Discovery KeyCare Access D medical aid plan: 2017 vs 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
KeyCare Access D
2018 costs Gap
In brief: On KeyCare Access D in 2018:
  • Emergencies, trauma, childbirth and care for newborn in private KeyCare Access Network hospitals.
  • All other procedures in contracted State hospitals.
  • Cancer treatment in State facilities.
  • Primary healthcare, maternity care, radiology and pathology covered by scheme.
See full benefits below
For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims from 100% to 500%
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims and
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.

Discovery also has its own, seamless, gap cover. You can read about it here.
What’s new in 2018?
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Contributions:
Main: Adult: Child:
Cost 2018: R2,018 R2,018 R546
Cost 2017: (R1,863) (R1,863) (R503)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: No savings option on this plan
Children: Pay for maximum 3 children
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
Income band: This plan is only available to households with income in R12,201+pm band.
View other income bands
Find out more
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IN HOSPITAL PROCEDURES:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • Covered in full at network hospitals
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Emergencies, trauma, childbirth and care for newborn in KeyCare Access Network
  • Traumas covered: injuries at work, burns, injuries from a crime, sexual assault, injuries from a car accident, injuries from a fall, loss of arm, leg or foot, near drowning, head injuries, poisoning or serious allergic reaction that may cause death
  • Other conditions in contracted state facilities
Specialised Radiology: TBC
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • Covered
Co-payments:
Alternatives to hospitals:
  • 2018: To be confirmed
  • 2017:
    • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
    • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
    • End of life care: R37,350 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home
  • No benefit
Casualty:
  • 2018: To be confirmed
  • 2017:
    • R300 co-payment for casualty visits
    • One visit per year per person, unless emergency or trauma
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • Chosen network GP: Unlimited
  • Non-network GP 4 consults per person
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • Emergencies, trauma, childbirth and cover for baby: R3,570 per person
  • No benefit
Pathology:
  • Some blood, urine and other fluid and tissue tests, as asked for by GP
  • No benefit
General radiology:
  • Basic X-rays covered, if done at a network provider and asked for by the GP
  • No benefit
Specialised radiology:
  • No benefit, unless PMB
  • No benefit
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit
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MATERNITY BENEFITS:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • Elective caesareans: not covered
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Consultations:
  • $$ 8 consults, paid by scheme
  • $$ Nuchal translucency or Non-Invasive Prenatal Test, paid by scheme
  • $$ Certain blood tests, paid by scheme
  • $$ Five pre- or postnatal classes with registered nurse
  • $$ For two years after birth: two visits for baby with GP, Paediatrician or ENT; one six week post-birth consult with midwife, GP or gynae; one nutritional assessment; two mental health consults; one lactation consult
  • No benefit
Scans:
  • $$ 2 x ultrasound scans, now paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • PMBs only, in State facility
  • Up to additional 500% of scheme rate to cover shortfall for specialists
  • Full cover for the 20% co-payment
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • Standard dentistry: includes consults, fillings and tooth removals at dentist in network. Paid by scheme
  • Full cover for in-hospital deductibles
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
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MEDICATION:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • PMBs chronic: paid by scheme
  • No benefit
Acute (presrcibed) medication: TBC
  • No benefit
Over-the-counter:
  • No benefit
  • No benefit
Birth Control:
  • No benefit
  • No benefit
On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
  • No benefit
Biological:
  • No benefit
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OPTOMETRY:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • One eye test per person
  • One pair of contact lenses or glasses every 24 months, from pre-selected options at your Network optometrist
  • Cataract surgery: contracted state facilities
  • No benefit
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MENTAL HEALTH:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital: TBC
  • No benefit
Out-of-hospital: TBC
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • 2018: To be confirmed
  • 2017:
    • R5,200 per family
  • No benefit
1.1. Hearing Aids:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Covered in full if you use network provider
  • No benefit
HIV:
  • Covered if on the HIV Care program
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other: TBC
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.
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WELLNESS/PREVENTATIVE BENEFITS:
KeyCare Access D
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered, for 65yrs+
  • No benefit
Pneumonia vaccines:
  • To be confirmed
  • No benefit
Back Rehabilitation Programme: TBC
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation: TBC
  • No benefit
Pap Smear:
  • Covered, every 3 years
  • No benefit
Mammogram:
  • Covered, every 2 years
  • If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • Kids' assessment, including height, weight, head circumference and health and milestone tracking
  • No benefit
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2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised