Health Booster

A program available on all options to provide Beneficiaries with certain additional benefits, at no extra cost to Members, for preventative care:

  • Only the benefits stated in the Benefit Structure under Health Booster, and applicable to that particular benefit option, will be paid by the Scheme; up to a maximum rand value which is determined according to specific tariff codes.

Qualification:

  • Members qualify automatically for Health Booster benefits according to the set criteria.
    - However, pre-authorisation is required in order to access the Maternity benefits on Health Booster. Contact the Client Service Centre on 0860 671 050 and obtain pre-authorisation.
    (Failing to do this will result in the service costs being deducted from day-to-day benefits.);
    - When maternity related claims are submitted by providers, these claims should specify the relevant ICD10 code as contained in the pre-authorisation letter;
    - Verify the tariff code or maximum rand value with the Call Centre Consultant;
    - Inform the relevant service provider accordingly.

Screening tests:

  • One of the benefits available on the Health Booster program is the Health Assessment.
  • This assessment comprises the following screening tests:
    - Body Mass Index (BMI);
    - Blood sugar (finger prick test);
    - Total Cholesterol (finger prick test);
    - Blood pressure (systolic and diastolic);
    - Prostate Phlebotomy for PSA;
  • Rapid Semi-Quantitive Prostate Specific Antigen (PSA) test (finger prick).
  • Principal Members and their Dependants are entitled to one Health Assessment per calendar year and must have the screening tests done at any pharmacy.
  • A Health Assessment (HA) form can be downloaded from KeyHealth’s website
  • No authorisation is required for these screening tests.
  • Results of these screening tests can be submitted by either the Member or the service provider and must be faxed to 012 679 4471 or emailed to This email address is being protected from spambots. You need JavaScript enabled to view it..
TYPE OF TEST WHO & HOW OFTEN
PREVENTIVE CARE
Baby immunisation Child dependants aged ≤6 – as required by the Department of Health.
Flu vaccination All beneficiaries.
Tetanus diphtheria injection All beneficiaries – as and when required.
Pneumococcal vaccination (Prevenar not included) All beneficiaries.
Malaria medication All beneficiaries – R380 once per year.
Baby growth assessments 3 baby growth assessments at a pharmacy/baby clinic for beneficiaries aged between 0 – 35 months – per year.
EARLY DETECTION TESTS
Pap smear (Pathologist) Female beneficiaries aged ≥15 – once per year.
Pap smear (including consultation and pelvic organs ultrasound; GP or Gynaecologist) Female beneficiaries aged ≥15 – once per year.
Mammogram Female beneficiaries aged ≥40 – once per year.
Prostate specific antigen (PSA) (Pathologist) Male beneficiaries aged ≥40 – once per year.
HIV/AIDS test (Pathologist) Beneficiaries aged ≥15 – once per year.
Health Assessment (HA): Body mass index, Blood pressure measurement, Cholesterol test (finger prick), Blood sugar test (finger prick) PSA (finger prick) All beneficiaries – once per year.
Dental consultation All beneficiaries – once per year.
WEIGHT LOSS (Pre-authorisation essential to access benefits)
Weight Loss Programme For all beneficiaries when the Health Assessment BMI is ≥ 30:
  • 3 x dietician consultations (one per week).
  • 3 x additional dietician consultations (one per week, provided that a weight loss chart was received from dietician proving weight loss after first three weeks).
  • One biokineticist consultation (to create a home exercise programme for the member).
  • 1 x follow-up consultation with biokineticist.
MATERNITY (Pre-authorisation essential to access benefits)
Antenatal visits (GP, Gynaecologist or midwife) & urine test (dipstick)# Female beneficiaries. Pre-notification of and pre-authorisation by the Scheme compulsory. 12 visits.
Ultrasounds (GP or Gynaecologist) – one before the 24th week and one thereafter # Female beneficiaries. Pre-notification of and pre-authorisation by the Scheme compulsory. 2 pregnancy scans.
Short payments/co-payments for services rendered in (#) above and birthing fees Covered to the value of R1 180 per pregnancy.
Paediatrician visits Baby registered on Scheme.
2 visits in baby’s 1st year.
1 visit in baby’s 2nd year.
Ante-natal vitamins Covered to the value of R1 990 per pregnancy.
Ante-natal classes Covered to the value of R1 990 for first pregnancy.