Discovery KeyCare Plus C medical aid plan: 2019

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

KeyCare Core C
2019 Costs:
Total Cost pm:

Main member:

R1,661

Adult:

R1,661

Child:

R376
Savings (per year):
  • No savings option on this plan
NEED HELP?
We can help you manage or change this plan.
Click here to start.

IN HOSPITAL PROCEDURES:
KeyCare Core C
Scheme Benefits: Notes and Links:
Specialists:
  • Contracted professionals in your chosen hospital: covered in full
  • Non-contracted professionals in your chosen hospital: 100% scheme rate
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Full Cover Hospital Network: hospital account covered in full, if you use your chosen hospital
  • Partial Cover Hospital Network: no cover
  • Non-network hospital: no cover unless PMB, then 80% of scheme rate
  • Day procedures: KeyCare Start day surgery network
Specialised Radiology:
Supplementary Services: (Physio, etc)
Transplants:
Co-payments:
  • 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: R44,050 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home
Casualty:
    li>After hours care at your chosen GP or network provider
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
  • endoscopic procedures
  • cochlear implants
  • bunions
  • varicose veins
  • refractive eye surgery
  • non cancerous breast conditions
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

.
.
.
.
OUT OF HOSPITAL BENEFITS (non-PMB):
KeyCare Core C
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
General info:
GP consultations:
  • Chosen network GP: Unlimited
  • Non-network GP: 2 consults per person
  • Consult includes selected blood tests and x-rays, as well as medicine
Childcare:
Specialists consultations:
  • 2 consults upto R2,000 per person, if referred by chosen GP
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
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
MATERNITY BENEFITS:
KeyCare Core C
Scheme Benefits Notes and Links:
Hospital stay:
  • Up to 100% scheme rate
  • Elective caesareans: not covered
Consultations:
    Discovery pays for:
  • 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
  • One lactation consult
Scans:
    Discovery pays for:
  • 2 x ultrasound scans
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
CANCER (ONCOLOGY):
KeyCare Core C
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, in State Facilities
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
DENTISTRY:
KeyCare Core C
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: includes consults, fillings and tooth removals at dentist in network
Specialised Dentistry:
In-Hospital Dentistry:
Orthodontics:
Maxillo Facial Surgery:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
MEDICATION:
KeyCare Core C
Scheme Benefits: Notes and Links:
Chronic:
  • Chronic medicine is covered in a State facility
Acute (presrcibed) medication:
  • Medicines that are on medicine list and are prescribed by Network GP are paid for by scheme
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • No benefit
Biological:
  • No benefit, unless PMB level of care
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
OPTOMETRY:
KeyCare Core C
Scheme Benefits: Notes and Links:
Optometry:
Limit:Paid by scheme
Consult:1 per person
Frames:1 per person, incl lenses
Single lensessee above
Bifocals:
Multifocals
ContactsOption of contacts or glasses
Refractive Surgery:n/a
Notes:From network providers
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
MENTAL HEALTH:
KeyCare Core C
Scheme Benefits Notes and Links:
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
Out-of-hospital:
  • See above
/td>
Trauma:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
OTHER BENEFITS:
KeyCare Core C
Scheme Benefits Notes and Links:
General Appliances:
  • No benefit
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
  • State facilities
HIV:
  • Covered if on the HIV Care program
Emergency Transport:
  • Discovery 911
International Insurance:
Other:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
WELLNESS/PREVENTATIVE BENEFITS:
KeyCare Core C
Scheme Benefits: Notes and Links:
Flu vaccination:
Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
Child Immunisation:
Pap Smear:
Mammogram:
PAS Test:
HIV Test:
Other:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
PROSTHETICS:
KeyCare Core C
Scheme Benefits: Notes and Links:
Overal Limit:
  • Covered at network hospitals, subject to authorisation
Sub-limits:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    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