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|
 Accidents |
 Specialists |
 Oncology |
 MRI & CT Scans |
 Savings |
 Routine Expenses |
 Pathology |
 Optical |
 Dental |
 Chronic Medication |
 Ambulance |
 Medical Applicances |
 Scopes |
 PMB's |
FREE Additional Benefits |
||
 Easy-ER |
 Health Booster |
 Smart Baby |
2022 Contributions
| Principal Member |
Adult Dependant |
Child Dependant |
|
| Monthly Contribution |
R2 196 | R1 357 | R674 |
| Monthly Savings |
R172 | R106 | R53 |
|
Total Monthly |
R2 368 | R1 463 | R727 |
*Note: Contributions charged up to a maximum of 3 child dependants
 English Brochure |
| pa | - Per annum |
| pfpa | - Per family per annum |
| pbpa | - Per beneficiary per annum |
| pfp2a | - Per family every 2 years |
| pfp4a | - Per family every 4 years |
Benefits
Click on the tabs below to see a full description of the option benefits
Disaster or major medical expenses cover
| Included | Benefit description | Benefit value |
|---|---|---|
| |
Hospital related costs All costs related to treatment at Netcare or Life Healthcare (DSP hospital network) will be paid in full. There is no restriction on the number of admissions to hospital, but all in-hospital procedures should be pre-authorised prior to admission. *30% co-payment applicable on hospital account if non-DSP hospital is utilised voluntarily. | Unlimited |
| |
Injuries suffered as result of an accident Almost all accidents are regarded as a PMB (Prescribed Minimum Benefit) and the treatment of such injuries, including the hospitalisation, will therefore be covered in full by the Scheme, as per the rules and clinical protocols. |
Unlimited |
|
|
Specialist services in-hospital The services provided by any Specialist whilst the member is in hospital are covered by the Scheme. |
Unlimited |
| |
Oncology The diagnosis and treatment of cancer related conditions. |
R169 000pfpa |
 Conditions apply |
MRI & CT scans Includes scans done for diagnostic reasons both in- and out-of-hospital. |
R17 800 pfpa |
Day-to-day medical expenses cover (outside of the hospital)
| Included | Benefit description | Benefit value |
|---|---|---|
| |
Medical savings account (MSA) A portion of a member’s monthly contribution is allocated in advance at the beginning of the year to a 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. |
Principal Member: R2 064 pa Adult dependant: R1 272 pa Child dependant: R636 pa |
| |
Routine medical expenses 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 benefit is a family benefit which means that one member of a family can use the total benefit allocation. |
Principal Member: R3 090 pa Adult dependant: R2 125 pa Child dependant: R945 pa |
| |
Pathology Blood tests done outside of the hospital as requested by a GP or Specialist are paid from the day-to-day benefit amount, i.e. the MSA and/or routine expenses portion. |
Subject to amount available in MSA |
| Conditions apply |
Optical services 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 expenses portion. |
Subject to amount available in MSA and/or routine benefit allocation |
Dentistry
| Included | Benefit description | Benefit value |
|---|---|---|
| Conditions apply |
Dental treatment The provision of conservative dental treatment to members which include the consultation at the dentist, any x-rays, oral hygiene treatment, fillings, extractions and root canal treatment. |
Unlimited |
Chronic medication
| Included | Benefit description | Benefit value |
|---|---|---|
| |
Chronic medication for CDL conditions Prescribed medication used continuously for 3 months or more for one of the 26 CDL (Chronic Disease List) illness conditions. |
Unlimited |
| |
Extra chronic medication Prescribed medication used continuously for 3 months or more for (3 extra chronic conditions) that are not on the CDL (Chronic Disease List) illness conditions for children under the age of 21. |
Unlimited |
Supplementary services cover
| Included | Benefit description | Benefit value |
|---|---|---|
| |
Prosthesis/Prosthetics/Fixation Devices Internal or external devices used as a replacement for body part (e.g. knee, hip, etc). Such devices may be removeable or permanently implanted. |
R3 500 pfpa |
| |
Emergency transport by ambulance Netcare 911 (DSP provider) provides members with emergency transport from any accident scene by road or air ambulance and medically justified inter-hospital transfers. |
Unlimited |
| Conditions apply |
Medical appliances 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). |
R7 900 pfpa |
| |
Endoscopic procedures (scopes) All scopes are covered in full if done at a DSP hospital (Life Healthcare and Netcare) or if done in the doctor’s rooms, subject to the use of a Onecare Specialist. |
Unlimited |
PMBs
| Included | Benefit description | Benefit value |
|---|---|---|
| |
Prescribed Minimum Benefits 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. |
Unlimited |
FREE additional benefits
| Included | Benefit description | Benefit value |
|---|---|---|
| |
Easy-ER Gives all KeyHealth beneficiaries free, direct access to any hospital’s ER facility for medical treatment in emergency situations. No upfront payments required. Also includes cover for dental emergencies. KeyHealth guarantees payment for the full ER event – no savings or day-to-day benefits used! |
Unlimited |
| |
Health Booster Is aimed at preventative treatment and early detection. This benefit is provided at no extra cost and does not form part of the normal day-to-day benefits. Includes malaria medication, baby immunisations, flu vaccine, pap smear, HIV test, mammogram, prostate test, general health assessment, weight loss benefits, contraceptive benefits and maternity benefits. |
More than R34 000 worth of benefits |
| |
Smart Baby Programme Smart Baby is there to make a pregnancy even more special by offering great maternity benefits, support, general advice on health and wellness, and simply making the journey as enjoyable as possible for you. Benefits on this program include –
|
Applicable to every pregnancy on the Scheme |
Not Included
Hospitalisation benefits for the following procedures:
- Varicose vein surgery
- Reflux surgery
Specialised dentistry
