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

What's on this page:

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

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.

Monthly Costs (2025)

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

Keyhealth:Silver (2025 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R5,423
  • R2,918
  • R1,133
  • Only pay for 3 children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R9,300
  • R6,760
  • R1,880
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

In-hospital Procedures (2025):

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

Keyhealth: Silver
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 100% scheme rate
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
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.
Specialised Radiology:
  • MRI and CT Scans: R21,950 per family with R1,650 co-payment. In and out of hospital.
  • PET Scans: PMBs only
Scopes:
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions:
  • Varicose vein surgery
  • Reflux Surgery
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:
  • Hospice, private nursing, rehab, step-down facilities and wound care: R37,600 per family
  • Wound care: R12,050, sublimit of above, in and out of hospital
Casualty/ER:
  • PMBs only
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: Silver
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R9,300
  • R6,760
  • R1,880
PMBs out of hospital:
GP consultations:
  • From day-to-day benefit
Childcare:
  • Growth Assessments: 3 growth assessments, 0- 7yrs
  • 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: R21,950 per family with R1,650 co-payment. In and out of hospital.
  • PET scans: No benefit
Scopes:
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: R8,050 per family, unless PMB
1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

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 (2025):

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

Keyhealth: Silver
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R9,300
  • R6,760
  • R1,880
Chronic:
  • Also: additional 4 conditions: acne, ADHD or ADD (children under 21yrs), rhinitis and depression
Acute (prescribed) medication:
  • From day-to-day benefit
Over-the-counter:
  • R2,090 per family, from day-to-day benefit
Birth Control:
  • Contraceptive device: From "Appliances" benefit, R9,500 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

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.


What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover.