Discovery KeyCare Plus B medical aid plan: 2017

Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB. Pay for maximum 3 children. Income-limited plan: R8,101-R11,550pm only

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IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
  • Covered in full at network hospitals
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Hospital Choice:
  • KeyCare Hospital Network or KeyCare day surgery network
Specialised Radiology:
Supplementary Services: (Physio, etc)
Transplants:
  • Covered
Co-payments:
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
  • End of life care: R37,350 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Chosen network GP: Unlimited
  • Non-network GP 4 consults per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • Strong>R3,570 per person
Pathology:
  • Some blood, urine and other fluid and tissue tests, as asked for by GP
General radiology:
  • Basic X-rays covered, if done at a network provider and asked for by the GP
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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MATERNITY BENEFITS:
Hospital stay:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Consultations:
  • 4 visits to GP, gynaecologist or midwife at Network Hospital
  • Selected blood tests are also covered
Scans:
  • One routine scan, between 10 and 20 weeks

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • PMBs only, in allocated network provider

Note: 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.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Standard dentistry: includes consults, fillings and tooth removals at dentist in network. Paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Orthodontics:
  • No benefit
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Acute (presrcibed) medication:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
Notes:

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OPTOMETRY:
Optometry:
  • One eye test per person
  • One pair of contact lenses or glasses every 24 months, from pre-selected options at your Network optometrist
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
  • 21 days per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Out-of-hospital:
  • Major affective disorders, anorexia and bulimia: 15 consultations per person paid by scheme as an alternative to in-hospital treatment
  • Acute stress disorder due to recent significant trauma: 12 consultations per person paid by scheme as an alternative to in-hospital treatment
  • Otherwise, no benefit

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OTHER BENEFITS:
General Appliances:
  • R5,200 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
Dialysis:
  • Covered in full if you use network provider
HIV:
  • Covered if on the HIV Care program
Emergency Transport: Discovery 911
International Coverage:
  • No benefit
Other:
  • Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered, for 65yrs+
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
  • Covered
Child Immunisation:
Pap Smear:
  • Covered, every 3 years
Mammogram:
  • Covered, every 2 years
  • If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
PAS Test:
  • Covered
HIV Test:
  • Covered

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,280 R1,280 R358
Children: Pay for maximum 3 children
Income limit: R8,101-R11,550 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, GP consults, specialists, casualty visits, acute meds, pathology and radiology. Limits and co-payments apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Sub-limits:

    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