Keyhealth Equillibrium medical aid plan: 2019

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

Equilibrium
2019 Costs:
Total Cost pm:

Main member:

R2,033

Adult:

R1,255

Child: (Pay only for first 3)

R623
Savings: R1,776 R1,092 R540
Extended Fund: R2,695 R1,850 R825
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IN HOSPITAL PROCEDURES:
Equilibrium
Scheme Benefits: Notes and Links:
Specialists: 2019 Benefits coming soon! Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice: 2019 Benefits coming soon!
Specialised Radiology:
  • MRI and CT scans: R14,700 per family with R1,480 co-payment, in and out of hospital. Not covered if for investigative purposes only.
  • PET scans: no benefit
Supplementary Services: (Physio, etc) 2019 Benefits coming soon!
Transplants: 2019 Benefits coming soon!
Co-payments: 2019 Benefits coming soon!
Alternatives to hospitals: 2019 Benefits coming soon!
Casualty: 2019 Benefits coming soon!
Other: 2019 Benefits coming soon!
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Equilibrium
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: R1,776 R1,092 R540
Extended Fund: R2,695 R1,850 R825
General info: 2019 Benefits coming soon!
GP consultations: 2019 Benefits coming soon!
Childcare: 2019 Benefits coming soon!
Specialists consultations: 2019 Benefits coming soon!
Pathology: 2019 Benefits coming soon!
General radiology: 2019 Benefits coming soon!
Specialised radiology: 2019 Benefits coming soon!
Supplementary Services: (Physio, etc) 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MATERNITY BENEFITS:
Equilibrium
Scheme Benefits Notes and Links:
Hospital stay: 2019 Benefits coming soon!
Consultations: 2019 Benefits coming soon!
Scans: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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CANCER (ONCOLOGY):
Equilibrium
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital): 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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DENTISTRY:
Equilibrium
Scheme Benefits Notes and Links:
Standard Dentistry: 2019 Benefits coming soon!
Specialised Dentistry: 2019 Benefits coming soon!
In-Hospital Dentistry: 2019 Benefits coming soon!
Orthodontics: 2019 Benefits coming soon!
Maxillo Facial Surgery: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MEDICATION:
Equilibrium
Scheme Benefits: Notes and Links:
Chronic: 2019 Benefits coming soon!
Acute (presrcibed) medication: 2019 Benefits coming soon!
Over-the-counter: 2019 Benefits coming soon!
Birth Control: 2019 Benefits coming soon!
On Discharge: 2019 Benefits coming soon!
Biological: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OPTOMETRY:
Equilibrium
Scheme Benefits: Notes and Links:
Optometry: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MENTAL HEALTH:
Equilibrium
Scheme Benefits Notes and Links:
In-hospital: 2019 Benefits coming soon!
Out-of-hospital: 2019 Benefits coming soon! /td>
Trauma: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OTHER BENEFITS:
Equilibrium
Scheme Benefits Notes and Links:
General Appliances: 2019 Benefits coming soon!
  • No benefit
1.1. Hearing Aids: 2019 Benefits coming soon!
1.2. Wheelchairs: 2019 Benefits coming soon!
Dialysis: 2019 Benefits coming soon!
HIV: 2019 Benefits coming soon!
Emergency Transport: 2019 Benefits coming soon!
International Insurance: 2019 Benefits coming soon!
Other: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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WELLNESS/PREVENTATIVE BENEFITS:
Equilibrium
Scheme Benefits: Notes and Links:
Flu vaccination: 2019 Benefits coming soon!
Pneumonia vaccines: 2019 Benefits coming soon!
Back Rehabilitation Programme: 2019 Benefits coming soon!
Biometric Screening: 2019 Benefits coming soon!
Child Immunisation: 2019 Benefits coming soon!
Pap Smear: 2019 Benefits coming soon!
Mammogram: 2019 Benefits coming soon!
PAS Test: 2019 Benefits coming soon!
HIV Test: 2019 Benefits coming soon!
Other: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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PROSTHETICS:
Equilibrium
Scheme Benefits: Notes and Links:
Overal Limit: 2019 Benefits coming soon!
Sub-limits: 2019 Benefits coming soon!
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    Important!
  • Unless specified, assume that all benefits are paid 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