Keyhealth Gold 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:
Gold
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R4,516 R3,054 R885
Cost 2017: (R4,143) (R2,802) (R812)
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
Savings: R5,412 R3,660 R1,056
Extended Fund: R4,440 R3,310 R1,060
Children: Pay for all children
  • There are no major changes to this plan in 2018, other than the usual monetary increases in premiums, benefits and co-payments

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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:
Gold
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists:
  • 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:
  • Unlimited
  • Non-DSP use for PMBs: 30% co-payment. (DSP is any Netcare of Life healthcare)
Specialised Radiology:
  • MRI and CT scans: R14,700 per family with R1,480 co-payment, in and out of hospital. Not covered if for investigative purposes only.
  • PET scans: 2 scans per person. Maximum R16,300 per scan
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • Unlimited, subject to use of DSP
Co-payments:
  • Specialised radiology: R1,480 co-payment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Hospice, private nursing, rehab, step-down and wound care: R36,100 per family in and out of hospital
  • Wound care sublimit: R11,900
Casualty:
  • Emergencies: scheme pays full account, including for dental emergencies.
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Gold
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit


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Childcare:
  • Peadiatrician: 2 consults in baby's first year, paid by scheme
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
Pathology:
  • 30% co-payment
  • Paid from day-to-day benefit
General radiology:
  • Paid from day-to-day benefit
Specialised radiology:
  • MRI and CT scans: R14,700 per family with R1,480 co-payment, in and out of hospital. Not if for investigative purposes only.
  • PET scans: 2 scans per person. Maximum R16,300 per scan
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
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MATERNITY BENEFITS:
Gold
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • Private ward for 3 day stay forr natural birth

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Consultations:
  • 12 consults, paid by scheme
  • R1,060 for any shortfalls
  • Vitamins: R1,790 per pregnancy
  • Antenatal classes: R1,790 for first pregnancies
Scans:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Gold
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • R358,000 per family, subject to use of DSP and scheme protocols
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:
Gold
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Standard dentistry: paid by scheme. Includes plastic dentures every 4 years
  • Specialised dentistry: 80% scheme tariff, includes metal frame dentures, crowns and bridges and periodontics. Paid by scheme.
  • Implants: no benefit
  • In-hospital: R1,480 co-payment. For young children and removal of wisdom teeth.

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Orthodontics:
  • 80% scheme tariff
  • , where function is impaired. 9-18yrs.
Maxillo Facial Surgery:
  • Subject to protocols

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:
Gold
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • PMBs chronic: paid by scheme. 15% co-payment for non-DSP use

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Acute (presrcibed) medication:
  • Paid from day-to-day benefit
Over-the-counter:
  • Limited to R1,810 per family
  • Paid from day-to-day benefit
Birth Control:
  • Meds: Paid from day-to-day benefit
  • Devices: paid from medical appliances benefit (R8,100 per family)
On Discharge:
  • R475
Biological:
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OPTOMETRY:
Gold
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Limited to R2,790 per person every 2 years
  • Sub limits: Frames (R880), Lenses (one pair), Contact lenses (R1,330)
  • Paid from day-to-day benefit
  • Refractive surgery: subject to optical benefit
  • In addition, one pair of reading glasses (R160 limit) from the over-the-counter medicine benefit

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MENTAL HEALTH:
Gold
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • Psychiatric: R36,100 per family in and out of hospital, with sub limit of R14,700 for out-of hospital

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Out-of-hospital:
  • Psychiatric: R36,100 per family in and out of hospital, with sub limit of R14,700 for out-of hospital
Trauma:
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OTHER BENEFITS:
Gold
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • R8,100 per family, in and out of hospital. Includes wheelchairs, orthopaedic appliances, incontinence equipment and contraceptive devices.
  • No benefit

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1.1. Hearing Aids:
  • R14,300 per family every 5 years. Maximum R7,100 per ear.
  • Maintenance: R890, including batteries
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • PMB only
HIV:
  • Unlimited
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
Gold
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

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Pneumonia vaccines:
  • Covered
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered, 15yrs+
  • No benefit
Mammogram:
  • Covered, 40yrs+ every two years
  • No benefit
PAS Test:
  • Covered, 40yrs+
  • No benefit
HIV Test:
  • Covered
  • , 15yrs+
  • No benefit
Other:
  • Tetanus injection
  • Malaria medication (R340)
  • HPV vaccination, age 9-14yrs
  • Weight loss programme for BMI over 30
  • No benefit

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:
  • R41,800 per family, subject to authorisation and protocols

    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