Discovery Health KeyCare Series Medical Aid Plans

 

Overall, the Discovery Health KeyCare Series Medical Aid Plans are a series of trustworthy and comprehensive medical aid plans that offers 24/7 medical emergency assistance to up to 3 Family Members. The Discovery Health KeyCare Series Medical Aid Plans start from R930 ZAR.

 

🔎 KeyCare Option	🥇 KeyCare Plus	🥈 KeyCare Core	🥉 KeyCare Start	🏅 KeyCare Start Regional
👤 Main Member Contribution	R1,380 – R2,801	R1,084 – R2,068	R1,044 – R2,737	R930 – R2,190
👥 Adult Dependent Contribution	R1,380 – R2,801	R1,084 – R2,068	R1,044 – R2,737	R930 – R2,190
💙 Child Dependent Contribution	R502 – R750	R284 – R470	R637 – R744	R560 – R670
📉 Annual Limit	Unlimited Hospital Cover	Unlimited Hospital Cover	Unlimited Hospital Cover	Unlimited Hospital Cover
💶 Prescribed Minimum Benefits (PMB)	✅ Yes	✅ Yes	✅ Yes	✅ Yes
➡️ Screening and Prevention	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes
💳 Medical Savings Account	None	None	None	None
🍼 Maternity Benefits	Limited	Limited	✅ Yes	✅ Yes
🔁 Gap Cover	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes

 

 

 

Discovery Health KeyCare Series – 21 Key Point Quick Overview

 

1. ☑️ Discovery Health KeyCare Series Overview
2. ☑️ Discovery Health KeyCare Series Contributions
3. ☑️ Discovery Health KeyCare Series Benefits at a Glance
4. ☑️ Discovery Health KeyCare Series Benefits and Cover Comprehensive Breakdown
5. ☑️ Discovery WELLTH Fund
6. ☑️ Discovery WHO Outbreak Benefit
7. ☑️ Discovery Health Care Connected Care
8. ☑️ KeyCare Online Practice (KeyCare Start Regional Only)
9. ☑️ KeyCare Hospital At Home
10. ☑️ KeyCare Day-To-Day Benefits and Cover
11. ☑️ Discovery Maternity and Early Childhood Benefit
12. ☑️ KeyCare Chronic Benefits
13. ☑️ Discovery Health Care Programmes
14. ☑️ Discovery Health Comprehensive Cancer Cover
15. ☑️ Discovery Health Hospital Benefit
16. ☑️ Discovery Health KeyCare Cover for Day Surgery Network Procedures
17. ☑️ Discovery Health KeyCare Additional Benefits
18. ☑️ Discovery Health KeyCare Series Exclusions and Waiting Periods
19. ☑️ Discovery Health KeyCare Series Plans Compared
20. ☑️ Our Verdict on Discovery Health KeyCare Series
21. ☑️ Discovery Health KeyCare Series Frequently Asked Questions

 

 

Medical Aid Discovery Health KeyCare Series Overview

 

The Discovery Health KeyCare Series starts from R930 and is a series of comprehensive medical insurance plans offered by Discovery Health. These plans provide an elevated level of coverage for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses. Gap Cover is available on the Discovery Health KeyCare Series, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8. Furthermore, the KeyCare plans are designed to provide affordable access to quality healthcare for individuals and families. KeyCare plans typically cover in-hospital expenses and day-to-day benefits such as GP visits and medication.  The exact benefits and cover levels will vary between the different KeyCare plans. However, they are generally more basic and lower cost compared to the more comprehensive plans offered by Discovery Health.  KeyCare plans may also include a network of preferred healthcare providers and hospitals. However, you may also be able to use other providers at an additional cost.

 

 

Discovery Health KeyCare Series Contributions

 

Keycare Plus

 

💶 Income Level	👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
R14,401+	R2,801	R2,801	R750
R8,951 – R14,400	R1,897	R1,897	R535
R0 – R8,950	R1,380	R1,380	R502

 

Keycare Core

 

💶 Income Level	👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
R14,401+	R2,068	R2,068	R470
R8,951 – R14,400	R1,352	R1,352	R336
R0 – R8,950	R1,084	R1,084	R284

 

Keycare Start

 

💶 Income Level	👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
R14,401+	R2,737	R2,737	R744
R9,551 – R14,400	R1,758	R1,758	R689
R0 – R9,550	R1,044	R1,044	R637

 

Keycare Start Regional

 

💶 Income Level	👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
R14,401+	R2,190	R2,190	R670
R9,551 – R14,400	R1,405	R1,405	R620
R0 – R9,550	R930	R930	560

 

 

Discovery Health KeyCare Series Benefits at a Glance

 

🔎 KeyCare Options	🥇 KeyCare Plus	🥈 KeyCare Core	🥉 KeyCare Start	🏅 KeyCare Regional
📌 Day-to-Day Cover	Covers the KeyCare Network GPs. Network pharmacies cover the medicine list. If your KeyCare Network GP refers you, specialists cost up to R5,000 annually.	GP referrals cover up to R5,000 per year for specialists. This plan provides no daily cover.	Daily care at your KeyCare Start Network GP Network pharmacies cover the medicine list. Your KeyCare Start Network GP can refer you for two specialist visits up to R2,500 per year.	KeyCare Online Practice referrals to your KeyCare Start Regional Network GP for daily care. The medicine list is covered when prescribed by your KeyCare Start Regional Network GP and purchased from a network pharmacy. Your KeyCare Start Regional Network GP can refer you to two yearly specialist visits up to R2,500.
📍 Non-Emergency Casualty Visits	One casualty visit per year in any KeyCare hospital casualty unit Unlimited for emergencies The consultation costs R450. Visits require approval.	This is not covered under this plan	Your KeyCare Start Network GP or provider provides after-hours care.	KeyCare Start Regional Network GPs and KeyCare Online Practices provide after-hours care.
💊 Chronic Medicine Prescriptions	Your KeyCare Network GP or pharmacy must dispense your approved chronic medication.	You must get your approved chronic medicine from a KeyCare Network pharmacy and your nominated GP.	State facilities cover chronic medication.	The network pharmacies and KeyCare Start Regional Network GPs cover your approved chronic medication. Your chosen GP must prescribe chronic medication.
🎀 Cancer	Prescribed Minimum Benefit treatment is covered (PMB). Use a network provider.	Prescribed Minimum Benefit treatment is covered (PMB). Use a network provider.	Your treatment in a state facility is covered.	Your treatment in a state facility is covered.
📊 Chronic Dialysis	Once registered, you must use a network provider or a state facility. Discovery Health will pay 80% of Discovery Health Rate if you leave (DHR)	Once registered, you must use a network provider or a state facility. Discovery Health will pay 80% of Discovery Health Rate if you leave (DHR)	Your treatment in a state facility is covered.	Your treatment in a state facility is covered.
🏥 Full Cover on the Hospital Network	Discovery Health will pay a 100% Discovery Health Rate (DHR).	Discovery Health will pay a 100% Discovery Health Rate (DHR).	Your KeyCare Start Network Hospital receives the Discovery Health Rate (DHR).	Your KeyCare Start Regional Network Hospital receives the Discovery Health Rate (DHR).
🚑 Partial Cover on the Hospital Network	Discovery Health will pay 70% of the hospital bill, and you will pay the rest. Discovery Health will pay 80% of the Discovery Health Rate for PMB admissions (DHR)	Discovery Health will pay 70% of the hospital bill, and you will pay the rest. Discovery Health will pay 80% of the Discovery Health Rate for PMB admissions (DHR)	The cover is not provided for non-emergency hospital admissions	The cover is not provided for non-emergency hospital admissions
⚕️ Pre-defined list of approved procedures in the KeyCare Day Surgery Network	100% Discovery Health Rate (DHR) in KeyCare Day Surgery Network.	100% Discovery Health Rate (DHR) in KeyCare Day Surgery Network.	100% Discovery Health Rate (DHR) in KeyCare Start Day Surgery Network.	100% Discovery Health rate (DHR) in your region’s KeyCare Start Day Surgery Network.

 

Get a Discovery Health Medical Aid quote from our Dedicated Medical Aid Specialists Broker

 

 

Discovery Health KeyCare Series Benefits and Cover Comprehensive Breakdown

 

Emergency Cover

 

In case of a traumatic incident or after a traumatic event, you can get help from a trained professional. Calling Emergency Assist will help you and your loved ones in need.  Furthermore, family members can get help after a traumatic event at any time.  Discovery Health Emergency Cover covers the following medical services:

 

• The emergency vehicle (or other medical transport).
• The hospital’s account of the incident.
• The observations of the physician who admitted you to the hospital.
• The anesthesiologist.
• Any additional approved healthcare provider.

 

The survivors of gender-based violence can receive counseling and other support as part of this service.

 

Prescribed Minimum Benefits

 

All medical schemes are required by the Prescribed Minimum Benefit (PMB) provisions of the Medical Schemes Act 131 of 1998 and its Regulations to cover the costs associated with the diagnosis, treatment, and care of:

 

• A life-threatening medical condition
• A defined listing of 271 conditions
• A list of 27 chronic illnesses.

 

Your medical condition must be on the list of Prescribed Minimum Benefit (PMB) conditions to qualify for coverage. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits.  In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health network.  Once your condition has stabilized, you will be transferred to a hospital or other service providers in the Discovery Health network, if necessary, according to the scheme’s rules.  Discovery Health will cover up to 80% of the Discovery Health Rate if you do not use a DSP (DHR). Your responsibility will be the difference between what Discovery Health will pay and the actual cost of your treatment.  Furthermore, Discovery Health will pay according to your plan’s benefits if these criteria are unmet.

 

Screening and Prevention

 

This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases.  The Discovery Health wellness providers cover a variety of screening tests, including blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms or ultrasounds, and prostate screenings.

 

The Discovery Health Screening and Prevention covers the following:

 

• Screening for kids will assess the child’s growth and development, including weight, height and body mass index measurements, blood pressure, and more.
• Screening for Adults includes blood pressure, blood glucose, HIV, and more. Discovery also covers mammograms, breast ultrasounds, pap smears, and more.
• Screening for Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.

 

After all your membership members have completed their health check, you can access additional screening and preventive healthcare services through the WELLTH Fund.

 

 

Discovery WELLTH Fund

 

The WELLTH Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your individual health requirements.  This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks.  Your WELLTH Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.

 

The Discovery Health WELLTH Fund for the KeyCare Series covers the following:

 

🔎 General Health	You have access to screenings for vision, hearing, dental, and skin conditions as part of your primary care. Additionally, you are eligible for one GP screening consultation
⚕️ Physical Health	Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations.
💙 Mental Health	You have access to a mental health evaluation to promote mental health.
🩺 Women and Men’s Health	You have access to various screening and prevention services for women and men. These include, for instance: Consultation with your doctor for gynecological, prostate, or cardiac issues Bone density analysis
👶 Children’s Health	A pediatrician, speech pathologist, or physiotherapist can evaluate your child’s progress toward important developmental milestones as part of a well-child checkup.
➡️ Medical Monitoring Devices	You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar.

The WELLTH Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider.  Furthermore, the benefit is available to new members in the joining year and subsequent years.  The benefit is available once per lifetime per beneficiary. Cover for eligible healthcare services is limited to the Discovery Health Rate (DHR), subject to the overall benefit maximum.  Your WELLTH Fund maximum is based on the size and composition of your family as stated in your policy:

 

• Limited to R2,500 per adult dependent.
• Limited to R1,250 per two-year-old or older child dependent.
• Limited to R10,000 per family.

 

Furthermore, the WELLTH Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.

 

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Discovery WHO Outbreak Benefit

 

The basket of care includes the following:

 

• COVID-19 vaccines and their administration according to the COVID-19 guidelines of the National Department of Health.
• Screening consultations with a network general practitioner (virtual, telephone, or in-person).
• COVID-19 PCR and Rapid Antigen screening tests if referred by a qualified medical practitioner.
• A set of defined pathology tests for COVID-19-positive individuals.
• A predetermined assortment of x-rays and scans for COVID-19-positive individuals.
• Members at risk who meet the clinical entry criteria will receive supportive care, including medication and a home monitoring device to track oxygen saturation levels.
• When you are admitted to the hospital because of symptoms of COVID-19, you will be covered by the Hospital Benefit of the KeyCare Series and, if necessary, the PMBs.

 

Access to the Long COVID Recovery Programme:

 

• A six-month support program for members whose COVID-19 symptoms persist beyond 21 days after acute diagnosis.
• According to the Scheme’s clinical entry criteria and treatment guidelines, the program includes the following:
• Up to two specialists and GP consultations.
• A defined basket of pathology tests.
• Allied healthcare professional support.
• A home monitoring device.
• A defined basket of x-rays and scans.

 

How members of the Discovery Health KeyCare Series are covered in terms of Monkeypox:

 

• The treatment protocol for confirmed cases consists of a diagnostic PCR screening test
• Two visits to a dermatologist or general practitioner.
• Formulary of supportive medications for pain management.

 

 

Discovery Health Care Connected Care

 

Discovery Health Medical Scheme provides home-based access to health and wellness services. Connected Care is an integrated ecosystem of benefits, services, and digitally connected capabilities designed to assist you in managing your health and wellness.

 

📉 Health Monitoring Devices	Access to the most up-to-date medical examination, remote monitoring, and point-of-care devices to facilitate the delivery of quality care at home.
➡️ Electronic Prescriptions	Electronic prescribing for expedited access to medications.
🔁 Home Nurses	Hospital-related care is provided at home by registered nurses.
💊 Medicine Ordering and Tracking	Order and track the delivery of your medication from the dispensary to your door.
💻 Online Coaches	At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19.
📌 Condition-Specific Information	Educational content pertinent to your condition is readily accessible.

 

Connected care for members at home

 

Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations.

Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions. You will not see any changes to your regular benefits because of having cover approved for these gadgets.

 

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Connected care for those with chronic conditions

 

Through Connected Care, you and your doctor can work together to keep your chronic condition under control while you are at home.

Eligible members can use various digital services connected to smart remote monitoring, point-of-care devices, and individualized coaching consultations to monitor and control their chronic condition in the comfort of their homes.

 

 

 

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KeyCare Online Practice (KeyCare Start Regional Only)

 

KeyCare Start Regional provides cover for healthcare services in select regions through KeyCare Online Practice, an integrated healthcare platform. Furthermore, the KeyCare Online Practice provides easy access to online and in-person GP consultations, medication, and basic x-rays. The KeyCare Start Regional option is available in the following locations within South Africa:

 

• Belville – Western Cape
• George – Western Cape
• Tzaneen – Limpopo
• Polokwane – Limpopo
• Mbombela – Mpumalanga
• Trichardt – Mpumalanga

 

 

KeyCare Hospital At Home

 

Hospital at Home patients receives specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being. They all work together to make your healthcare more efficient and your life safer.  Suppose you have a valid pre-authorization for hospitalization. In that case, Discovery Health will use your Hospital Benefit to cover any services provided as part of Discovery’s Hospital at Home program.  For those who meet the program’s clinical and benefit criteria, this unlocks cover for approved medical devices and services.

 

Furthermore, Discovery Health covers the following:

 

• 24/7 clinical oversight from a care team virtually, including nurses, doctors, and allied healthcare professionals.
• 24/7 real-time remote monitoring, which is supported by innovative healthcare technology.
• Hospital-level diagnostics and intervention to manage post-surgical or medical care at home.

 

Acute Care at home

 

This includes cover and treatment for COVID-19, as well as post-discharge care. In addition, you are eligible for the Home Monitoring Device Benefit.

 

Home Monitoring Devices

 

• Suppose you meet the Scheme’s clinical entry criteria. In that case, you have healthcare coverage up to a limit of R4,250 per person per year at 100% of the Discovery Health Rate (DHR) for monitoring certain conditions like chronic obstructive pulmonary disease, congestive heart failure, diabetes, pneumonia, and COVID-19.
• If you meet the clinical entry criteria, the Scheme also covers up to 75% of the Discovery Health Rate (DHR) for defined point-of-care medical devices. You are responsible for 25% of the total cost of these devices. In addition, you have access to the most advanced remote medical examination device, known as TytoHome.
• TytoHome enables you to conduct a medical examination by transmitting throat, ear images, and heart and lung sound to your doctor in real time.

 

Home Care Cover

 

• Discovery Home Care is a service that provides you with high-quality care in the comfort of your own home if your doctor recommends it as an alternative to hospitalization. Postnatal care, end-of-life care, intravenous infusions (drips), and wound care are provided. These services are covered by the Hospital Benefit, pending authorization.
• Discovery Home Care is the designated service provider (DSP) for intravenous infusion administration. Use Discovery Home Care for these infusions to avoid a 20% co-payment.

 

Home-based care for follow-up treatment after hospital admission

 

• Once discharged from the hospital, patients with clinically appropriate conditions such as chronic obstructive pulmonary disease, chronic cardiac failure, ischemic heart disease, and pneumonia have access to enhanced home-based care.
• If you meet the clinical entry criteria, you are covered for bedside medicine reconciliation before admission discharge, a follow-up consultation with a GP or specialist, and a defined basket of supportive care at home, including in-person and virtual consultations with a Discovery Home Care nurse.

 

 

KeyCare Day-To-Day Benefits and Cover

 

🔎 General Practitioner (GP) Visits	Medically necessary GP consultations are unlimited. Depending on your plan, you must choose a KeyCare, KeyCare Start, or KeyCare Start Regional GP when joining. Discovery Health will cover consultations and minor procedures at your chosen GP. Pre-authorization is needed after 15 GP visits. KeyCare Start Regional covers GP consultations referred through KeyCare Online Practice.
🩸 Blood, urine, and other fluid and tissue tests	Discovery Health will cover network GP blood, urine, and other fluid and tissue tests. These tests require a KeyCare pathology form from your network GP.
🩺 Day-to-day Medicine	Depending on your plan, Discovery Health will cover the medicine list if your Network GP prescribes and dispenses it.
👩‍⚕️ Basic X-Rays	Discovery Health will pay for network-provided basic x-rays. Your network GP must order x-rays.
👨‍⚕️ Out-of-Network GP Visits	KeyCare Plus allows you to see any GP out-of-network if your preferred GP is unavailable. KeyCare Start allows out-of-network visits to any KeyCare Network GP. KeyCare Start Regional allows out-of-network visits to any GP in the network. The Discovery Health Rate covers up to four out-of-network GP visits per year on KeyCare Plus and two on KeyCare Start and Start Regional (DHR). Our medicine list, GP visits, selected blood tests, and X-rays are covered.
👁️ Eyecare	You can get one eye exam every two years at a KeyCare Optometry Network optometrist. The optometrist will offer specific glasses. Contact lenses can replace glasses. Glasses and contacts can be replaced every 24 months.
🦷 Dentistry	Our dentist network covers consultations, fillings, and tooth extractions. Limits may apply.
➡️ Casualty Visits	KeyCare Plus covers one casualty visit annually at any KeyCare hospital casualty unit. There is a co-payment of R450. Casualty visits require pre-authorization. Your KeyCare Start GP or network provider can provide after-hours care. After-hours care is available from your KeyCare Start Regional GP or the KeyCare Online Practice.
🔁 Medical Equipment	Suppose you get them from a network provider. In that case, KeyCare Plus covers wheelchairs, batteries, cushions, transfer boards, mobile ramps, commodes, long-leg calipers, crutches, and walkers on the medical equipment list. The annual family limit is R5,400. This is not covered on the KeyCare Start or Regional plans
📌 Specialist Benefit	Two visits to a specialist up to R2,500 annually for KeyCare Start and Start Regional, and up to R5,000 annually for KeyCare Plus and Core. Before seeing a specialist, your network GP must refer you and provide a reference number. You do not need a GP referral or reference number to see a maxillo-facial surgeon, periodontist, ophthalmologist, or maternity care specialist on KeyCare Plus. The Specialist Benefit covers out-of-hospital MRI and CT scans.
📍 Alternative Healthcare	Physiotherapists, psychologists, speech therapists, audiologists, homeopaths, and chiropractors are excluded from cover on all KeyCare plans.

 

 

Discovery Maternity and Early Childhood Benefit

 

With the Discovery Health KeyCare Series, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your baby’s life.  This applies from the date of activation of the benefit for each pregnancy and for each child from birth until they are two years old.  Discovery Health Maternity Benefit covers the following:

 

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During Pregnancy:

 

• Scans and Screenings
• Eight antenatal consultations with a midwife, GP, or gynecologist.
• 2 x 2D ultrasound scans
• Nuchal translucency test
• 3D and 4D scans up to the 2D scan rate.
• Non-invasive Prenatal Test (NIPT)
• One flu vaccination during pregnancy.
• Discovery Health will cover predetermined blood tests to confirm your pregnancy.

 

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After giving birth, Discovery Health covers the following:

 

• GP and Specialist help for up to 2 years.
• Postnatal care, including complications during delivery, nutritional assessment, etc.

 

Discovery Health prenatal and postnatal care includes:

 

• Five antenatal or postnatal classes.
• One Breastfeeding consultation.

 

 

KeyCare Chronic Benefits

 

The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL).

 

Discovery Health Chronic Benefit Cover Summarized

 

🅰️ Prescribed Minimum Benefit (PMB) Conditions	Under the Prescribed Minimum Benefits, you can receive treatment for a set of medical conditions (PMBs). The PMBs cover the 27 chronic conditions included in the Chronic Disease List (CDL).
🅱️ Medicine Cover for the Chronic Disease List	Discovery Health will pay for medications up to the Discovery Health Rate maximum (DHR). The DHR for medication consists of the price of the medication and the dispensing fee. The scheme will cover up to the cost of the cheapest equivalent drug on the formulary for medications, not on the list.

 

Discovery Health KeyCare Series Full List of conditions covered:

 

• Addison’s disease
• Asthma
• Bipolar mood disorder
• Bronchiectasis
• Cardiac failure
• Cardiomyopathy
• Chronic obstructive pulmonary disease
• Chronic renal disease
• Coronary artery disease
• Crohn’s disease
• Diabetes insipidus
• Diabetes Type 1
• Diabetes Type 2
• Dysrhythmia
• Epilepsy
• Glaucoma
• Hemophilia
• HIV
• Hyperlipidemia
• Hypertension
• Hypothyroidism
• Multiple sclerosis
• Parkinson’s disease
• Rheumatoid arthritis
• Schizophrenia
• Systemic lupus erythematosus
• Ulcerative colitis

 

Chronic Medicine

 

On the KeyCare Series, you can get your medication from more than 2,500 pharmacies in the Scheme’s pharmacy network. Through MedXpress, you can order or reorder your medication online and have it delivered to your place of business or residence. Alternatively, you can:

 

• You can order your medication online and pick it up at a MedXpress Network Pharmacy or
• Fill a prescription as usual at any pharmacy in the MedXpress Network.

 

Additional Chronic Benefits on the KeyCare Series

 

Chronic Dialysis

 

If Discovery Health has approved your treatment plan and you use a provider in the network, Discovery Health will cover all costs associated with your chronic dialysis.  Furthermore, Discovery Health will pay up to 80% of the Discovery Health Rate if you go elsewhere (DHR).

 

Member Care Programme

 

• If you have been diagnosed with one or more chronic diseases, you may be eligible for the Discovery Health Member Care Program.
• Discovery Health will confirm your eligibility by contacting you.
• The program provides coordinated care to help you manage your conditions and obtain the highest standard of healthcare.
• If you are registered and participate in the program, Discovery Health will fully cover your treatment’s cost.
• If you choose not to participate, Discovery Health will pay up to 80% of the Discovery Health Rate for your hospital and related bills (DHR)

 

Medicine Tracker

 

You can set reminders and prompts to help you take your medication as prescribed and on time. For example, your approved chronic medication will be displayed automatically, and you will be prompted to take your medication and confirm each dose.

 

 

Discovery Health Care Programmes

 

Discovery Health will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions.  You must be registered with these condition-specific care programs to access additional benefits and services. On a personalized dashboard, you and your Premier Plus GP can identify the next steps to manage your condition and maintain your health over time optimally.  The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.

 

😷 Discovery Health Disease Prevention Programme	KeyCare Premier Plus GPs can enroll you in the Disease Prevention Programme if you have cardiometabolic risk syndrome. GPs, dietitians, and health coaches coordinate care. In addition, consultations, pathology tests, and medicine are covered for enrolled members. Health coaching will help you manage your condition daily.
🧠 Discovery Health Mental health Care Programme	Premier+ GPs can enroll cardiometabolic risk syndrome patients in the Disease Prevention Programme. Dietitians, health coaches, and GPs coordinate care. Enrolled members receive medicine, pathology, and consultations. Health coaching assists with daily management.
🍬 Discovery Health Diabetes Care Programme	Your KeyCare Premier Plus GP can enroll you in the Diabetes Care Programme if you receive the Chronic Illness Benefit (CIB) for diabetes. The program covers extra glucometer strips and dietitian and biokinetics visits. A nurse educator can help you manage your condition.
⚕️ Discovery Health HIV Care Programme	KeyCare Premier Plus GPs register HIV patients for care, including social worker cover. Guaranteed confidentiality. Avoid a 20% co-payment by getting your medicine from a DSP.
📌 Discovery Health Cardio Care Programme	If referred by your KeyCare Premier Plus GP and enrolled in the Cardio Care Programme, you can receive a defined basket of care and an annual cardiovascular assessment if you are on the Chronic Illness Benefit (CIB) for hypertension, hyperlipidemia, or ischemic heart disease.

 

 

Discovery Health Comprehensive Cancer Cover

 

You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.

 

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1️⃣ Discovery Health Prescribed Minimum Benefits (PMB)	PMB cancer treatment is always covered. KeyCare Start and Start Regional cover cancer treatment in the network or at a state facility. If you use another provider, Discovery Health will only cover 80% of the Discovery Health Rate (DHR).
2️⃣ Discovery Health Oncology Benefit	After Discovery Health approves your cancer treatment, the Oncology Care Programme covers you. Discovery Health Rate covers 100% of cancer-related healthcare services (DHR). If you do not use the DSP or your doctor charges more, you might have to pay a co-payment. KeyCare Start and Start Regional cover cancer treatment in the network or at a state facility. Discovery Health will cover 80% of the DHR if you use another provider.
3️⃣ Discovery Health – Covering Medicine	To avoid a 20% co-payment, get your approved oncology medicine from a DSP on the Scheme’s medicine list. Ask your doctor if they use the Scheme’s DSPs for your in-room or facility treatment.
4️⃣ Discovery Health advanced Illness Benefit	Members receive comprehensive palliative care. This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services. Your palliative care treatment plan includes GP consultations.

 

 

Discovery Health Hospital Benefit

 

The KeyCare Series includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.

 

• If you require hospitalization, Discovery Health will cover your hospital bills.
• There is no annual overall hospital limit on any of the plans. However, there are maximum reimbursement amounts for certain treatments.
• Discovery Health may not cover the expenses if you do not contact the scheme before being discharged.

 

The following table summarizes how Discovery Health pays for approved hospital admissions within the KeyCare Series per plan.

 

🔎 KeyCare Option	🥇 KeyCare Plus	🥈 KeyCare Core	🥉 KeyCare Start	🏅 KeyCare Start Regional
🏥 Full Cover Hospital Network	Discovery will pay a 100% Discovery Health Rate (DHR).	Discovery will pay a 100% Discovery Health Rate (DHR).	Fully covered at your KeyCare Start Regional Network Hospital.	Fully covered at your preferred KeyCare Start Network hospital.
🚑 Full Cover Hospital Network	You can use any KeyCare Network-approved hospital.	You can use any KeyCare Network-approved hospital.	It would help if you visited the KeyCare Start Network Hospital of your choice. You will be responsible for all costs if you do not utilize a network hospital. Not applicable in an emergency	Visit your KeyCare Start Regional Network hospital. You pay for everything if you do not use your KeyCare Start Regional Network hospital. Emergency exceptions apply.
⚕️ Partial Cover Hospital Network	Discovery Health will pay up to 70% of the hospital bill, and you will pay the rest. Discovery Health pays up to 80% of Discovery Health Rate for Prescribed Minimum Benefit admissions (DHR).	Discovery Health will pay up to 70% of the hospital bill, and you will pay the rest. Discovery Health pays up to 80% of Discovery Health Rate for Prescribed Minimum Benefit admissions (DHR).	Cover not provided for non-emergency admissions	Cover not provided for non-emergency admissions
📌 Defined list of procedures that can be performed in a Day Surgery Network	KeyCare Day Surgery Network-covered.	KeyCare Day Surgery Network-covered.	KeyCare Start Day Surgery Network-covered.	KeyCare Start Regional Day Surgery Network-covered
📍 Defined List of procedures that can be performed in specialist rooms	The Scheme-approved rate.	The Scheme-approved rate.	The Scheme-approved rate.	The Scheme-approved rate.
☑️ Cover for non-network hospitals	Discovery Health will not cover you if you are admitted to a non-network hospital for a planned procedure. Discovery Health pays 80% of the Discovery Health Rate for PMB admissions (DHR).	Discovery Health will not cover you if you are admitted to a non-network hospital for a planned procedure. Discovery Health pays 80% of the Discovery Health Rate for PMB admissions (DHR).	Discovery Health will not cover you if you are admitted to a non-network hospital for a planned procedure. Discovery Health pays 80% of the Discovery Health Rate for PMB admissions (DHR).	Discovery Health will not cover you if you are admitted to a non-network hospital for a planned procedure. Discovery Health pays 80% of the Discovery Health Rate for PMB admissions (DHR).
✅ Cover for Specialists and Healthcare Providers in the Discovery Health network	Full cover provided.	Full cover provided.	Full cover at a KeyCare Start Network Hospital contracted provider.	KeyCare Start Regional Network hospital cover
➡️ Cover for Specialists and Healthcare Providers not in the Discovery Health network	Paid according to the Discovery Health Rate (DHR). The member must pay the balance if they charge more.	Paid according to the Discovery Health Rate (DHR). The member must pay the balance if they charge more.	Discovery Health will pay the Discovery Health Rate (DHR) for providers at your KeyCare Start and KeyCare Start Regional hospital, with whom the scheme does not have a payment arrangement. However, you must pay the balance.	Discovery Health will pay the Discovery Health Rate (DHR) for providers at your KeyCare Start and KeyCare Start Regional hospital, with whom the scheme does not have a payment arrangement. However, you must pay the balance.
🚩 Radiology and Pathology Accounts	According to the Discovery Health Rate (DHR).	According to the Discovery Health Rate (DHR).	According to the Discovery Health Rate (DHR).	According to the Discovery Health Rate (DHR).
✳️ Cover for scopes	KeyCare Day Surgery Network PMB. Hospital Benefit covers doctor-ordered scopes.	KeyCare Day Surgery Network PMB. Hospital Benefit covers doctor-ordered scopes.	KeyCare Start Day Surgery Network PMB. Hospital Benefit covers doctor-ordered scopes.	KeyCare Start Regional Day Surgery Network PMB. Hospital Benefit covers doctor-ordered scopes.
💊 Alcohol and Drug Rehabilitation	Discovery Health covers 21 days of rehabilitation per person per year. Three days for detoxification per approved admission.	Discovery Health covers 21 days of rehabilitation per person per year. Three days for detoxification per approved admission.	Discovery Health covers 21 days of rehabilitation per person per year. Three days for detoxification per approved admission.	Discovery Health covers 21 days of rehabilitation per person per year. Three days for detoxification per approved admission.
🧠 Mental Health Cover	Mental well-being 21 days for admissions or up to 15 outpatient consultations per person for major affective disorders, anorexia, and bulimia; up to 12 outpatient consultations for acute stress disorder accompanied by recent significant trauma. Three days per approved admission for attempted suicide. Twenty-one days for other mental health admissions. All mental health admissions are fully covered at network facilities. Discovery Health will pay up to 80% of the Discovery Health Rate (DHR) for your hospital bill if you go elsewhere.	Mental well-being 21 days for admissions or up to 15 outpatient consultations per person for major affective disorders, anorexia, and bulimia; up to 12 outpatient consultations for acute stress disorder accompanied by recent significant trauma. Three days per approved admission for attempted suicide. Twenty-one days for other mental health admissions. All mental health admissions are fully covered at network facilities. Discovery Health will pay up to 80% of the Discovery Health Rate (DHR) for your hospital bill if you go elsewhere.	Mental well-being 21 days for admissions or up to 15 outpatient consultations per person for major affective disorders, anorexia, and bulimia; up to 12 outpatient consultations for acute stress disorder accompanied by recent significant trauma. Three days per approved admission for attempted suicide. Twenty-one days for other mental health admissions. All mental health admissions are fully covered at network facilities. Discovery Health will pay up to 80% of the Discovery Health Rate (DHR) for your hospital bill if you go elsewhere.	Mental well-being 21 days for admissions or up to 15 outpatient consultations per person for major affective disorders, anorexia, and bulimia; up to 12 outpatient consultations for acute stress disorder accompanied by recent significant trauma. Three days per approved admission for attempted suicide. Twenty-one days for other mental health admissions. All mental health admissions are fully covered at network facilities. Discovery Health will pay up to 80% of the Discovery Health Rate (DHR) for your hospital bill if you go elsewhere.

