Discovery KeyCare Plus B 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 Plus B
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,386 R1,386 R389
Cost 2017: (R1,280) (R1,280) (R358)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
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
Income band: This plan is only available to households with income in R8,551-R12,200pm band.
View other income bands

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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
KeyCare Plus B
2017 v 2018 benefits 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

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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)
  • 100% scheme rate
  • Up to 500% of scheme rate for service providers
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:
  • R325 co-payment for casualty visits at network hospital
  • 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

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OUT OF HOSPITAL BENEFITS:
KeyCare Plus B
2017 v 2018 benefits Gap benefits Notes
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


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Childcare:
  • No benefit
Specialists consultations:
  • R3,860 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 Plus B
2017 v 2018 benefits 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

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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 Plus B
2017 v 2018 benefits Gap benefits Notes
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
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 Plus B
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Standard dentistry: includes consults, fillings and tooth removals at dentist in network
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments

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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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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
KeyCare Plus B
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No benefit

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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

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OPTOMETRY:
KeyCare Plus B
2017 v 2018 benefits Gap benefits Notes
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

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MENTAL HEALTH:
KeyCare Plus B
2017 v 2018 benefits Gap benefits Notes
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

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Out-of-hospital:
  • See above
  • No benefit
Trauma:
  • Offers out of hospital claims for recovery after traumatic events for rest of year, and year after that

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OTHER BENEFITS:
KeyCare Plus B
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • R5,400 per family, from network provider
  • No benefit

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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:
  • Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment
  • 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 Plus B
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered, for 65 yrs+
  • No benefit

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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

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit: .
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Sub-limits:
  • Covered at network hospitals, subject to authorisation
  • An additional R40,000 per sublimit, per event

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    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