This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Keyhealth Gold.
In-hospital Procedures (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated
|
non-Network Specialists: |
|
network Specialists: |
|
non-Network GPs: |
|
network GPs: |
|
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 nd CT Scans: R21,000 per family. In and out of hospital.
- PET scans: No benefit
|
Scopes: |
|
Supplementary Services: (Physio, etc) |
|
Transplants: |
|
|
Dialysis: |
|
|
Exclusions: |
. |
Alternatives to hospitals: |
- Hospice, private nursing, rehab, step-down facilities and wound care: R48,700 per family
- Wound care: R16,000, sublimit of above, in and out of hospital
|
|
Casualty: |
|
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:
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.
|
. |
Out-of-hospital Procedures (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
|
|
|
|
|
|
|
- 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.
|
There is a savings account on this plan, as well as an additional fund paid by the medical aid. |
|
- Growth Assessments: 3 growth assessments, 0- 35 months
- Paediatrician: 2 consults 0-1yr, and 1 consult 1-2yrs
- Immunisations: Up to 6yrs
|
|
|
|
|
- MRI nd CT Scans: R21,000 per family. In and out of hospital.
- PET scans: No benefit
|
Scopes: |
|
|
|
- Wheelchairs, orthopaedic appliances and incontinence equipment:R10,800 per family, in and out of hospital.
- Includes contraceptive device
|
- R19,250 per family, every 5 years
- Batteries and maintenance: R1,215 per person
|
- See "General Appliances" limit
|
- 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:
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.
|
. |
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.
Medication Benefit (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
|
|
|
|
|
|
|
Chronic: |
- Additional R10,300 per family
|
|
|
- R2,460 per family, from day-to-day benefits
|
- Contraceptive device: From "Appliances" benefit, R8,800 per family
- Tablets: R185 every 20 days
- Injectables: R285 every 72 days
|
|
|
- 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:
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.
|
. |
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.
|