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KeyHealth Member Information

Member Services

Electronic Communication

Hospital Benefits

KeyHealth Medical Scheme provides beneficiaries with comprehensive and unlimited hospital plans at private and state hospitals.

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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.
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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
    – Monday to Friday, 08:00-19:00, excluding public holidays
Click here for Required Information for Authorisation

Required information for authorisation

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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)

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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.