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KeyHealth Member Information

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South African medical aid schemes offer various plans. Each plan has its own list of benefits, which consist of conditions, medicines, treatments, and procedures for which the member enjoys limited or unlimited cover. Depending on the type of plan and the amount the member contributes monthly to remain on their chosen plan, there are limitations that apply to certain claims or benefits, as well as exclusions. Overall, a certain number of restrictions are necessary to ensure that the scheme remains viable and able to fund its members’ benefits and claims.

The more comprehensive the plan you select, the more benefits you will enjoy, but the higher your monthly membership contribution will be. It is advisable to join the plan with the most comprehensive cover and list of benefits that you can afford without placing yourself in financial difficulty. Changes and upgrades to more comprehensive plans with better benefits, or downgrades to a less expensive plan, can generally be made annually only, unless the medical aid specifies otherwise.

Compulsory Benefits

According to the current version of the Medical Schemes Act No. 131 of 1998, medical aid schemes are compelled to cover certain medical aid benefits:

  • Prescribed Minimum Benefits (PMBs), which consist of a list of conditions for which cover of benefits is compulsory, irrespective of medical aid scheme or plan. Certain provisos may apply to fully cover benefits, such as use of a designated service provider (DSP), if voluntary, and/or a co-payment if treatment medicines are used that do not appear on the medical scheme’s formulary. Breaks in membership of 90 days or longer will usually affect PMB benefits adversely.
  • Treatment of chronic conditions, as listed in the Chronic Disease List (CDL).
  • Medical emergencies.

KeyHealth’s Additional Benefits

Irrespective of which KeyHealth plan you select, our medical scheme provides all members with three sets of complimentary benefits, completely free to you, our member, and your dependents, if applicable:

  • Easy-ER;
  • Health Booster; and
  • Smart Baby.

In addition to KeyHealth’s additional free benefits, we offer our members a few major medical aid benefits, one of which you might not have thought of. First of all, our medical aid plans are smart and simple, with no frills and fripperies that are intended to tempt you to join our fund, and really only muddy the waters and confuse you. Secondly, we realise that medical aid cover is generally expensive, but being without medical aid cover and benefits can ruin you financially when life happens, or you experience a medical emergency with costly treatments and dire consequences, if treatment is withheld.

We constantly strive to ensure that our membership contributions are as affordable as possible, while providing you with maximum benefits per plan. For many people, buying medical aid cover and benefits is a grudge purchase because of their expense, but not having the benefits of medical aid cover may be disastrous when a medical emergency, hospitalisation, and the necessity of a surgical procedure arises.

Compare KeyHealth’s medical aid plans, their benefits, terms, and conditions easily, quickly and simply – at a glance – on our web pages, and select the option that best suits you and your pocket. This is the essence of KeyHealth’s medical aid benefits.

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