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Gold


Hospital


Accidents

Specialists

Oncology

MRI & CT
Scans

Rehab /
Wound Care

Savings

Routine
Expenses

Pathology

Optical

Dental

Special
Dental

Chronic
Medication

Prosthesis

Ambulance

Medical
Appliances

Hearing
Aids

Scopes

PMB's
   
FREE Additional Benefits

Easy-ER

Health Booster

Smart Baby

2018 Contributions
  Principal
Member
Adult
Dependant
Child
Dependant
Monthly
Contribution
R4 065 R2 749 R797
Monthly
Savings
R451 R305 R88

Total Monthly
Contribution

R4 516 R3 054 R885

   English Brochure
   Afrikaanse Brosjure

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
pfp5a  - Per family every 5 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) (e.g. ward & theatre fees, radiology, pathology etc.) 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 utilised voluntarily.

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.

R358 000 pfpa

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

 

R14 700 pfpa

  conditions
Conditions apply
Rehabilitation
Provides for both in- and out-of-hospital services rendered after an operation or procedure at a rehab or step down facility and private nursing to assist with patient recovery.
R36 100 pfpa
  conditions
Conditions apply
Wound care
The provision of nursing services and equipment to prevent wound complications and promote wound healing.
R11 900 pfpa

Day-to-day medical expenses cover (outside of the hospital)

IncludedBenefit descriptionBenefit value
  yes

Medical savings account (MSA)
A portion of a member’s monthly contribution is allocated in advance at the beginning of the year to a MSA that is used to pay for day-to-day medical expenses. The MSA can also be used to pay for expenses not covered by the Scheme (e.g. co-payments, exclusions, etc.) and is carried forward to the following year if there is a positive balance at the end of that year. This is a family benefit which means that one member of a family can use the total benefit allocation.

Principal Member:
R5 412 pa
Adult dependant:
R3 660 pa
Child dependant:
R1 056 pa

  yes

Routine medical expenses
Includes day-to-day medical expenses for GP and Specialist consultations, X-rays; prescribed (acute) and over-the-counter medication, blood tests, physiotherapy, optical, etc. This additional day-to-day benefit becomes available once the MSA is exhausted and is also a family benefit which means that one member of a family can use the total benefit allocation.

Principal Member:
R4 440 pa
Adult dependant:
R3 310 pa
Child dependant:
R1 060 pa

  conditions
Conditions apply
Pathology
Blood tests done outside of the hospital as requested by a GP or Specialist are paid from the day-to-day benefit amount, i.e. the MSA and/or routine expenses portion.

Subject to amount available in MSA

  conditions
Conditions apply
Optical services
Optical services, including eye tests, frames, lenses and contact lenses, are paid from the day-to-day benefit amount, i.e. the MSA and/or routine expenses portion.

R2 790 pbp2a

Dentistry

IncludedBenefit descriptionBenefit value
  conditions
Conditions apply
Dental treatment
The provision of conservative dental treatment to members which include the consultation at the dentist, any X-rays, oral hygiene treatment, fillings, extractions and root canal treatment.

Unlimited

  conditions
Conditions apply
Specialised dental treatment
The provision of specialised dental treatment to members which include crowns and bridges, partial metal dentures, orthodontics and periodontics.

Unlimited

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
  conditions
Conditions apply

Prosthesis / Prosthetics / Fixation Devices
Internal or external devices used as a replacement for body part (e.g. knee, hip, etc.) Such devices may be removeable or permanently implanted.

R41 800 pfpa
  yes Emergency transport by ambulance
Netcare 911 (DSP provider) 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).

R8 100 pfpa

  conditions
Conditions apply
Hearing aids
The provision of a hearing aid device and the maintenance thereof.

 

R14 300 pfp5a
+
R890 for maintenance of device

  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.

Unlimited

PMB's

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 malaria medication, baby immunisations, flu vaccine, pap smear, HIV test, mammogram, prostate test, general health assessment, weight loss benefits and maternity benefits.

More than
R25 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 060 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



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