KeyHealth Hospital Plans Comparison Summary
The hospital plans comparison for each of our packages are briefly provided below to help you make an informed decision regarding the most appropriate package according to your needs and budget considerations.
Hospitalisation
Varicose vein surgery, facet joint injections, hysterectomy, rhizotomy, reflux surgery, back surgery, and joint replacements are covered by 100% up to the set limit for each package and according to our tariff structure. Medicine on discharge is also covered up to 100% according to tariff structure. The anaesthetist and specialist services are covered. Note that pre-authorisation for hospital treatments is compulsory. PMB conditions apply for the Silver, Essence and Equilibrium packages. State and private hospitals admissions are allowed.
Major Medical Occurrences
Sub-acute facilities and wound care is covered 100% with all packages. Note that authorisation is compulsory and subject to case management and Scheme protocols. Wound care is included up to the specified amount for each of the packages.
Hospice, private nursing, step-down facilities, rehabilitation and wound cover differs according to benefits of each package. For the Silver, Gold and Platinum packages, PBPA, in and out of hospital benefits apply. For Essence and Equilibrium packages PMB conditions apply.
Organ Transplant
Hospitalisation, organ harvesting, and drugs for immune suppressive therapy are covered 100%. Pre-authorisation is required for all packages. With exception of the Platinum package, PMB conditions in DSP hospitals only apply and benefits are subject to per case management. For the Platinum package unlimited benefit applies according to per case management and pre-authorisation.
Dialysis
Cover is 100% on per case management, subject to pre-authorisation and Scheme protocols. PMB conditions apply for Essence, Equilibrium, Silver, and Gold packages.
Oncology
Pre-authorisation is needed and benefits subject to per case management and Scheme protocols. Cover is 100% to the limit of the specific package.
Radiology & Pathology
Cover is 100% for specialised radiology including MRI and CT scans, subject to pre-authorisation. Note that benefits only apply when radiology is part of hospitalisation. If the radiology is for investigative purposes only, daily benefits will apply. X-rays are covered in all packages, but PET is not covered in the Essence, Equilibrium and Silver packages. Two scans are covered in Gold and Platinum to the benefit limits and subject to conditions. Pathology is covered 100% and unlimited for all packages.
Emergency Care
We cover the Prescribed Minimum Benefits (PMB) as stated in the Medical Schemes Act No. 131 of 1998 for the specified conditions in a state hospital. The list of conditions can be viewed at the Council for Medical Schemes. This means that the emergency medical conditions allowed for including 25 chronic conditions are covered. The medical practitioner on duty or in whose care the member is will determine where the condition qualifies as PMB.
Hospital Plans Authorisation for Treatment
Specific conditions and Scheme protocols apply for each of the above benefits and up to the specified amount according to our guidelines. Before admission to the hospital the member needs to phone our Authorisation Call Centre to get the required authorisation. Information that must be supplied includes that of the membership number and full details of the patient that will be hospitalised. The name and practice number of the hospital and reason for admission must also be provided. Dates of procedures and admission in addition to the details of medical practitioner such as practice number, surname, initials and telephone number must be submitted.
Once the information is processed, the member receives an authorisation number and this must be obtained within 24 hours before admission. In the case of an emergency a family member or hospital can call on behalf of the member if the member cannot make the call to obtain necessary authorisation.
View our Benefits section for more information on the benefits for 2012 and 2013 and to make a hospital plans comparison.
