Discovery KeyCare Plus A medical aid plan: 2019

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KeyCare Plus A
2019 Costs:
Total Cost pm:

Main member:

R1,088

Adult:

R1,088

Child: (Pay only for first 3)

R396
Savings (per year):
  • No savings option on this plan
Income band:
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IN HOSPITAL PROCEDURES:
KeyCare Plus A
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 100% scheme rate
  • Professionals in network: covered in full
  • 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: 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
Specialised Radiology:
  • 100% scheme rate
Supplementary Services: (Physio, etc)
  • Up to 100% 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:
  • R355 co-payment for casualty visits at network hospital
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?
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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 A
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
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
Childcare:
Specialists consultations:
  • R4,050 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?
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MATERNITY BENEFITS:
KeyCare Plus A
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?
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CANCER (ONCOLOGY):
KeyCare Plus A
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, in allocated network provider
What next?
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DENTISTRY:
KeyCare Plus A
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:
  • No benefit
Maxillo Facial Surgery: TBC
What next?
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MEDICATION:
KeyCare Plus 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:
  • Medicines on medicine list, if prescribed by KeyCare network GP: Covered
Biological:
  • No benefit, unless PMB level of care
What next?
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OPTOMETRY:
KeyCare Plus A
Scheme Benefits: Notes and Links:
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
What next?
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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.

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MENTAL HEALTH:
KeyCare Plus 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
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Trauma:
  • Offers out of hospital claims for recovery after traumatic events for rest of year, and year after that
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.

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OTHER BENEFITS:
KeyCare Plus A
Scheme Benefits Notes and Links:
General Appliances:
  • R5,400 per family, from network provider
  • No benefit
1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
Dialysis:
  • Covered in full if you use network provider
HIV:
  • Covered if on the HIV Care program
Emergency Transport:
  • Discovery 911
International Insurance:
  • No benefit
Other:
  • Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment
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.

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WELLNESS/PREVENTATIVE BENEFITS:
KeyCare Plus A
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered, for 65 yrs+
Pneumonia vaccines:
  • To be confirmed
Back Rehabilitation Programme: TBC
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
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.

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PROSTHETICS:
KeyCare Plus A
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