• Benefits, Keyhealth Plan, prosthetics, Scheme Plans

Keyhealth Equilibrium:
prosthetic benefits (2025)

Contents:

This page has information on: Costs and Prosthetics for Keyhealth Equilibrium

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 Providers. Where stipulated, you must use 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.

Monthly Costs (2026)

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

Keyhealth:Equilibrium (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R3,296
  • R2,035
  • R1014
Savings:
  • R2,880
  • R1,776
  • R888
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R3,755
  • R2,585
  • R1,150
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
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Prosthetics benefits (2025):

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

Keyhealth: Equilibrium
Assume scheme pays all these costs, unless otherwise stated
Overall Limit:
  • Prosthetics / prosthesis Internal, external, fixation devices and implanted devices: R4,150 per family, unless PMB
  • Prosthetics required for PMB conditions are always paid in full by scheme, with no co-payment, if you follow the protocols. More info here
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Sub-limits: . Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Note:
  • PMBs: Prescribed Minimum Benefits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs here.
  • DSPs: Designated Service Providers. Where stipulated, you must use 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.
    Important!
  • Unless specified, assume that all benefits 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.
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