Discovery Health KeyCare Plus Medical Aid Plan (🇿🇦2025)

Overall, the Discovery Health KeyCare Plus Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures for its Family Members. The Discovery Health KeyCare Plus Medical Aid Plan starts from R1,817 ZAR.

 

🔎 Medical Aid Plan	🥇 KeyCare Plus
👤 Main Member Contribution	R1,817 – R3,687
👥 Adult Dependent Contribution	R1,817 – R3,687
🍼 Child Dependent Contribution	R661 – R986
🔁 Gap Cover	✅ Yes
📉 Annual Limit	Unlimited Hospital Cover
📈 Above Threshold Benefit (ATB)	None
🌎 International Cover	None
😷 Screening and Prevention	✅ Yes
💙 Medical Savings Account	None

 

 

Discovery Health KeyCare Plus – 21 Key Point Quick Overview

1. ✅ Discovery Health KeyCare Plus Overview
2. ✅ Discovery Health KeyCare Plus Contributions
3. ✅ Discovery Health KeyCare Plus Benefits at a Glance
4. ✅ Discovery Health KeyCare Plus Benefits and Cover Comprehensive Breakdown
5. ✅ Discovery Health Personal Health Pathway
6. ✅ Discovery Health WHO Outbreak Benefit
7. ✅ Discovery Health app and Virtual Benefits
8. ✅ Discovery Health Hospital At Home
9. ✅ Discovery Health Day-To-Day Benefits and Cover
10. ✅ Discovery Maternity and Early Childhood Benefits
11. ✅ Discovery Health Chronic Benefits
12. ✅ Discovery Health Care Programs
13. ✅ Discovery Health Comprehensive Cancer Cover
14. ✅ Discovery Health Hospital Benefit
15. ✅ Discovery Health KeyCare Cover for Day Surgery Network Procedures
16. ✅ Discovery Health KeyCare Additional Benefits
17. ✅ Discovery KeyCare Plus Value-Added Offers
18. ✅ Discovery Health KeyCare Plus Exclusions and Waiting Periods
19. ✅ Discovery Health KeyCare Plus Plan vs Similar Plans from Other Medical Schemes
20. ✅ Our Verdict on Discovery Health KeyCare Plus
21. ✅ Discovery Health KeyCare Plus Frequently Asked Questions

 

Discovery Health KeyCare Plus Overview

The Discovery Health KeyCare Plus starts from R1,817 and is part of a series of comprehensive medical insurance plans offered by Discovery Health.

 

💙Discovery Health has the following plans to offer under the Discovery Health KeyCare series:

• • 💙Start Regional
  • 💙Start
  • 💙Plus
  • 💙Core

 

The KeyCare Plus plan offered by the Discovery Health Medical Scheme provides members access to affordable healthcare services through a network of hospitals and healthcare providers. Gap Cover is available on the Discovery Health Coastal Saver, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.

 

Discovery Health KeyCare Plus Contributions

💴 Income Level	👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R15,991+	R3,687	R3,687	R986
R9,901 – R15,990	R2,497	R2,497	R704
R0 – R9,900	R1,817	R1,817	R661

 

 

Discovery Health KeyCare Plus Benefits at a Glance

🟥 GP and specialist cover	Day-to-day cover at your nominated KeyCare Network GP. Medicine from our medicine list is covered if you use a network pharmacy. Specialists are covered at the agreed rate or up to 100% of the Discovery Health Rate for specialists we don’t have a payment arrangement with, subject to the benefit limit of R5,550 per person per year. You must be referred by your nominated KeyCare Network GP and get a reference number from us before your consultation with the specialist.
🟧 Non-Emergency Casualty Visits	Cover for one casualty visit per person per year in any casualty unit at a hospital in the KeyCare network. Unlimited for emergencies. Not covered. We cover after-hours care at your nominated KeyCare Start Network GP or network provider. We cover after-hours care at your nominated KeyCare Start Regional Network GP or KeyCare Online Practice. You pay the first R500 of the consultation. You must get approval before your visit.
🟨 Chronic Medicine Prescriptions	Your approved chronic medication must be dispensed by your nominated KeyCare Network GP, or you must get your approved chronic medicine from a pharmacy in the network.
🟩 Cancer	We cover your treatment if it is a Prescribed Minimum Benefit. You must use a network provider.
🟦 Chronic Dialysis	You must use a network provider once you are registered, or you can go to a state facility. If you go elsewhere we will pay 80% of the Discovery Health Rate.
🟪 Full Cover on the Hospital Network	We pay up to the Discovery Health Rate (100%).
🟥 Pre-defined list of approved procedures in the KeyCare Day Surgery Network	100% Discovery Health Rate (DHR) in KeyCare Day Surgery Network.

