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Essence


Hospital


Accidents

Specialists

Oncology

MRI & CT
Scans

Medical
Appliances

Chronic
Medication

Ambulance

Scopes

PMB's
 
FREE Additional Benefits

Easy-ER

Health Booster

Smart Baby

2017 Contributions

  Principal
Member
Adult
Dependant
Child
Dependant
Monthly
Contribution
R1 278 R1 013 R427

pa   - Per annum
pfpa  - Per family per annum
pbpa  - Per beneficiary per annum
pfp2a  - Per family every 2 years
pfp4a  - Per family every 4 years

yesBenefits


Click on the tabs below to see a full description of the option benefits

Disaster or major medical expenses cover

IncludedBenefit descriptionBenefit value
  yes

Hospital related costs
All costs related to treatment at any Netcare or Life Healthcare hospital (DSP hospital network) will be paid in full. There is no restriction on the number of admissions to hospital, but all in-hospital procedures should be pre-authorised prior to admission.
*30% co-payment applicable on hospital account if non-DSP hospital is voluntarily utilised.

Unlimited

  yes

Injuries suffered as result of an accident
Almost all accidents are regarded as a PMB (Prescribed Minimum Benefit) and the treatment of such injuries, including the hospitalisation, will therefore be covered in full by the Scheme.

Unlimited

  conditions
Conditions apply
Specialist services in-hospital
The services provided by any Specialist whilst the member is in hospital are covered by the Scheme.

Unlimited

  yes

Oncology
The diagnosis and treatment of cancer related conditions.

R131 500 pfpa

  conditions
Conditions apply
MRI & CT scans
Includes scans done for diagnostic reasons both in- and out-of-hospital.

 

R13 900 pfpa

Chronic medication

IncludedBenefit descriptionBenefit value
  yes

Chronic medication for CDL conditions
Prescribed medication used continuously for 3 months or more for one of the 26 CDL (Chronic Disease List) illness conditions.

Unlimited

Supplementary services cover

IncludedBenefit descriptionBenefit value
  yes

Emergency transport by ambulance
Netcare 911 provides members with emergency transport from any accident scene by road or air ambulance and medically justified inter-hospital transfers.

Unlimited

  conditions
Conditions apply
Medical appliances
The provision of medical equipment used for the treatment and cure of medical conditions or procedures, including equipment such as wheelchairs, crutches and contraceptive devices).

 

R6 200 pfpa

  yes

Endoscopic procedures (scopes)
Colonoscopy and/or gastroscopy are covered in full if done at one of the major hospital groups in the country or if done in the doctor’s rooms.
For any other scope, a co-payment will be applicable.

Unlimited

PMBs

IncludedBenefit descriptionBenefit value
  yes

Prescribed Minimum Benefits
Prescribed Minimum Benefits (PMBs) are a set of legislated, defined benefits to ensure that all medical scheme members are entitled to certain minimum health services, regardless of the benefit option they have selected on their scheme.

Unlimited

FREE additional benefits

IncludedBenefit descriptionBenefit value
  yes

Easy-ER
Gives all KeyHealth beneficiaries free, direct access to any hospital’s ER facility for medical treatment in emergency situations. No upfront payments required. Also includes cover for dental emergencies. KeyHealth guarantees payment for the full ER event – no savings or day-to-day benefits used!
Unlimited

  yes

Health Booster
Is aimed at preventative treatment and early detection. This benefit is provided at no extra cost and does not form part of the normal day-to-day benefits. Includes a dental check-up, malaria medication, baby immunisations, flu vaccine, pap smear, HIV test, mammogram, prostate test, general health assessment, weight loss benefits and maternity benefits.

More than
R23 000 worth of benefits


  yes

Smart Baby Program
Smart Baby is there to make a pregnancy even more special by offering great maternity benefits, support, general advice on health and wellness, and simply making the journey as enjoyable as possible for you.   Benefits on this program include –
  • A benefit of R1 000 that will cover any short payments/co-payments for services rendered during ante-natal visits to a GP, Gynaecologist or Midwife, or during pregnancy scans (including the cost for birthing fees).
  • For first-time mothers The New Baby & Childcare Handbook by Marina Petropulos to assist during this exciting time.
  • Access to the KeyHealth Smart Baby Facebook group providing valuable information and answers to questions regarding the pregnancy and general childcare.
  • Regular, valuable communication during the pregnancy.
  • Information regarding KeyHealth’s maternity benefits available to mothers and babies (e.g.  12 ante-natal visits, scans, ultrasounds, vitamins and ante-natal classes etc.) and how to access these benefits.
  • Information applicable to baby’s first year (e.g. vaccinations, Easy-ER, etc.).
Applicable to every pregnancy on the Scheme

noNot Included


Hospitalisation benefits for the following procedures:

  • Varicose vein and reflux surgery
  • Facet joint injections
  • Rhizotomy
  • Hysterectomy
  • Back surgery (including spinal fusion)
  • Joint replacements (e.g. hip and knee)
  • Hernia procedures requiring a prosthesis / internal fixation device

Day-to-day benefits
Basic and specialised dentistry
Prosthesis benefits



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