The KeyCare Series
The KeyCare Plans offer you affordable cover in the KeyCare network of hospitals and doctors
You have access to additional benefits
- Emergency response services nationwide with Discovery 911
- Cover for when you need to see a specialist
- Cover for when you need to see a gynaecologist when you are pregnant
Hospital Benefits
We cover you in hospital for emergency and planned hospital admissions. In an emergency, go straight to hospital but call us or get someone to call us within 12 hours. For planned hospital admissions, please call us 48 hours before you go to hospital to confirm your admission.
| KeyCare Series | |
|---|---|
| Overall limit | There is no overall hospital limit on the KeyCare Plans Limits apply to some healthcare services and procedures |
| Choice of hospitals | The KeyCare Plans cover you in any hospital in the KeyCare network* |
| Procedures and consultations by specialists participating in direct payment arrangements | The KeyCare Plans cover you in full if you consult a specialist who charges according to the KeyCare payment arrangement |
| Other healthcare professionals | Your plan covers you up to 100% of the Discovery Health Rate |
| Dentistry | No benefit |
| Endoscopies (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) | As part of an approved hospital admission: no overall limit |
| MRI and CT scans | As part of an approved hospital admission: no overall limit If admitted for conservative back or neck treatment: no benefit |
| Terminal care benefit | R16 950 for each person |
| Dialysis | We cover these expenses in full as long as we have approved your treatment plan and you use a provider in our network |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
For more detailed information on how we cover specific healthcare services go to Do We Cover
* If you don’t use KeyCare network hospitals, you will need to pay your claims. This does not apply in an emergency.
The benefits described in this section are subject to clinical guidelines and policies.
KeyCare hospitals for 2010
DiscoveryCare offers specific benefits to help you manage chronic conditions
You have flexible cover for chronic diseases. You have full cover for approved medicine on the Discovery Health medicine list or up to an allocated amount for medicine not on our list. We pay medicine up to a maximum of the Discovery Health medication rate. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit.
| Additional benefits | |
|---|---|
| Specialists | We cover consultations at specialists up to R2 000 for each person for each year. You must conf rm your benefits with us. On KeyCare Plus, your chosen GP must refer you. |
| Antenatal benefits | We cover:
|
| Screening Benefit | If you go for certain preventive screening tests, we will cover the claim. The screening tests include the following group of tests: blood glucose, blood pressure,cholesterol and body mass index at a Discovery Wellness Network provider. The benefit also covers a mammogram, Pap smear, PSA and HIV screening tests. Members from the age of 65 and members registered for certain chronic conditions are also covered for a seasonal flu vaccine from this benefit. |
| Day-to-day benefits - KeyCare Plus only | |
| Casualty | You must visit a casualty unit at a KeyCare network hospital. If you go to one of our preferred casualty units in the KeyCare network of hospitals, you pay R95 of the casualty unit’s account. You can also visit other casualty units in the KeyCare network of hospitals that are not part of the preferred casualty units. In this case you will pay the R210 of the casualty unit’s account. |
| Trauma Recovery Extender Benefit | We will cover specific out-of-hospital claims for your recovery after certain traumatic events. Your cover applies for the rest of the year in which the trauma takes place, as well as the year after your trauma. |
| Cover for GPs | Consultations and minor procedures at your chosen KeyCare network GP |
| X-rays and blood tests | Selected basic x-rays and blood tests only if requested by your chosen KeyCare network GP |
| Medicine | Acute medicines (according to the KeyCare acute medicine list) only if prescribed by your chosen KeyCare network GP |
| Dentistry | Selected basic dentistry (consultations, fillings and extractions) only at a dentist within the KeyCare dentist network |
| Glasses and eye tests | One eye test and one pair of clear single vision, bifocal or multifocal lenses with a basic frame, or a basic set of contact lenses for each person, every 24 months from your last date of service. Cover only at an optometrist within the KeyCare optometry network |
Exclusions on the KeyCare Plans
The Discovery Health Medical Scheme does not cover certain healthcare services.
In addition to the general Discovery Health Medical Scheme exclusions applicable on all plans, KeyCare Plans have the following exclusions, except as stipulated in the Prescribed Minimum Benefits:
- In-hospital management of
- dentistry
- obesity
- skin disorders
- diagnostic work-up
- conservative back and neck treatment
- functional nasal problems
- elective caesarean section, except if medically necessary
- surgery for oesophageal reflux
- back and neck surgery
- hip and knee replacements
- cochlear implants, auditory brain implants and internal nerve stimulators. This includes procedures, devices and processors.
- Brachytherapy for prostate cancer
- Refractive eye surgery
- Fibroadenosis
- Healthcare services outside South Africa
We also do not cover the cost of treatment for any complications, or the direct or indirect expenses related to these conditions and treatments.
If we apply waiting periods because you have never belonged to a medical scheme or have had a break in membership of more than 90 days before joining Discovery Health, you will not have access to the Prescribed Minimum Benefits during your waiting periods. This includes emergency admissions.
2010 Monthly contributions
| KeyCare Plan | Main member | Adult | Child* |
|---|---|---|---|
| KeyCare Plus (R8 001 +) | R171 | R1 030 | R275 |
| KeyCare Plus (R6 001 – R8 000) | R692 | R692 | R193 |
| KeyCare Plus (R3 751 – R6 000) | R494 | R494 | R143 |
| KeyCare Plus (R0 – R3 750) | R412 | R412 | R110 |
| KeyCare Core (R8 001 +) | R761 | R761 | R171 |
| KeyCare Core (R6 001 – R8 000) | R492 | R492 | R123 |
| KeyCare Core (R0 – R6 000) | R396 | R396 | R99 |
* We count a maximum of three children when we work out the monthly contribution.
How to join Discovery Health
We market our Discovery Health Plans through independent and accredited financial advisers. If you want a financial adviser to help you choose a Health Plan to suit the needs of your family, please send us your contact details and we will contact you.
