• topimg-8
  • topimg-10
  • topimg-3

Equilibrium


Hospital


Accidents

Specialists

Oncology

MRI & CT
Scans

Savings

Routine
Expenses

Pathology

Optical

Dental

Chronic
Medication

Ambulance

Medical
Applicances

Scopes

PMB's
FREE Additional Benefits

Easy-ER

Health Booster

Smart Baby

2017 Contributions

  Principal
Member
Adult
Dependant
Child
Dependant
Monthly
Contribution
R1 685 R1 016 R516
Monthly
Savings
R132 R80 R40

Total Monthly
Contribution

R1 817 R1 096 R556

*Note: Contributions charged up to a maximum of 3 child dependants


pa   - Per annum
pfpa  - Per family per annum
pbpa  - Per beneficiary per annum
pfp2a  - Per family every 2 years
pfp4a  - Per family every 4 years

yesBenefits


Click on the tabs below to see a full description of the option benefits

Disaster or major medical expenses cover

IncludedBenefit descriptionBenefit value
  yes

Hospital related costs
All costs related to treatment at Netcare or Life Healthcare (DSP hospital network) will be paid in full. There is no restriction on the number of admissions to hospital, but all in-hospital procedures should be pre-authorised prior to admission.
*30% co-payment applicable on hospital account if non-DSP hospital is utilised volentarily.

Unlimited

  yes

Injuries suffered as result of an accident
Almost all accidents are regarded as a PMB (Prescribed Minimum Benefit) and the treatment of such injuries, including the hospitalisation, will therefore be covered in full by the Scheme.

Unlimited

  conditions
Conditions apply

Specialist services in-hospital
The services provided by any Specialist whilst the member is in hospital are covered by the Scheme.

Unlimited

  yes

Oncology
The diagnosis and treatment of cancer related conditions.

R131 500 pfpa

  conditions
Conditions apply
MRI & CT scans
Includes scans done for diagnostic reasons both in- and out-of-hospital.

 

R13 900 pfpa

Day-to-day medical expenses cover (outside of the hospital)

IncludedBenefit descriptionBenefit value
  yes

Medical savings account (MSA)
A portion of a member’s monthly contribution is allocated in advance at the beginning of the year to a MSA that is used to pay for day-to-day medical expenses. The MSA can also be used to pay for expenses not covered by the Scheme (e.g. co-payments, exclusions, etc.) and is carried forward to the following year if there is a positive balance at the end of that year. This is a family benefit which means that one member of a family can use the total benefit allocation.

Principal Member:
R1 584 pa
Adult dependant:
R960 pa
Child dependant:
R480 pa

  yes

Routine medical expenses
Includes day-to-day medical expenses for GP and Specialist consultations, X-rays; prescribed (acute) and over-the-counter medication, blood tests, physiotherapy, optical, etc. This benefit is a family benefit which means that one member of a family can use the total benefit allocation.
Principal Member:
R2 070 pa
Adult dependant:
R1 150 pa
Child dependant:
R625 pa

  yes

Pathology
Blood tests done outside of the hospital as requested by a GP or Specialist are paid from the day-to-day benefit amount, i.e. the MSA and/or routine expenses portion.

Subject to amount available in MSA

  conditions
Conditions apply
Optical services
Optical services, including eye tests, frames, lenses and contact lenses, are paid from the day-to-day benefit amount, i.e. the MSA and/or routine expenses portion.

Subject to amount available in MSA and/or routine benefit allocation

Dentistry

IncludedBenefit descriptionBenefit value
  conditions
Conditions apply
Dental treatment
The provision of conservative dental treatment to members which include the consultation at the dentist, any x-rays, oral hygiene treatment, fillings, extractions and root canal treatment.

Unlimited

Chronic medication

IncludedBenefit descriptionBenefit value
  yes

Chronic medication for CDL conditions
Prescribed medication used continuously for 3 months or more for one of the 26 CDL (Chronic Disease List) illness conditions.

Unlimited

  yes

Extra chronic medication
Prescribed medication used continuously for 3 months or more for (3 extra chronic conditions) that are not on the CDL (Chronic Disease List) illness conditions for children under the age of 21.

Unlimited

Supplementary services cover

IncludedBenefit descriptionBenefit value
  yes

Emergency transport by ambulance
Netcare 911 provides members with emergency transport from any accident scene by road or air ambulance and medically justified inter-hospital transfers.

Unlimited

  conditions
Conditions apply
Medical appliances
The provision of medical equipment used for the treatment and cure of medical conditions or procedures, including equipment such as wheelchairs, crutches and contraceptive devices).

R6 200 pfpa

  yes

Endoscopic procedures (scopes)
Colonoscopy and/or gastroscopy are covered in full if done at one of the major hospital groups in the country or if done in the doctor’s rooms.
For any other scope, a co-payment will be applicable.

Unlimited

PMBs

IncludedBenefit descriptionBenefit value
  yes

Prescribed Minimum Benefits
Prescribed Minimum Benefits (PMBs) are a set of legislated, defined benefits to ensure that all medical scheme members are entitled to certain minimum health services, regardless of the benefit option they have selected on their scheme.

Unlimited

FREE additional benefits

IncludedBenefit descriptionBenefit value
  yes

Easy-ER
Gives all KeyHealth beneficiaries free, direct access to any hospital’s ER facility for medical treatment in emergency situations. No upfront payments required. Also includes cover for dental emergencies. KeyHealth guarantees payment for the full ER event – no savings or day-to-day benefits used!
Unlimited

  yes

Health Booster
Is aimed at preventative treatment and early detection. This benefit is provided at no extra cost and does not form part of the normal day-to-day benefits. Includes malaria medication, baby immunisations, flu vaccine, pap smear, HIV test, mammogram, prostate test, general health assessment, weight loss benefits and maternity benefits.

More than
R23 000 worth of benefits


  yes

Smart Baby Program
Smart Baby is there to make a pregnancy even more special by offering great maternity benefits, support, general advice on health and wellness, and simply making the journey as enjoyable as possible for you.   Benefits on this program include –
  • A benefit of R1 000 that will cover any short payments/co-payments for services rendered during ante-natal visits to a GP, Gynaecologist or Midwife, or during pregnancy scans (including the cost for birthing fees).
  • For first-time mothers The New Baby & Childcare Handbook by Marina Petropulos to assist during this exciting time.
  • Access to the KeyHealth Smart Baby Facebook group providing valuable information and answers to questions regarding the pregnancy and general childcare.
  • Regular, valuable communication during the pregnancy.
  • Information regarding KeyHealth’s maternity benefits available to mothers and babies (e.g.  12 ante-natal visits, scans, ultrasounds, vitamins and ante-natal classes etc.) and how to access these benefits.
  • Information applicable to baby’s first year (e.g. vaccinations, Easy-ER, etc.).
Applicable to every pregnancy on the Scheme

noNot Included


Hospitalisation benefits for the following procedures:

  • Varicose vein and reflux surgery
  • Facet joint injections
  • Rhizotomy
  • Back surgery (including spinal fusion)
  • Joint replacements (e.g. hip and knee)
  • Any procedure requiring a prosthesis / internal fixation device

Specialised dentistry
Prosthesis benefits



Not quite right? View our other options: