Discovery KeyCare Access A medical aid plan: 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.

KeyCare Access A
2018 Costs:
Total Cost pm:

Main member:

R697

Adult:

R697

Child: (Pay only for first 3)

R306
Savings Account:
  • No savings option on this plan
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child: (Pay only for first 3)

R
Savings (per year):
  • No savings option on this plan
Income band:
In brief (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.
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
KeyCare Access A
Scheme Benefits: Gap Benefits:
Specialists:
  • Covered in full at network hospitals
AskAdam Gap
  • N/A
Discovery Gap
  • Not available n this plan
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
  • If non-network hospital is used, there in no benefit, unless for PMB in which case paid at 80% scheme rate
  • No benefit
Specialised Radiology:
  • 100% scheme rate
  • No benefit
Supplementary Services: (Physio, etc)
  • 100% scheme rate
AskAdam Gap
  • Gap tops up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
Transplants:
  • Covered
AskAdam Gap
  • Gap pays up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
Co-payments:
  • N/A
  • N/A
Alternatives to hospitals:
  • 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
  • Terminal care: R40,450 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home
  • No extra benefit available
Casualty:
  • R325 co-payment for casualty visits at network hospital
  • 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.
Other:
    Excluded unless PMB:
  • Dentistry
  • nail disorders
  • skin disorders
  • investigations
  • functional nasal surgery
  • elective caesarean section
  • reflux surgery
  • hiatus hernia
  • back and neck treatment or surgery
  • knee or shoulder surgery
  • joint replacements
  • cochlear implants
  • bunions
  • varicose veins
  • refractive eye surgery
  • non cancerous breast conditions
  • No benefit for exclusions
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
KeyCare Access A
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • Chosen network GP: Unlimited
  • Non-network GP 4 consults
  • Out of hospital treatment for conditions that are PMBs is always paid for by the scheme (not out of savings), but according to protocols
  • No benefit
Childcare:
  • No extra benefit available
Specialists consultations:
  • R3,860 per person
  • You must use a Specialist from network for maternity, baby care (up to 12 months), and trauma and emergencies
  • . For all other consults, you must use the State network specialists
  • 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:
  • Paid out of pocket
  • No benefit
Supplementary Services: (Physio, etc)
  • Paid out of pocket
  • No benefit
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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MATERNITY BENEFITS:
KeyCare Access A
Scheme Benefits Gap benefits
Hospital stay:
  • 100% scheme rate
  • Elective caesareans: not covered
AskAdam Gap
  • Gap pays up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
  • No benefit for exclusions
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
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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CANCER (ONCOLOGY):
KeyCare Access A
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, in allocated network provider
  • If you use a non-network provider, scheme will pay claims at 80% scheme rate
  • No benefit
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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DENTISTRY:
KeyCare Access A
Scheme Benefits Gap benefits
Dentistry:
  • Standard dentistry: includes consults, fillings and tooth removals at dentist in network
AskAdam Gap:
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
Orthodontics:
  • You pay this out of pocket
  • No extra benefit available
Maxillo Facial Surgery: TBC
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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MEDICATION:
KeyCare Access A
Scheme Benefits Gap benefits
Chronic:
  • No benefit
Acute (presrcibed) medication:
  • Medicines that are on medicine list and are prescribed by Network GP are paid for by scheme
  • 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
  • No benefit
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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OPTOMETRY:
KeyCare Access A
Scheme Benefits Gap benefits
Optometry:
  • One eye test per person, at network optometrist
  • One pair of contact lenses or glasses every 24 months, from pre-selected options at your Network optometrist
  • No benefit
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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MENTAL HEALTH:
KeyCare Access A
Scheme Benefits Gap benefits
In-hospital:
  • Major affective disorders, anorexia and bulimia: 21 days for admissions or 15 out-of-hospital consultations
  • Acute stress disorder accompanied by recent significant trauma: 21 days for admissions or 12 out-of-hospital consultations
  • Other mental health admissions: 21 days in-hospital
  • Alcohol and drug rehab: 21 days in-hospital
  • All admissions are covered in full at a network state facility, or at 80% scheme rate at a non-network facility
  • No extra benefit available
Out-of-hospital:
  • See above
  • No extra benefit available
Trauma:
  • Offers out of hospital claims for recovery after traumatic events for rest of year, and year after that
  • No extra benefit available
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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OTHER BENEFITS:
KeyCare Access A
Scheme Benefits Gap benefits
General Appliances:
  • R5,400 per family, from network provider
  • 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 extra benefit available
HIV:
  • Covered if on the HIV Care program
  • No benefit
Emergency Transport:
  • Discovery 911
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other:
  • Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment
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More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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WELLNESS/PREVENTATIVE BENEFITS:
KeyCare Access A
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered, for 65 yrs+
  • 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
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR
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PROSTHETICS:
KeyCare Access A
Scheme Benefits Gap benefits
Overal Limit:
  • Covered at network hospitals, subject to authorisation
.
Sub-limits: . .
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


OR

    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