Discovery Health 2017 – Part 28

[banner id=”19730″]

In part twenty two we looked at the Core range as a whole. Now it’s time for the KeyCare range.

So how do I best explain the KeyCare options?

The first thing that sprang to mind for me was socialism. But not socialism in a bad way, if you know what I mean.
Think of it…Everyone enjoys the same benefits but those who earn more pay more.

Discovery Health refers to the KeyCare range as an affordable medical aid.
I think it’s great because those who aren’t familiar with medical savings accounts – and the fact that these accounts can run empty very quickly – can see a doctor as often as they need to.

After all, how do you explain to someone that they must keep paying for the medical aid, BUT that they can’t see the doctor anymore?

The doctors on the network get to see a lot more clients than they might have previously done.  But to see more clients they must agree to charging the Discovery Health rate (DHR). And the same thing applies to hospitals.

Here are your three options

First and foremost there is KeyCare Plus.
KeyCare Plus offers:

  • Unlimited hospital cover at a KeyCare networked hospital or day surgery network. Up to 70% of the DHR is paid for procedures in the Partial cover hospital network
  • Unlimited cover at a network of GP’s

Second in rank is KeyCare Access.
KeyCare Access offers:

  • Unlimited hospital cover for emergencies and childbirth at a KeyCare networked hospital. Other conditions are covered at a network of state facilities
  • Unlimited cover at a network of GP’s

Lastly there is KeyCare Core.
KeyCare Core offers:

  • Unlimited cover at a KeyCare networked hospital or day surgery network. Up to 70% of the DHR for procedures in the Partial cover hospital network

For the relatively small difference in cost I’d say look at the KeyCare Plus plans.

So how does the “earn more pay more” thing work?

Let’s take each of the three plans individually. You will notice that each plan type has a set of income brackets. The bracket you fall into will determine the price you pay.

Key Care Plus
This plan comes with three salary brackets:

  • R0 to R8, 100 a month
  • R8, 101 to R11, 550 a month, and
  • R11, 551 or more a month

KeyCare Access

This plan comes with four salary brackets:

  • R0 to R5, 050 a month
  • R5, 051 to R8, 100 a month
  • R8, 101 to R11, 550 a month, and
  • R11, 551 or more a month

Key Care Core
This plan comes with three salary brackets:

  • R0 to R8, 100 a month
  • R8, 101 to R11, 550 a month, and
  • R11, 551 or more a month

You will need to provide your last 3 months payslips as well as three months bank statements upon application.
Also, at the end of the year, you will need to re-submit proof of income for the following year.

So what kind of price increase can you look forward to in 2017 on the KeyCare range?

9, 9% price increase for 2017.

So what do KeyCare plans offer?

Hospital cover

All hospitals in the KeyCare network are private, and cover in them is unlimited. You can book in as often as is needed, in other words.

They also offer the option of using a Partial cover hospital network. In this instance, only 70% of the Discovery Health rate is paid for a procedure. If the reason for your admission is because of a prescribed minimum benefit (PMB), then Discovery Health will pay 80% of the DHR.

If you use a non-networked hospital for an approved admission Discovery Health will not pay (unless it’s because of a PMB, in which case they’ll pay 80% of the DHR).

On the KeyCare access range, the KeyCare networked hospital range is only available:

  • in emergencies (There is a list of 10 traumas one of which is car accidents)
  • for childbirth, and
  • care for your new born baby

21 procedures are only done in the day surgery network.  Example of this are:

  • Cataract surgery
  • Circumcision
  • Tonsillectomy
  • Adenoidectomy (where do they get these words?), and
  • All the different types of scopes you can think of

Specialists while in hospital?

Those that are in the KeyCare network are paid in full. Those that aren’t, are paid at 100% of the DHR which means you might need to pay any difference. Radiology and pathology are paid at 100% of the DHR.

Private specialists may be seen out of hospital but this is limited to R3, 570 per person on your plan.

For those on chronic medication

Chronic medication is offered for all 27 diseases appearing on the prescribed minimum benefits list (PMB’s).

All these chronic medications must be on the KeyCare medicine list and come from designated service providers in the network. If you get your medicine elsewhere you will end up paying 20% of the DHR for these. If the medicine is not on their list, then you will pay for it yourself.

On the KeyCare Plus and Access range, these must be prescribed by your KeyCare GP. On the KeyCare Core plan, any GP can prescribe them.

The KeyCare networked GP’s

When you sign up for a KeyCare Plus or Access plan, you will need to choose a KeyCare networked doctor upfront. In fact, you can select up to two doctors. This doctor must be seen every time you wish to see a doctor although pre-authorisation is required after the 15th GP visit. Of course you can change your preferred doctor by calling Discovery Health and selecting another one at any time.

If your chosen KeyCare GP is unavailable, you and your family are allowed to consult a non KeyCare networked GP up to four times a year. This is paid at 100% of the DHR so you might end up paying in.

Day-to-day medicines are paid for IF prescribed by your KeyCare networked GP. These need to be on the Discovery Health medicine list. Certain blood tests and X-rays will also be paid for if asked for by your KeyCare GP.

Dentists are also covered for basic things like:

  • Consultations
  • Fillings, and
  • Tooth removals

One eye test is paid for per person on your plan. This must be done at a KeyCare networked optometrist. Once every two years you and your dependants each qualify for a set of contact lenses or spectacles.  The optometrist has a specific range from which you may choose.

Casualty benefit

On KeyCare plus and Access you may go to any of the casualty units at a KeyCare networked hospital and only pay R300 for a consultation. The balance is paid for by Discovery Health. The difference is that on KeyCare Access this is only allowed once a year.

On KeyCare Core this option is not available.

The oncology benefit

I can’t stress this enough. If cancer treatment is vital in your family, then you need to be on either the Executive plan or any of the Comprehensive plans.

That’s because these plans offer up to R400, 000 of approved cancer treatment in every 12 month cycle.

On the KeyCare plans cancer is treated if it is a prescribed minimum benefit (PMB). You must use the KeyCare network or a state facility for treatment if you’re on the KeyCare Access option.

If you use anyone else, then Discovery Health will only pay 80% of the DHR. Should your oncologist charge more than 100% of the DHR, you will find yourself having to make co-payments.


If approved, then these are done in one of the day surgery networks. On KeyCare Access these are done in a state facility unless they have something to do with emergencies, trauma, childbirth, or care for a new born.

MRI and CT scans

The good news is that these are paid from the hospital benefit up to 100% of the DHR IF related to an approved admission.
If not related to your admission, or because of conservative back and neck treatment, then it is paid from your specialist benefit up to the maximum of R3, 570 per person.

Antenatal benefits

This allows:

  • four visits to a GP, midwife, or gynaecologist every year
  • One scan between 10 and 20 weeks
  • Certain blood tests requested by your GP or gynaecologist
  • KeyCare Access covers specialist visits in the KeyCare network for maternity care of your baby up to 12 months after the birth.

These expenses are covered at 100% of the DHR.

Part of the hospital benefit is the following:

  • Alcohol and drug rehab – 21 days per person at a networked facility. On KeyCare Access this is done at a state facility.
  • Mental health – 21 days admission or 15 out of hospital consultations per person for things like bulimia and anorexia at a networked facility. Anything stress related is limited to 12 out of hospital consultations. On KeyCare Access a state facility must be used. Using anyone else means that Discovery Health will only pay 80% of the DHR for the hospital account.
  • Chronic dialysis – Paid in full if approved and where their provider is used. If you go anywhere else then Discovery will only pay 80% of the DHR.
  • Cataract surgery – Must be approved by Discovery Health, and done at a doctor and facility in the network or at a state facility in the case of KeyCare Access.

Prevention and Screening benefits

I haven’t really discussed these benefits in previous articles, but they are important since these tests are free at Discovery wellness providers.

Things like:

  • Blood glucose
  • Blood pressure
  • Cholesterol
  • Body mass index (BMI)
  • HIV screening
  • Mammogram once every two years
  • Pap smear once every three years
  • Prostrate test every year, and
  • A whole bunch of kid’s growth assessment tests. Things like height, weight, and head circumference.

If you only want to read the pillar articles relating to Discovery Health 2017, then click on the links below:

If you’d like to drill down in more detail, here are the links to each and every plan:

Looking for assistance with your medical aid? Drop us a line below.

[banner id=”19730″]

Until next time.

The InsuranceFundi Team

If you would like further information, submit your details below & we will contact you.