Discovery KeyCare Plus A medical aid plan: 2019

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Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

KeyCare Plus B
2018 Costs:
Total Cost pm:

Main member:

R1,386

Adult:

R1,386

Child: (Pay only for first 3)

R389
Savings Account:
  • No savings option on this plan
2019 Costs:
Total Cost pm:

Main member:

R1,456
(5.05%)

Adult:

R1,456

Child: (Pay only for first 3)

R463
Savings (per year):
  • No savings option on this plan
Income band:
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In brief (2018):
  • KeyCare Hospital network must be used
  • Cancer treatment for PMBs only at network provider
  • Primary healthcare, maternity care, radiology and pathology covered by scheme
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
KeyCare Plus B
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • Professionals in network: covered in full
  • You or gap cover pay the balance, if any
AskAdam Gap
  • N/A
Discovery Gap
  • Not available n this plan
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
  • No benefit, unless PMB
Specialised Radiology:
  • 100% scheme rate
  • No benefit
Supplementary Services: (Physio, etc)
  • Up to 100% scheme rate
AskAdam Gap
  • Gap tops up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
Transplants:
  • Covered
AskAdam Gap
  • Gap pays up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
Co-payments:
  • N/A
  • 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
  • No extra benefit available
Casualty:
  • R355 co-payment for casualty visits at network hospital
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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
  • No benefit for exclusions
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)
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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 Plus B
Scheme Benefits Gap benefits
Main: 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:
  • Chosen network GP: Unlimited
  • Non-network GP: 4 consults per person
  • Consult includes selected blood tests and x-rays, as well as medicine
  • No benefit, unless PMB
Childcare:
  • No extra benefit available
Specialists consultations:
  • R4,050 per person, if referred by chosen GP
  • No benefit, unless PMB
Pathology:
  • Some blood, urine and other fluid and tissue tests, as asked for by GP
  • No benefit, unless PMB
General radiology:
  • Basic X-rays covered, if done at a network provider and asked for by the GP
See above
Specialised radiology:
  • No benefit, unless PMB
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit, unless PMB
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MATERNITY BENEFITS:
KeyCare Plus B
Scheme Benefits Gap benefits
Hospital stay:
  • Up to 100% scheme rate
  • Elective caesareans: not covered
AskAdam Gap
  • Gap pays up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
  • No benefit for exclusions
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
  • No benefit, unless PMB
Scans:
    Discovery pays for:
  • 2 x ultrasound scans
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CANCER (ONCOLOGY):
KeyCare Plus B
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, in allocated network provider
  • No benefit, unless PMB
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DENTISTRY:
KeyCare Plus B
Scheme Benefits Gap benefits
Standard Dentistry:
  • Standard dentistry: includes consults, fillings and tooth removals at dentist in network
Specialised Dentistry: AskAdam Gap:
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
In-Hospital Dentistry:
Orthodontics:
  • No benefit
Maxillo Facial Surgery: TBC
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)
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MEDICATION:
KeyCare Plus B
Scheme Benefits Gap benefits
Chronic:
  • Conditions covered:27 CDL conditions
  • No benefit, unless PMB
Acute (presrcibed) medication:
  • Medicines that are on medicine list and are prescribed by Network GP are paid for by scheme
  • No benefit, unless PMB
Over-the-counter:
  • No benefit
  • No benefit, unless PMB
Birth Control:
  • No benefit
  • No benefit, unless PMB
On Discharge:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
  • No benefit, unless PMB
Biological:
  • No benefit, unless PMB level of care
  • No benefit, unless PMB
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OPTOMETRY:
KeyCare Plus B
Scheme Benefits Gap benefits
Optometry:
Limit:Paid by scheme, every 24 months
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
  • No benefit, unless PMB
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MENTAL HEALTH:
KeyCare Plus B
Scheme Benefits Gap benefits
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
  • No extra benefit available
Out-of-hospital:
  • See above
  • No extra benefit available
Trauma:
  • Offers out of hospital claims for recovery after traumatic events for rest of year, and year after that
  • No extra benefit available
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OTHER BENEFITS:
KeyCare Plus B
Scheme Benefits Gap benefits
General Appliances:
  • R5,400 per family, from network provider
  • No benefit
1.1. Hearing Aids:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Covered in full if you use network provider
  • No extra benefit available
HIV:
  • Covered if on the HIV Care program
  • No benefit
Emergency Transport:
  • Discovery 911
  • No benefit
International Insurance:
  • No benefit
  • 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:
KeyCare Plus B
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered, for 65 yrs+
  • No benefit
Pneumonia vaccines:
  • To be confirmed
  • No benefit
Back Rehabilitation Programme: TBC
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation: TBC
  • No benefit
Pap Smear:
  • Covered, every 3 years
  • No benefit
Mammogram:
  • Covered, every 2 years
  • If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • Kids' assessment, including height, weight, head circumference and health and milestone tracking
  • No benefit
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PROSTHETICS:
KeyCare Plus B
Scheme Benefits Gap benefits
Overal Limit:
  • Covered at network hospitals, subject to authorisation
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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