Gold Option
Gold is the superior medical cover for individuals and families who demand both substantial cover and security from their plans.
With a premium rate and loaded value, this option offers an unlimited hospital plan, superior day-to-day cover and benefits for 44 chronic medical conditions, as well as dental cover, increased savings, and out-of-hospital mental health cover.
It sets the new standard in gold medical cover.
Our superior medical cover that sets the new gold standard.
Gold
2022 monthly contributions
– Monthly contribution: R5 380
– Monthly savings: R597
– Total monthly contribution: R5 977
– Monthly contribution: R3 638
– Monthly savings: R404
– Total monthly contribution: R4 042
– Monthly contribution: R1 056
– Monthly savings: R117
– Total monthly contribution: R1 173
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 & ICT Scans
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Rehab / Wound Care
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Savings
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Routine Expenses
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Pathology
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Optical
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Dental
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Chronic Medication
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Prosthesis
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Ambulance
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Medical Appliances
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Hearing Aids
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Scopes
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PMB's
Click on the tabs below to see a full description of the option benefits.
Major medical expenses cover
All costs related to treatment at any Netcare, Life Healthcare hospitals (countrywide) and Mediclinic (Western Cape, Polokwane, Bloemfontein) – hospitals that are part of our Designated Service Provider (DSP) network – will be paid in full. A list of hospitals in areas where DSP hospitals are not present is available on request. There is no restriction on the number of hospital admissions, but all in-hospital procedures must be pre-authorised prior to admission.
*If a non-DSP hospital is voluntarily used, a 30% co-payment will be applicable on the hospital account.
Benefit value
Unlimited
Treatment for almost all accidents is regarded as a Prescribed Minimum Benefit (PMB). Treatment of such injuries, including hospitalisation, is therefore covered in full by the Scheme, subject to Scheme rules and clinical protocols.
Benefit value
Unlimited
The services provided by specialists while the member is in hospital are covered by the Scheme.
Any service falling within the Scheme rules and rendered by the Scheme’s Specialist Network (DSP) or preferred provider for PMB conditions will be covered in full.
Benefit value
Unlimited*
*Conditions apply
The diagnosis and treatment of cancer-related conditions.
Benefit value
R433 500 per family per annum
Includes scans done for diagnostic purposes in and out of hospital.
Benefit value
R17 800 per family per annum
*Conditions apply
Provides for both in- and out-of-hospital services rendered after an operation or procedure at a rehabilitation or step-down facility and private nursing to assist with patient recovery.
Benefit value
R43 600 per family per annum*
*Conditions apply
The provision of nursing services and equipment to prevent wound complications and promote wound healing.
Benefit value
R14 300 per family per annum sublimit included in the overall sub-acute facility benefits of R43 600*
*Conditions apply
Day-to-day medical expenses cover (out of hospital)
A portion of a member’s monthly contribution is allocated in advance (at the beginning of the year) to a medical savings account (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.
Benefit value
Principal Member: R7 164 per annum
Adult Dependant: R4 848 per annum
Child Dependant: R1 404 per annum
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 depleted and is a family benefit, which means that one member of a family can use the total benefit allocation.
Benefit value
Principal Member: R5 380 per annum
Adult Dependant: R4 010 per annum
Child Dependant: R1 290 per annum
Blood tests done out of hospital as requested by a GP or specialist are paid from the day-to-day benefit amount, i.e. the MSA and / or routine benefit allocation.
Benefit value
Subject to amount available in MSA and / or routine benefit allocation
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 benefit allocation.
Benefit value
R3 230 per family every 2 years*
*Conditions apply
Dentistry
The provision of conservative dental treatment to members, which includes the dentist consultation, X-rays, oral hygiene treatment, fillings, extractions and root canal treatment.
Benefit value
Unlimited*
*Conditions apply
The provision of specialised dental treatment to members, which includes crowns and bridges, partial metal dentures, orthodontics and periodontics.
Benefit value
Unlimited*
*Conditions apply
Chronic medication
Prescribed medication used continuously for 3 months or more for one of the 26 PMB CDL conditions.
Benefit value
Unlimited
Prescribed medication used continuously for 3 months or more for 18 additional chronic conditions that are not on the PMB Chronic Disease List (CDL).
Benefit value
R9 200 per family per annum*
*Conditions apply
Supplementary services cover
- Combined benefit: in and out-of-hospital.
- Out-of-hospital treatment is limited to R17 800
- Pre-authorisation compulsory.
- Case Management applies.
Benefit value:
R43 600 per family per annum
(Internal, external, fixation devices and implanted devices)
- Pre-authorisation compulsory.
- Subject to case Management, reference pricing, preferred provider, and Scheme protocols.
Benefit value
R50 500 per family per annum
Netcare 911 (DSP) provides members with emergency transport from any accident scene by road or air ambulance and medically justified inter-hospital transfers. 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 700 per family per annum*
*Conditions apply
The provision of hearing aid(s) and the maintenance thereof.
Benefit value
R17 250 per family every 5 years*
+ R1 085 yearly for maintenance (including batteries) of the hearing aid(s) *
*Conditions apply
All scopes are covered in full if done at a DSP hospital – Netcare, Life Healthcare hospitals (countrywide) and Mediclinic (Western Cape, Polokwane, Bloemfontein) and other selected hospitals – or if done in the doctor’s rooms, subject to use of the KeyHealth Specialist Network.
Benefit 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
