Discovery KeyCare Core A medical aid: 2020

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KeyCare Core A
2020 Costs:
Total Cost pm:

Main member:

R949

Adult:

R949

Child:

R245
Savings (per year):
  • No savings option on this plan
Income band:



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IN HOSPITAL PROCEDURES:
KeyCare Core A
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • The Blue Plan gap cover will increase this to 500% scheme rate
network Specialists:
  • Full cover, for contracted specialists
  • The Blue Plan gap cover will increase this to 500% scheme rate
non-Network GPs:
  • Up to 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
network GPs:
  • Full cover, for contracted specialists
  • The Blue Plan gap cover will increase this to 500% scheme rate
Hospital Choice:
  • Full Cover Hospital Network: hospital account covered in full, if you use your chosen hospital
  • Partial Cover Hospital Network: hospital account covered up to 70% account or 80% of scheme rate for PMB admissions
  • Non-network hospital: no cover unless PMB, then 80% of scheme rate
  • Day procedures: KeyCare day surgery network
Penalty for using other hospital:
  • See above
Specialised Radiology:
  • Up to 100% scheme rate
Supplementary Services: (Physio, etc)
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • Covered
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:
  • No benefit, unless PMB
  • Both the Blue Plan and Red Plan gap cover will pay up to R20,000 per person for unpaid casualty costs in event of emergency
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 R157,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R157,000 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)



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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.

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OUT OF HOSPITAL BENEFITS (non-PMB):
KeyCare Core A
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • No benefit
Childcare:
Specialists consultations:
  • R4,450 per person, if referred by chosen GP
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • No benefit, unless PMB
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB



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MATERNITY BENEFITS:
KeyCare Core A
Scheme Benefits Notes and Links:
Hospital stay:
  • Up to 100% scheme rate
  • Elective caesareans: not covered
  • The Blue Plan gap cover will increase this to 500% scheme rate
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



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CANCER (ONCOLOGY):
KeyCare Core A
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, in allocated network provider



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DENTISTRY:
KeyCare Core A
Scheme Benefits Notes and Links:
Standard Dentistry:
  • No benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry:
In-Hospital Dentistry:
  • No benefit
Orthodontics:
  • No benefit
Maxillo Facial Surgery: TBC



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MEDICATION:
KeyCare Core A
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
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



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OPTOMETRY:
KeyCare Core A
Scheme Benefits: Notes and Links:
Optometry:
Limit:No benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a



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MENTAL HEALTH:
KeyCare Core A
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
Trauma:
  • No benefit, unless PMB



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OTHER BENEFITS:
KeyCare Core A
Scheme Benefits Notes and Links:
General Appliances:
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
  • Covered in full if you use network provider
International Insurance:
  • No benefit
Other: TBC



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WELLNESS/PREVENTATIVE BENEFITS:
KeyCare Core A
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered, for 65 yrs+
Pneumonia vaccines:
  • To be confirmed
Biometric Screening:
  • Covered
Child Immunisation: TBC
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
Other:
  • Kids' assessment, including height, weight, head circumference and health and milestone tracking



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PROSTHETICS:
KeyCare Core A
Scheme Benefits: Notes and Links:
Overal Limit:
  • Covered at network hospitals, subject to authorisation
Sub-limits: .



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    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