Great-value, low-cost critical benefits, just in case.
Essence is the ideal ‘just-in-case’ medical benefit for individuals starting out and for those who only need that crucial cover for emergencies and unexpected medical expenses.
With a low cost and unbeatable value for money, this option includes an unlimited private hospital plan and covers the basic 26 chronic medical conditions.
It’s what you absolutely need when you need it most.
Essence 2025 Monthly Contributions
- Principal Member: R2 187
- Adult Dependant: R1 753
- Child Dependant: R788
Medical Benefits
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Hospital
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Accidents
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Specialists
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Oncology
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MRI & CT Scans
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Medical Appliances
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Chronic Medication
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Ambulance
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Scopes
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PMB's
Click on the tabs below to see the full description of the option benefits.
Major medical expenses cover
All costs related to treatment at any Life Healthcare and Netcare hospitals nationally and selected Mediclinic hospitals in the Western Cape, Bloemfontein, and Polokwane and other selected hospitals (DSP hospital network), will be paid in full. There is no restriction on the number of admissions to the hospital, but all in-hospital procedures should be pre-authorised prior to admission.
*30% co-payment applicable on the hospital account if a non-DSP hospital is voluntarily used.
Benefits value: Unlimited
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, as per the rules and clinical protocols.
Benefit value: Unlimited
The services provided by any Specialist whilst the member is in hospital are covered by the Scheme.
Benefit value: Unlimited
*Conditions apply
The diagnosis and treatment of cancer related conditions.
Benefit value: R197 500 Per family per annum
Includes scans done for diagnostic reasons both in and out of hospital.
Benefit value: R20 900 Per family per annum
*Conditions apply
Chronic medication
Prescribed medication used continuously for 3 months or more for one of the 26 CDL (Chronic Disease List) illness conditions
Benefit value: Unlimited
Supplementary services cover
- Per family per annum.
- In-hospital benefit only.
- Pre-authorisation compulsory.
- Case Management applies.
- Out-of-hospital: PMB entitlement.
Benefit value: R25 100
- PMB entitlement only.
- Pre-authorisation compulsory.
- Subject to case Management, reference pricing, preferred provider, and Scheme protocols.
Netcare 911 (DSP provider) provides members with emergency transport from an accident scene by road or air ambulance and medically justified inter-hospital transfers. For emergencies members may also be transferred from their homes to the hospital.
Benefit value: Unlimited.
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.
Benefit value: R9 200 Per family per annum
*Conditions apply
All scopes are covered in full if done at a DSP hospital – any Life Healthcare and Netcare hospitals nationally and selected Mediclinic hospitals in the Western Cape, Bloemfontein, and Polokwane and other selected hospitals (DSP hospital network) or if done in the doctor’s rooms, subject to the use of a KeyHealth Specialist.
Benefits value: Unlimited
Prescribed Minimum Benefits (PMB)
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.
Benefit value: Unlimited
Additional Benefits
Health Booster provides additional benefits to members at no extra cost. It is aimed at preventative treatment and therefore gives access to free screening tests.
Easy-ER offers all KeyHealth members direct access to the closest hospital’s emergency room (ER) for medical treatment in emergency situations.
KeyHealth’s Smart Baby Programme offers support and general advice on health and wellness during pregnancy and peace-of-mind for mothers- and fathers-to-be.
- Hospitalisation benefits for the following procedures:
- Varicose vein
- Facet joint injections
- Rhizotomy
- Back surgery (including spinal fusion)
- Joint replacements (e.g. hip and knee)
- Hernia procedures requiring a prosthesis / internal fixation device
- Specialised dentistry
- Prosthesis benefits
