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SA's No 1 Insurance Blog

If managing a budget ain’t your thing then this one’s for you!

In case you missed it…in the previous article we discussed how to choose your plan at Discovery Health.

Let’s be honest…

The guys at Discovery Health understand the ‘pain and pleasure’ principle better than most.
Give the client a budget, let them manage their own medical expenses. If they run out of money, they feel the pain, if they don’t, then they get to keep what they’ve saved.

Problem is, having a savings account doesn’t work for everyone, and by ignoring those who need a basic medical aid, they’d be missing a massive opportunity. At the same time they didn’t want to offer a low cost medical plan with all of the benefits offered on their existing plans. After all, who wouldn’t want the same benefits only cheaper?

With KeyCare the focus is on offering an unsophisticated product whereby they take away the necessity to self-manage your expenses, but in return make the decisions as to:

  • Which doctors you may see
  • Which hospitals you may use, and
  • What sort of benefits you get to enjoy.

This means you may visit the KeyCare doctor as often as you need to (although you do need to get authorisation after a certain number of visits). That KeyCare doctor then prescribes medicine on a specific formulary, or refers you to a KeyCare specialist who then uses a KeyCare networked hospital if need be.

Interested?

The person most advantaged by these plans is your lower income earner. That’s because the cost is broken down into income bands with the lower earner enjoying the same benefits as the higher income earner.

Take the top of the range KeyCare Plus plan for instance:

  • Someone earning less than R8, 550 a month pays R990 a month as a main member
  • Compare this to the individual earning more than R12, 201 a month who pays R2, 064 a month for exactly the same thing.

You can immediately see the advantages for a company whose staff consist of:

  • low-income earners and
  • lacking in understanding of how a medical aid works.

No complaints about having run out of medical savings and demanding to know why they’re still paying for something in August which stopped working in March. If you think about it, it’s a pretty good question.

If you’re looking for all the ‘bells and whistles’ with your medical scheme then this isn’t the plan for you. These plans are aimed at offering primary care only.
Things like physiotherapists, psychologists, speech therapists, audiologists, homeopaths, and chiropractors are not covered. Dentistry is also limited to the cost of consultation, fillings, and tooth removals, so forget about crowns, root canals, and their ilk.

There are three plan types available from most comprehensive to least are:

  • KeyCare Plus
  • KeyCare Access, and
  • KeyCare Core

KeyCare Plus allows you:

  • to see a KeyCare networked doctor,
  • KeyCare dentist,
  • grab a pair of spectacles from a KeyCare optometrist once every two years,
  • Visit a KeyCare networked private hospital or KeyCare day surgery facility.
  • Casualty visits at any KeyCare hospital with a R325 co-payment
  • There is also limited access (up to R3, 860 per person) to private specialists.

KeyCare Access is focused on mothers to be. It allows you:

  • to see a KeyCare networked doctor,
  • KeyCare dentist,
  • the spectacles every two years from a KeyCare optometrist, and
  • A hospital stay at either a KeyCare access hospital (for emergencies and trauma) OR certain state hospitals for anything else. Childbirth covered in the KeyCare Access network.
  • Casualty visits at any KeyCare hospital with a R325 co-payment
  • Private specialists are only covered (up to R3, 860) when seen for emergencies, trauma, childbirth, and for your baby up to 12 months after childbirth.

KeyCare Core allows for:

  • Hospital stays in a KeyCare networked hospital or KeyCare day surgery facility, and
  • Limited access (up to R3, 860 per person) to private specialists.

Are you the perfect candidate for KeyCare?

Three things which could sway you towards KeyCare:

  • Do you fall into one of the lower income bands where this option offers the most value for money?
  • Do you have a large family who need to see the doctor every other month?
  • Are you petrified at the prospect of landing up in a state hospital?

We’ll get into specifics of KeyCare at a later stage. Look out for the next article wherein we unravel the Executive plan.

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