This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery KeyCare Start A.
In-hospital Procedures (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
| non-Network Specialists: |
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| network Specialists: |
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| non-Network GPs: |
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| network GPs: |
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| Hospital Choice: |
- Chosen KeyCare Start Network hospital: Covered in full
- Otherwise, no cover unless emergency
- Day procedures: KeyCare Start Day Surgery Network
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| Day Hospitals: |
- Certain procedures are covered in full at Day Hospital
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| Penalty for using other hospital: |
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| Other Co-payments: |
- Admission that meet criteria for home-based care: R5,250 co-payment
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| Specialised Radiology: |
- MRI and CT scans, Part of approved admission: Covered by scheme
- MRI and CT scans, Not part of approved admission: R2,780, from specialist benefit
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| Scopes: |
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| Supplementary Services: (Physio, etc) |
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| Transplants: |
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| Dialysis: |
- Covered in State facilities
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| Exclusions: |
Exclusions:
- Dentistry
- Tonsillectomies, Myringotomies and Adenoidectomies
- 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
- Arthroscopy
- Joint replacements
- Endoscopic procedures
- Cochlear implants
- Bunions
- Varicose veins
- Refractive eye surgery
- Non cancerous breast conditions
- Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
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| Alternatives to hospitals: |
- Hospital at home: Used in case of early hospital release, or as an alternative to admission. Includes physical and virtual care, monitoring devices and access to procedures and interventions to manage care at home.
- Monitoring devices: As approved, for chronic and acute conditions
- Palliative care at home: Unlimited, as approved
- Home Care As an alternative to hospital admission. Services such as postnatal care, end-of-life care, IV infusions (drips), and wound care.
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| Casualty: |
- After hours care at your chosen GP or network provider
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| Other: |
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| Note: |
- PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
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View all the other benefits for this plan:
In-hospital |
Out-of-hospital |
Medication |
Maternity
Cancer |
Mental Health |
Dentistry |
Optometry
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
Compare any two plans, side by side |
View all the Discovery plans, with costs and brief summary.
Find all other open medical aid plans here.
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Out-of-hospital Procedures (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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- All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
- This can include consults with specialists, blood or other tests, radiology and medicine
- The benefit is paid by the scheme, and not out of your savings account
- If you have no day-to-day funds, you still have cover for PMBs
- Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
- See our Guide to PMBs for more information.
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- Discovery provides a Personal Health Fund for day-to-day expenses, over and above any other day-to-day benefit.
- You accumulate money into this fund by completing certain health check and milestones
- You can accumulate a maximum of R500 per adult and R250 per child. There is a maximum of R1,000 per family that can be acumulated.
- Once allocated, this money can be used to pay for almost any day-to-day expenses
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- Chosen KeyCare Network GP: Unlimited
- Consult includes selected blood tests and x-rays, as well as medicine
- Virtual Urgent Care: 1 session per family, paid by scheme
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- GP/Paediatrician/ENT consults: 2 consults, for children 0-2yrs. Paid by scheme.
- Child assessment: height, weight, head circumference and health and milestone tracking
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- Two consults up to R2,780 per person, if referred by chosen GP
- Shared with out-of-hospital specialised radiology benefit
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- Some blood, urine and other fluid and tissue tests, as asked for by GP
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- Basic X-rays covered, if done at a network provider and asked for by the GP
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- R2,780 per person, if referred by chosen GP
- Shared with specialist benefit
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| Scopes: |
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- PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
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View all the other benefits for this plan:
In-hospital |
Out-of-hospital |
Medication |
Maternity
Cancer |
Mental Health |
Dentistry |
Optometry
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
Compare any two plans, side by side |
View all the Discovery plans, with costs and brief summary.
Find all other open medical aid plans here.
|
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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
Medication Benefit (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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| Chronic: |
- Medicine from State facilities only
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- Medicines that are on medicine list and are prescribed by Network GP are paid for by scheme
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- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
View all the other benefits for this plan:
In-hospital |
Out-of-hospital |
Medication |
Maternity
Cancer |
Mental Health |
Dentistry |
Optometry
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
Compare any two plans, side by side |
View all the Discovery plans, with costs and brief summary.
Find all other open medical aid plans here.
|
| . |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
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