Hospital Benefits
KeyHealth Medical Scheme provides beneficiaries with comprehensive and unlimited hospital plans at private and state hospitals.
Hospital cover includes the following, subject to Scheme rules, pre-authorisation, case management and clinical protocols:
- Medical and surgical ward.
- High care.
- Intensive care.
- Specialist provider(s).
- Associated provider(s); Radiology (x-ray, ultrasound), Pathology, Physiotherapy.
- Blood transfusions.
- Theatre.
Our hospital plans also cover the following, subject to Scheme rules, pre-authorisation, case management, clinical protocols and benefit option:
- In-and outpatient rehabilitation – The process of helping people who have suffered an illness or injury to regain lost skills, such as standing, walking, etc. to regain maximum self-sufficiency.
- Wound care – Specific types of treatment for pressure sores, skin ulcers and other wounds that break the skin.
- Hospice – Healthcare for terminally ill patients that focuses, among others, on the patient’s emotional and spiritual needs at the end of life.
- Private nursing – A cost-effective home healthcare service that acts as an alternative to long-term hospitalisation, this may include home ventilation, stoma therapy and administration of intravenous medication. This does not include palliative and / or frail care.
- Psychiatric treatment – Treatment of mental disorders, including admissions and consultations. This does not include IQ tests, learning problems and scholastic disorders.
- Dialysis – Kidney treatment that involves filtering and purifying the blood by using a machine.
- Oncology – Cancer treatment.
Hospital admission
Important Information
All hospital admissions must be pre-authorised by KeyHealth before the member is admitted. Only in emergencies can a member be admitted without pre-authorisation.
A member must get the hospital authorisation at least 24 hours before admission. If this was not possible because of an emergency hospital admission, a family member or a friend can call the Scheme on behalf of the member. The call must be within 2 working days after the emergency admission.
There is a penalty if the outlined authorisation process is not followed.
Contact Details
The member must use the following contacts to get pre-authorisation:
- Hospital Pre-authorisation: 0860 671 060
- Live chat on keyhealthmedical.co.za
– Monday to Friday, 08:00-19:00, excluding public holidays
Required information for authorisation
When requesting hospital authorisation the member will need the following information:
- Membership number
- Full name, surname and dependant code of the patient
- Name and practice number of the hospital
- Reasons for the hospital admission:
- Admission diagnosis or ICD-10 code
- If the admission is for planned surgery, all relevant procedure (tariff) codes and CPT4 codes (if available)
- Date of admission and scheduled date of the procedure
- Practice number of:
- The treating doctor / specialist
- The referring doctor / specialist
- Other service providers (if applicable)
- Alternatively, the initials, surname and telephone number of both the treating and referring doctor / specialist
- The expected time of stay in the hospital
Medication on discharge
- Medication prescribed to members when they are discharged from hospital is limited to an amount of R575 per admission for all benefit options.
KeyHealth Designated Service Providers (DSPs)
To ensure that members receive quality healthcare within reasonable proximity to where they live, South Africa’s biggest private hospital groups are on KeyHealth’s list of Designated Service Providers (DSPs).
These are: Netcare, Life Healthcare and Mediclinic (Western Cape, Polokwane, Bloemfontein).
How to use the DSP hospital network
- Members must use a DSP hospital within the reasonable proximity of 40 kilometres from the member’s home to the hospital.
- If a member chooses not to use a DSP hospital, the member will be required to pay 30% out of their pocket for the hospital admission.
- Where there is no DSP hospital in a 40 kilometre radius from the member’s home, the member is allowed to use any other hospital near them without paying extra out of pocket.
- If a member voluntarily travels outside of his residential area to an area where there is a DSP hospital but makes use of a non-DSP hospital, the member will be liable to pay 30% out of their pocket for the hospital admission.
