Keyhealth Gold:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Keyhealth Gold. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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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 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
• 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.

In-hospital Procedures (2025):

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

Keyhealth: Gold
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	100% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Choose any Netcare or Lifecare, and Mediclinic in Western Cape, Bloemfontein and Polokwane
Penalty for using other hospital:	Use of non-Network hospital: 30% penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	MRIs, CT scans etc: R1,650 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI and CT Scans: R22,000 per family with R1,650 co-payment. In and out of hospital. PET scans: 2 scans per family, R29,400 per scan	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	100% scheme rate
Transplants:	PMBs only
Dialysis:	PMBs only
Exclusions:	. NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Hospice, private nursing, rehab, step-down facilities and wound care: R50,900 per family Wound care: R16,700, sublimit of above, in and out of hospital
Casualty/ER:	PMBs only	Gap Cover: Can cover ER claims (Plans coming soon)
Other:
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

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

Keyhealth: Gold
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R8,436 R5,700 R1,656 Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account R6,020 R4,480 R1,440 Other Day-to-Day Funds:
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
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	Gap Cover: Can pay for child ER visits (Plans coming soon)
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: R22,000 per family with R1,650 co-payment. In and out of hospital. PET scans: 2 scans per family, R29,400 per scan	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	From day-to-day benefit
General Appliances:	Wheelchairs, orthopaedic appliances, contraceptive device and incontinence equipment: R9,500 per family, in and out of hospital. Prosthetics / prosthesis Internal, external, fixation devices and implanted devices: R59,100 per family, unless PMB
1.1. Hearing Aids:	R20,150 per family, every 5 years Batteries and maintenance: R1,270 per person Paid by scheme
1.2. Wheelchairs:	See "General Appliances" limit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

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

Keyhealth: Gold
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R8,436 R5,700 R1,656 Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account R6,020 R4,480 R1,440 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. Additional R10,800 per family
Acute (prescribed) medication:	From day-to-day benefit
Over-the-counter:	R2,570 per family, from day-to-day benefit
Birth Control:	Contraceptive device: From "Appliances" benefit, R11,300 per family Tablets: R185 every 20 days Injectables : R285 every 72 days
On Discharge:	R670 per admission
Biological:	PMBs only
View other benefits for this plan: In-hospital | 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. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider