Discovery Keycare Start C:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery KeyCare Start C. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

• View all the Discovery plans, with costs and brief summary.
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Terminology:

• 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
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

In-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: KeyCare Start C
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	network Doctors: paid in full non-network Doctors: 100% scheme rate
Hospital Choice:	Chosen KeyCare Start Network hospital: Covered in full Otherwise, no cover unless emergency Day procedures: KeyCare Start Day Surgery Network
Penalty for using other hospital:	See above
Co-payments:	Admission that meet criteria for home-based care: R5,250 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
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
Scopes:	PMBs only
Supplementary Services: (Physio, etc)	Covered in full
Transplants:	Covered
Dialysis:	Covered in State facilities
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 NB: See scheme's rules for all exclusions. All schemes have plenty!
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.
Casualty/ER:	After hours care at your chosen GP or network provider
Other:	.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: KeyCare Start C
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings (per year): No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits.
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	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
Childcare:	GP/Paediatrician/ENT consults: 2 consults, for children 0-2yrs. Paid by scheme. Child assessment: height, weight, head circumference and health and milestone tracking
Specialists consultations:	Two consults up to R2,780 per person, if referred by chosen GP Shared with out-of-hospital specialised radiology benefit
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:	R2,780 per person, if referred by chosen GP Shared with specialist benefit
Scopes:	PMBs only
Supplementary Services: (Physio, etc)	PMBs only
General Appliances:	No benefit
1.1. Hearing Aids:	No benefit
1.2. Wheelchairs:	No benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: KeyCare Start C
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings (per year): No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. Medicine from State facilities only
Acute (prescribed) 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:	PMBs only
View 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.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider