Boitumelo isn’t your average young women starting her first job. She’s also the head of a single parent household with a young son to take care of.
Her story gets a lot more complicated. Her son lives with her mom in the Transkei while Boitumelo stays in Gauteng. Her son is often sick and it’s important that he see the doctor regularly. Problem is that everytime her son gets sick, her mom must leave home at four in the morning and queue at the local clinic for the whole day.
Boitumelo wishes she could afford a medical aid, but medical aid is expensive and complicated, isn’t it?
Why the ‘standard’ Discovery Health plans won’t work for her
When Boitumelo met with us, she was faced with three major hurdles:
- As this was her first job out of school, she couldn’t afford the more comprehensive plans
- She needed a medical aid where her son could see the doctor as often as needed, and
- Her mom was unfamiliar with how a medical aid works and wouldn’t know the first thing about how to manage the medical savings account
Truth be told, Boitumelo can’t afford to spend a Rand more than R2,000 a month. A basic hospital plan – without the medical savings account – would cost her R2,163 a month next year (2019). Where would that leave her if her son needed to see a doctor and not a hospital?
The closest plan to suit her needs was the Essential Smart plan. This would allow her to visit a Smart network doctor as often as needed as long as she paid R100 for every consultation. There were a couple of problems with the Essential Smart plan:
- The first problem was the cost at R2,570 a month for the two of them
- The second was the availability of Smart network doctors in the rural area where her mom stayed
- The third problem Boitumelo faced, was that her mom isn’t smartphone savvy.
Was there a solution to Boitumelo’s dilemma?
Indeed, there was. The KeyCare range suited her budget perfectly. Now the problem was deciding on which one would best suit her needs.
KeyCare plans are focussed on providing affordable health care for those taking baby steps and joining a medical scheme for the first time.
Size wise, KeyCare is the third largest medical scheme open medical scheme in South Africa with more than 400,000 beneficiaries – So, you’re in good company if you join.
Since KeyCare started some 16 years ago:
- It has paid R28.6 billion in claims,
- Delivered 83,750 babies
- Paid for 16.8 million KeyCare networked doctor visits, and
- Filled 9 million chronic medication scripts
KeyCare works differently from all the other plans available at Discovery. The cost of KeyCare depends on your monthly income, the more you earn, the more you pay. However, everyone enjoys the same benefits regardless of income.
The most affordable option is the KeyCare Core Plan
This is what most know as a hospital plan. You must use a KeyCare networked hospital, and don’t worry…they’re all private hospitals, and there are a ton of them all over the country. Chronic illness benefits are also provided and these can be prescribed by any KeyCare networked GP. The private specialist cover is limited to R4,050 per person.
There are two income bands which apply:
- R0 to R13,050 per month, and
- R13,051 and higher per month
The KeyCare Start Plan is best of both.
KeyCare Access has been rebranded as KeyCare Start and slots in between the KeyCare Core and the KeyCare Plus plans.
Here you must use a chosen KeyCare Start networked private hospital, BUT you also get to visit a KeyCare Start network doctor and have access to medicine on the medicine list. Chronic medication, chronic dialysis & cancer treatment are provided through state facilities only.
A “hub and spoke” system has been introduced based on regions. The “hub” will be a KeyCare Start hospital offering all the medical services needed.
This “Hub” is surrounded by the KeyCare Start GP network and a network of other healthcare professionals offering benefits like dentistry, optometry, day surgeries, and after-hours casualty care at your KeyCare Start GP. This network is connected to the “Hub” through a referral system (Spokes) to ensure your health condition doesn’t slip through the cracks.
Some of the other goodies on offer are:
- 2 specialist visits covered at up to R2,000 per person if referred by your KeyCare Start GP
- 2 out of network visits to a KeyCare Start GP are also allowed. For instance, if you’re on holiday in another province.
- Unlimited GP visits to your KeyCare Start GP
- Medicine is dispersed by your chosen GP
- An annual check-up at a wellness provider
- Full in-hospital cover for specialists contracted to KeyCare
Discovery Health has also set three income bands for KeyCare Start:
- R0 to R9,150 per month
- R9,151 to R13,050 per month, and
- R13,051 and higher per month
Finally, we get to the most comprehensive of the three plans – KeyCare Plus.
This is what Boitumelo decided to go with.
Basically, this plan allows you to use any KeyCare networked private hospital and to visit your chosen KeyCare networked GP as often as needed. Casualty visits are covered at KeyCare networked hospitals with a casualty department once it’s been authorised and a co-payment of R355 has been made.
While on the topic of hospitals, there is also a list of partial cover hospitals and day surgery networks. With the partial cover hospitals, KeyCare will only pay 70% of the bill, so we’re not sure why you would want to use one. Maybe it has to do with the specialist only working from that hospital?
The major difference between this plan and KeyCare Start seems to be the following:
- With KeyCare Start you have 3 income bands versus 2 on KeyCare Plus
- With KeyCare Start you must choose a designated KeyCare Start hospital and GP. With KeyCare Plus you need only nominate your KeyCare networked GP
- Cancer treatment, chronic dialysis, and chronic medications are all provided through state facilities on KeyCare Start, and through network providers on the KeyCare Plus option. Chronic medication is dispensed through your KeyCare networked GP or through a network pharmacy.
- Specialist visits on KeyCare Start are limited to 2 per year at R2,000 per visit if referred by your KeyCare Start GP. On the KeyCare Plus plan, you are covered up to R4,050 per person if referred by your KeyCare networked GP.
Boitumelo managed to get cover for both her and her son at R1,919 a month just because she earned less than R13,051 a month. If she had earned a Rand more than R13,050 per month, her payment would have been R2,851 a month. In the end, it all turned out well for Boitumelo.
Click on the link below to download a copy of our Discovery Health cost comparison spreadsheet.
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