 

 

Discovery Health KeyCare Cover for Day Surgery Network Procedures

 

Discovery Health will cover planned day surgery procedures. The network for a day surgery depends on the plan you choose.  Furthermore, these services are covered by your Hospital Benefit. As a result, Discover Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.  If you utilize physicians, specialists, and other healthcare professionals with whom Discovery Health has a payment arrangement, the scheme will cover the full cost of these services.

 

The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:

 

• Biopsies
• Breast Procedures
• Ear, nose, and throat procedures
• Eye Procedures
• Ganglionectomy
• Gastrointestinal scopes and procedures
• Gynecological Procedures
• Orthopedic Procedures
• Removal of a foreign body
• Simple superficial lymphadenectomy
• Skin procedures
• Urological procedures

 

 

Discovery Health KeyCare Additional Benefits

 

International Second Opinion Services

 

• The Clinic by Cleveland Clinic provides second opinions for life-threatening and life-changing conditions through your specialist.
• Discovery Health will pay 75% for second opinions.

 

Claims relating to Traumatic Events

 

• Trauma Recovery Extender Benefit covers out-of-hospital trauma claims.
• The Trauma Recovery Extender Benefit pays claims for the rest of the year and the year after.
• For the year the trauma occurred, and the year after, you and your dependents on your health plan can receive six counseling sessions per person per year from a psychologist, clinical social worker, or registered counselor.
• To qualify, members must apply for this benefit.

 

In-Room Procedures

 

• The cover is limited to a defined list of specialist room procedures.
• The cover is paid according to the agreed rate, where Discovery Health has authorized it, and it is paid from the Hospital Benefit.

 

Advanced Illness Benefit

 

• Members receive comprehensive palliative care.
• This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services.
• Your palliative care treatment plan includes GP consultations.

 

Discovery KeyCare Series Value-Added Offers

 

• Healthy Care at Clicks or Dis-Chem offers discounts on a wide range of personal and family care products. Healthy Care includes baby care, dental care, eye care, foot care, sun care, hand care, first aid, and over-the-counter medicine.
• Your plan’s optometrists offer 20% off frames and lenses when you pay immediately.
• Expectant parents can cryogenically store their newborn baby’s umbilical cord blood and tissue stem cells at a discounted rate with Netcells’ exclusive offer.
• Vitality, the world’s leading science-based wellness program, rewards healthy living. As a result, Discovery Vitality members live longer and healthier lives.
• Discovery Health collaborates with myHealthTeam, a global leader in online patient communities. This gives members with diabetes, heart disease, and long-term COVID access to a digital community of patients to manage their conditions.

 

 

Discovery Health KeyCare Series Exclusions and Waiting Periods

 

Exclusions include the following:

 

• Reconstructive surgical procedures and treatments, including cosmetic procedures and treatments.
• Otoplasty for bat ears, blepharoplasty, and port-wine stains (eyelid surgery).
• Breast reductions or augmentations and gynecomastia are considered cosmetic procedures.
• Obesity
• Unless included in Prescribed Minimum Benefits (PMBs) or Assisted Reproductive Therapy, infertility is not covered (ART) Benefit.
• Frail care
• Abuse of alcohol, drugs, or solvents.
• Willful and significant infraction of the law.
• Willful participation in a war, a terrorist act, a riot, a civil disturbance, a revolt, or an uprising.
• Injuries incurred or medical care rendered during travel to or within a country at war.
• Experimental, unproven, or unregistered treatments or practices.
• Rescue and search.

 

Additional exclusions that only apply to the KeyCare Series include hospitalizations caused by the following, among other things:

 

• Dentistry
• Nail disorders
• Skin conditions, such as benign growths and lipomas
• Investigations
• Functional nasal surgery
• Elective cesarean section, unless medically required
• Hiatus hernia and esophageal reflux surgery.
• Back and neck surgery or treatment
• Knee and shoulder operations
• Arthroscopy
• Hips, knees, shoulders, and elbows are among the joints that can be replaced.
• Cochlear implants, auditory brain implants, and internal nerve stimulators (including related procedures, devices, processors, and hearing aids) are included in this category.
• Healthcare services are provided outside of the hospital and for which hospitalization is not required.
• Endoscopic procedures
• Hallux valgus (bunion) and Tailor’s bunion correction
• Removal of varicose veins
• Eye correction surgery
• Non-malignant breast disorders
• Health care outside of South Africa

 

Discovery Health’s waiting periods are as follows:

 

• During your waiting periods, you will not have access to the Prescribed Minimum Benefits (PMBs) if you are subject to waiting periods due to never having belonged to a medical scheme or a break in membership of more than 90 days before joining Discovery Health Medical Scheme, including emergency admission cover.
• If you had less than a 90-day break in cover before enrolling in Discovery Health Medical Scheme, you might be eligible for Prescribed Minimum Benefits (PMBs) during waiting periods.

