Keyhealth Silver 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:
Silver
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R3,216 R1,730 R670
Cost 2017: (R2,977) (R1,601) (R620)
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: No savings option on this plan
Extended Fund: R6,875 R4,995 R1,385
Children: Pay for maximum 3 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:
Silver
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: no benefit
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • Unlimited, subject to use of DSP
Co-payments:
  • Sigmoidoscopy and Cystoscopy: R2,100 co-payment in hospital
  • Hysteroscopy: R2,950 co-payment
  • Arthroscopy and Laparoscopy: R3,700 co-payment
  • 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: R26,600 per family in and out of hospital
  • Wound care sublimit: R8,550
Casualty:
  • Emergencies: scheme pays full account, including for dental emergencies.
Other:
  • Varicose vein surgery and reflux surgery: PMB only
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OUT OF HOSPITAL BENEFITS:
Silver
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit


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    Childcare:
    • After day-to-day benefit is depleted, an additional 3 consults with GP for children under 21yrs
    • Peadiatrician: 2 consults in baby's first year, paid by scheme
    • non-PMBs chronic: medicine for Acne, ADD/ADHD, Rhinitis for children under age of 21, with 10% co-payment. 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: No benefit
    Supplementary Services: (Physio, etc)
    • Paid from day-to-day benefit
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    MATERNITY BENEFITS:
    Silver
    2017 v 2018 benefits Gap benefits Notes
    Hospital stay:
    • Private ward for 3 days for 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):
    Silver
    2017 v 2018 benefits Gap benefits Notes
    Overall coverage (in and out of hospital):
    • R156,500 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:
    Silver
    2017 v 2018 benefits Gap benefits Notes
    Dentistry:
    • Standard dentistry: paid by scheme. Includes plastic dentures every 4 years
    • Specialised dentistry: no benefit
    • Hospitalisation: 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:
    Silver
    2017 v 2018 benefits Gap benefits Notes
    Chronic:
    • PMBs chronic: paid by scheme. 30% co-payment for non-DSP use
    • non-PMBs chronic: additional 3 conditions for children under 21 (Acne, ADD/ADHD, Rhinitis), 10% co-payment

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    Acute (presrcibed) medication:
    • Paid from day-to-day benefit
    Over-the-counter:
    • Limited to R1,480 per family
    • Paid from day-to-day benefit
    Birth Control:
    • Meds: Paid from day-to-day benefit
    • Devices: paid from medical appliances benefit (R6,700 per family)
    On Discharge:
    • R475
    Biological:
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    OPTOMETRY:
    Silver
    2017 v 2018 benefits Gap benefits Notes
    Optometry:
    • Limited to R1,395 per person every 2 years
    • sub limits: Frames (R465), Lenses (one pair), Contact lenses (R620)
    • Paid from day-to-day benefit
    • Refractive surgery: no benefit
    • In addition, one pair of reading glasses (R115 limit) from the over-the-counter medicine benefit

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    MENTAL HEALTH:
    Silver
    2017 v 2018 benefits Gap benefits Notes
    In-hospital:
    • Psychiatric: R17,700 per family in hospital

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    Out-of-hospital:
    • Psychiatric: R17,700 per family in hospital
    • Out of hospital: PMB only
    Trauma:
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    OTHER BENEFITS:
    Silver
    2017 v 2018 benefits Gap benefits Notes
    General Appliances:
    • R6,700 per family, in and out of hospital
    • 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:
    • 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:
    Silver
    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:
    • R5,600 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