Discovery KeyCare Core C 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.

COSTS and OVERVIEW:
KeyCare Core C
Quick Overview
Main: Adult: Child:
Total Cost pm: R1,525 R1,525 R345
Savings (per year): No savings option on this plan
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
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
Children: Pay for maximum 3 children
Income band: This plan is only available to households with income in R12,201+pm band.
View other income bands
  • KeyCare Hospital network must be used
  • Cancer treatment for PMBs only at network provider
  • Maternity care 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

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IN HOSPITAL PROCEDURES:
KeyCare Core C
Benefits Gap benefits
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:
  • KeyCare Hospital Network or KeyCare day surgery network
  • If non-network hospital is used, there in no benefit, unless for PMB in which case paid at 80% scheme rate
Specialised Radiology:
  • 100% scheme rate
  • N/A
Supplementary Services: (Physio, etc) TBC
Transplants:
  • Covered
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 benefit
Casualty:
  • No benefit, unless PMB
  • 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

OR
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OUT OF HOSPITAL BENEFITS:
KeyCare Core C
Benefits Gap benefits
GP consultations:
  • No benefit
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • R3,860 per person
  • No benefit
Pathology:
  • No benefit, unless PMB
  • No benefit
General radiology:
  • No benefit, unless PMB
  • No benefit
Specialised radiology:
  • No benefit, unless PMB
  • No benefit
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit

OR
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MATERNITY BENEFITS:
KeyCare Core C
Benefits Gap benefits
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

OR
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CANCER (ONCOLOGY):
KeyCare Core C
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

OR
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DENTISTRY:
KeyCare Core C
Benefits Gap benefits
Dentistry:
  • No benefit
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery: TBC
  • Dental reconstruction as result of trauma or oncology: R40,000 per event

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MEDICATION:
KeyCare Core C
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:
  • No benefit
  • No benefit
Biological:
  • No benefit
  • No benefit

OR
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OPTOMETRY:
KeyCare Core C
Benefits Gap benefits
Optometry:
  • No benefit
  • No benefit

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MENTAL HEALTH:
KeyCare Core C
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 facility, or at 80% scheme rate at a non-network facility
  • No benefit
Out-of-hospital:
  • See above
  • No benefit
Trauma:
  • No benefit

OR
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OTHER BENEFITS:
KeyCare Core C
Benefits Gap benefits
General Appliances:
  • No benefit
  • 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 policyholder was not at fault: Gap will provide all legal assistance, fully covered.

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WELLNESS/PREVENTATIVE BENEFITS:
KeyCare Core C
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

OR
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PROSTHETICS:
KeyCare Core C
Benefits Gap benefits
Overal Limit: .
Sub-limits:
  • Covered at network hospitals, subject to authorisation
  • An additional R40,000 per sublimit, per event

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