 

 

Discovery Health KeyCare Series Plans Compared

 

🔎 KeyCare Option	🥇 KeyCare Plus	🥈 KeyCare Core	🥉 KeyCare Start	🏅 KeyCare Start Regional
👤 Main Member Contribution	R1,380 – R2,801	R1,084 – R2,068	R1,044 – R2,737	R930 – R2,190
👥 Adult Dependent Contribution	R1,380 – R2,801	R1,084 – R2,068	R1,044 – R2,737	R930 – R2,190
💙 Child Dependent Contribution	R502 – R750	R284 – R470	R637 – R744	R560 – R670
🔁 Gap Cover	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes
📉 Annual Limit	Unlimited Hospital Cover	Unlimited Hospital Cover	Unlimited Hospital Cover	Unlimited Hospital Cover
🍼 Maternity Benefits	Limited	Limited	✅ Yes	✅ Yes
💶 Prescribed Minimum Benefits (PMB)	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes
➡️ Screening and Prevention	✅ Yes	✅ Yes	✅ Yes	✅ Yes
💳 Medical Savings Account	None	None	None	None

 

You might also like to read about the 5 Best Medical Aid for SASSA Pensioners where Discovery Health Keycare Series only came in 3rd place.

 

 

Our Verdict on Discovery Health KeyCare Series

 

The Discovery Keycare Series is a range of medical aid options offered by Discovery Health in South Africa. The series includes several options that offer varying levels of coverage for medical expenses. These plans have affordable monthly premiums while still providing comprehensive cover options. In addition, members have access to a decent range of healthcare providers on the KeyCare network. There are several preventative care, maternity, illness, HIV, and other benefits.  However, because of the KeyCare Series tier entry-level plans, several limits apply to medical procedures, conditions, and treatments. Therefore, members might be subject to higher out-of-pocket expenses, waiting periods, and several exclusions.  Overall, the Discovery Keycare Series is a good option for individuals and families looking for affordable medical aid coverage.

 

 

You might also like the following service Discovery has to offer

• Discovery Health Vitality
• Discovery Health Smart Series
• Discovery Health Saver Series
• Discovery Health Priority Series
• Discovery Health Executive Plan
• Discovery Health Core Series
• Discovery Health Comprehensive Series

 

 

 

Discovery Health KeyCare Series Frequently Asked Questions

 

What is the Discovery Health KeyCare Series?

The Discovery Health KeyCare Series is a range of medical aid options offered by Discovery Health in South Africa. The series includes several options that offer varying levels of coverage for medical expenses.

 

How do I enroll in the Discovery Health KeyCare Series?

To enroll in the Discovery Health KeyCare Series, you can visit the Discovery Health website or contact a representative to discuss your options and enroll.

 

What does the Discovery Health KeyCare Series cover?

The Discovery Health KeyCare Series covers a range of medical expenses, including hospitalization, doctor visits, diagnostic tests, and certain prescription drugs. The level of cover depends on the specific KeyCare plan you choose.

 

Are there any exclusions or limitations in the Discovery Health KeyCare Series?

Yes, the Discovery Health KeyCare Series has certain exclusions and limitations. For example, certain medical procedures may be excluded, and there may be limits on the coverage available for certain treatments.

 

How much is KeyCare Start in 2023?

KeyCare Start is from R930 up to R2,737 for the main member only.

 

Does KeyCare cover glasses?

KeyCare covers one eye test per insured person every two years. However, it would help if you used an optometrist in the KeyCare Optometry Network.

 

Does KeyCare cover dentistry?

KeyCare covers consultations, fillings, and tooth removals at a dentist on the Discovery Health network. However, certain limits and rules will apply.

 

What blood tests does KeyCare cover?

KeyCare covers a list of blood, urine, and other fluid and tissue tests done by a Network GP.

 

How do I submit a claim for the Discovery Health KeyCare Series?

You can submit a claim for the Discovery Health KeyCare Series online through the Discovery Health website. You can also submit claims by fax or mail or by visiting a Discovery Health claims office.

 

How long does it take to process a claim for the Discovery Health KeyCare Series?

The processing time for a claim for the Discovery Health KeyCare Series depends on several factors, including the type of claim, the complexity of the claim, and the volume of claims being processed. On average, claims are processed within 14 days.

 

Does KeyCare cover fillings?

KeyCare covers fillings when done at a dentist within the Discovery Health KeyCare dentist network.

 

Can I buy medication with KeyCare Plus?

KeyCare Plus covers a list of chronic medicine on the KeyCare list for Chronic Diseases. However, there might be limits to non-prescription medicine.

 

How can I verify my income for KeyCare?

If employed, you can send your last three months’ pay slips or the IRP5 certificate from the most recent tax year.

 

What is the cost of the Discovery Health KeyCare Series?

The Discovery Health KeyCare Series cost depends on the specific plan you choose, as well as factors such as your income level and the number of dependents you want to add. The KeyCare Series range from R930 on KeyCare Start Regional and goes up to R2,801 on KeyCare Plus.

 

What is the waiting period for Discovery Keycare Series?

The waiting period for Discovery Keycare series is typically three months for general benefits and a 12-month waiting period for pre-existing conditions. However, the specific waiting periods may vary depending on the plan you have chosen and your individual circumstances. It’s important to carefully review the terms and conditions of your plan to understand the waiting periods that apply to you.