Note: We are updating 2024 benefits as they are released. Some plans show old benefits until schemes release new plans.

Keyhealth Equilibrium: in-and-out of hospital benefits (2024)


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Monthly Costs:

Equilibrium 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R2,778
  • R1,716
  • R854
  • Only pay for 3 children
Savings:
  • R2,424
  • R1,500
  • R744
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R3,455
  • R2,380
  • R1,055
Children Rates:
  • Under 21yrs, unless student. Then, under 27yrs. Spouses/partners who are under 27 and full time students pay child rates.
  • Only pay for 3 children
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | 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 Keyhealth plans, with costs and brief summary
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In-hospital Procedures for 2024:

Keyhealth: Equilibrium
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Choose any Netcare or Lifecare, and Mediclinic in Western Cape, Bloemfontein and Polokwane
Day Hospitals: .
Penalty for using other hospital:
  • non-Network hospital: 30% co-payment
Other Co-payments: .
Specialised Radiology:
  • MRI and CT Scans: R21,000 per family. In and out of hospital.
  • PET scans: No benefit
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions:
  • Varicose vein surgery
  • Reflux Surgery
Alternatives to hospitals:
  • Hospice, private nursing, rehab, step-down facilities and wound care: PMBs only
Casualty:
  • PMBs only
Other:
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
♦️View all the other benefits for this plan:♦️
Inhospital | 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 Keyhealth plans, with costs and brief summary
.
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.

Out-of-hospital Procedures for 2024:

Keyhealth: Equilibrium
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R2,424
  • R1,500
  • R744
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R3,455
  • R2,380
  • R1,055
PMBs out of hospital:
  • 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.
General info:
GP consultations:
  • From day-to-day benefit
Childcare:
  • Growth Assessments: 3 growth assessments, 0- 35 months
  • Paediatrician: 2 consults 0-1yr, and 1 consult 1-2yrs
  • Immunisations: Up to 6yrs
  • Hearing test: Newborns
  • Eye test: 0-7yrs
Specialists consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • MRI and CT Scans: R21,000 per family. In and out of hospital.
  • PET scans: No benefit
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • Wheelchairs, orthopaedic appliances and incontinence equipment:R8,800 per family, in and out of hospital.
  • Includes contraceptive device
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
Note:
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | 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 Keyhealth plans, with costs and brief summary
.

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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Medication Benefit for 2024:

Keyhealth: Equilibrium
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R2,424
  • R1,500
  • R744
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R3,455
  • R2,380
  • R1,055
Chronic:
  • Also: additional 4 conditions: acne, ADHD or ADD (children under 21yrs), rhinitis and depression
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • Contraceptive device: From "Appliances" benefit, R8,800 per family
  • Tablets: R185 every 20 days
  • Injectables: R285 every 72 days
On Discharge:
  • R640
Biological:
  • PMBs only
Note:
  • 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:♦️
Inhospital | 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 Keyhealth plans, with costs and brief summary
.

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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