Silver 2022

Hospital	Accidents	Specialists
Oncology	MRI & CT Scans	Rehab / Wound Care
Routine Expenses	Pathology	Optical
Dental	Chronic Medication	Ambulance
Medical Appliances	Scopes	PMB's
Prosthesis
FREE Additional Benefits
Easy-ER	Health Booster	Smart Baby

2022 Monthly Contributions

*Note: Contributions charged up to a maximum of 3 child dependants

English Brochure

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 any Netcare or Life Healthcare Hospital (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.	Unlimited
Conditions apply	Specialist services in-hospital The services provided by any Specialist whilst the member is in hospital are covered by the Scheme, as per the rules and clinical protocols.	Unlimited
	Oncology The diagnosis and treatment of cancer related conditions.	R189 500 pfpa
Conditions apply	MRI & CT scans Includes scans done for diagnostic reasons both in- and out-of-hospital.	R17 800 pfpa
Conditions apply	Rehabilitation Provides for both in- and out-of-hospital services rendered after an operation or procedure at a rehab or step down facility and private nursing to assist with patient recovery.	R32 100 pfpa
Conditions apply	Wound care The provision of nursing services and equipment to prevent wound complications and promote wound healing.	R10 300 pfpa

Day-to-day medical expenses cover (outside of the hospital)

Included	Benefit description	Benefit value
	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: R8 315 pa Adult dependant: R6 045 pa Child dependant: R1 680 pa
	Additional GP consultations after depletion of day-to-day benefits for child dependants up to the age of 21 – 3 pfpa.
Conditions apply	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. routine expenses portion.	Subject to routine expenses benefits
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.	R1 690 pbp2a

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
Conditions apply	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.	R6 900 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).	R8 200 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 – A benefit of R1 230 that will cover any short payments/co-payments for services rendered during ante-natal visits to a GP, Gynaecologist or Midwife, or during pregnancy scans (including the cost for birthing fees). For first-time mothers The New Baby & Childcare Handbook by Marina Petropulos to assist during this exciting time. Access to the KeyHealth Facebook page providing valuable information and answers to questions regarding the pregnancy and general childcare. Regular, valuable communication during the pregnancy. Information regarding KeyHealth’s maternity benefits available to mothers and babies (e.g.  12 ante-natal visits, scans, ultrasounds, vitamins and ante-natal classes etc.) and how to access these benefits. Information applicable to baby’s first year (e.g. vaccinations, Easy-ER, etc.).	Applicable to every pregnancy on the Scheme

Not Included

Hospitalisation benefits for the following procedures:

• Varicose vein surgery
• Reflux surgery

Specialised dentistry