to MSA / day-to-day benefit.
Over-the-counter reading glasses R170 Pbpa. 1 pair per year. Subject to the over-the-counter medicine sublimit.

Optometry benefits: 
R2 940 Pbp2a total optical benefit. Subject to MSA / day-to-day benefit and Optical Management. Benefit confirmation compulsory.
Basic dentistry: 
DENIS protocols, Scheme Rules and Managed Care interventions apply. 100% Consultations, X-rays: Intra & Extra-oral, Oral hygiene, Fillings, Tooth extractions, Root canal treatment & Plastic dentures
Specialised Dentistry: 
DENIS protocols, Scheme Rules and Managed Care interventions apply. Exclusions apply in accordance with Scheme Rules.
Orthodontics: 

Orthodontics 80%

DENIS pre-authorisation compulsory. Cases will be clinically assessed using
orthodontic indices where function is impaired. Not for cosmetic reasons; laboratory
costs also excluded. Only 1 beneficiary per family may commence treatment per
calendar year. Limited to beneficiaries between 9 and 18 years.

Periodontics 80%

DENIS pre-authorisation compulsory. Limited to conservative, non-surgical therapy
(root planing) only and will be applied to beneficiaries registered on the
Perio Programme.

MRI and CT Scans (Out of Hospital): 
co-payment per scan (in- or out-of-hospital), excluding confirmed PMBs.
Radiology and Pathology: 
Subject to savings and day-to-day benefits. Pathology 70% of Scheme Rate.
Pregnancy benefits: 
12 Antenatal visits, 2 Ultrasounds (GP, Gynaecologist or midwife), urine test. Pre-notification of and pre-authorisation by the Scheme compulsory. Short payments/co-payments for services & birthing fees. 2 Paediatrician visits. Ante-natal vitamins & class
Physiotherapy and Occupational Therapy day to day: 
Subject to savings and day-to-day benefits. 100% of Scheme Rat
Chronic Conditions
Provider: 
Desinated Service Provider
Chronic Conditions: 

Category A (CDL) 100% & Unlimited – subject to reference pricing and protocols.

Registration on Chronic Disease Programme compulsary. (15% co-payment at non-DSP pharmacy.)

Preventative Care Benefits
Preventative Benefits: 

PREVENTIVE CARE

Baby immunisation. Child dependants aged ≤6 – as required by the Department of Health.

Flu vaccination. All beneficiaries.

Tetanus diphtheria injection. All beneficiaries – as and when required.

Pneumococcal vaccination. All beneficiaries.

Malaria medication. All beneficiaries – R340 once per year.

HPV vaccination. Female beneficiaries aged ≤9-14 – 2 doses per lifetime.

EARLY DETECTION TESTS

Pap smear (Pathologist). Female beneficiaries aged ≥15 – once per year.

Pap smear (including consultation and pelvic organs ultrasound; GP or Gynaecologist). Female beneficiaries aged ≥15– once per year.

Mammogram. Female beneficiaries aged ≥40 – once per year.

Prostate specific antigen (PSA) (Pathologist). Male beneficiaries aged ≥40 – once per year.

HIV/AIDS test (Pathologist). Beneficiaries aged ≥15 – once per year.

Health Assessment (HA): Body mass index, Blood pressure measurement, Cholesterol test (finger prick), Blood sugar test (finger prick) PSA (finger prick). Adult beneficiaries – once per year

Total Contributions
Total Contribution Main Member: 
4946.00
Total Contribution Adult: 
3345.00
Total Contribution Child*: 
970.00
GOLD OPTION
Annual Medical Savings Account
Annual Medical Savings Main Member: 
5928.00
Annual Medical Savings Adult: 
4008.00
Annual Medical Savings Child*: 
1164.00
Monthly Medical Savings
Savings Child*: 
97.00
Savings Adult: 
334.00
Savings Main Member: 
494.00
Risk Contributions
Risk Contribution Main Member: 
4452.00
Risk Contribution Adult: 
3011.00
Risk Contribution Child: 
873.00
Medical Aid Plan Name Term: 
Any