 

 

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

 

💙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.

 

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 Prescribed Minimum Benefit (PMB) conditions list 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 to determine 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.

 

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

 

💙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.

 

 

Discovery Health Personal Health Pathway

The Personal Health 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 Personal Health 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 Personal Health Fund for KeyCare Plus covers the following:

🅰️ General Health	You can access 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 check-up.
🚩 Medical Monitoring Devices	You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar.

The Personal Health 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 Personal Health Fund maximum is based on the size and composition of your family as stated in your policy:

• ✅Limited to R500 per adult dependent.
• ✅Limited to R250 per two-year-old or older child dependent.
• ✅Limited to R1000 per family.

 

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

 

 

Discovery Health 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 Plus and, if necessary, the PMBs.
• ✅ Access to the Long COVID Recovery Program.

 

💙How members of the Discovery Health KeyCare Plus 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 App and Virtual Benefits

Discovery Health Medical Scheme provides home-based access to health and wellness services. Discovery Health app and virtual benefits 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.

 

✅ 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.

 

✅ 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.

 

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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.

 

 

Discovery Health Hospital At Home

Hospital at Home patients receive 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.

 

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✅ 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

• ✅The Home Monitoring Device Benefit gives you access to a range of essential and registered home monitoring devices for certain chronic and acute conditions. Approved cover for these devices will not affect your day-to-day benefits.

 

✅ 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.

 

 

Discovery Health Day-To-Day Benefits and Cover

🩺 General Practitioner (GP) Visits	You have unlimited cover for medically appropriate GP consultations. When joining, you must nominate a GP from the KeyCare, KeyCare Start or KeyCare Start Regional GP Network, depending on the plan you choose. You must go to your nominated GP for us to cover your consultations, including some minor procedures. Preauthorisation is required after your 15th GP visit.
🩸 Blood, urine, and other fluid and tissue tests	We pay for a list of blood, urine and other fluid and tissue tests from a network GP. Your nominated network GP must ask for these tests by filling in a KeyCare pathology form. Claims are covered up to 100% of the Discovery Health Rate.
🧬 Day-to-day Medicine	We pay for medicine from our medicine list up to 100% of the Discovery Health Rate if they are prescribed and/or dispensed by your nominated Network GP depending on the plan you choose.
🩹 Basic X-Rays	We pay for a list of basic x-rays at a network provider. Your nominated network GP must ask for the x-rays to be done.
🅰️ Nurse-led consultations.	Nurse-led consultations at a network provider, with or without video call consultations with a General Practitioner, and referral for a face-to-face consultation, where needed and referred by the nurse. Limited to two consultations per person per year. We will cover the GP visit, selected blood tests, X-rays, and medicine on our medicine list if requested by the GP.
🅱️ Eyecare	We cover one eye test per person every two years, but you must go to an optometrist in the KeyCare Optometry Network. The optometrist will have a specific range of glasses which you can choose from. You can get a set of contact lenses instead of glasses if you choose to. You can get new glasses or contact lenses every 24 months.
🦷 Dentistry	We cover consultations, fillings and tooth removals at a dentist in our dentist network. Certain rules and limits may apply.
📌 Casualty Visits	On KeyCare Plus you have cover for one casualty visit per person per year at any casualty unit at a hospital in the KeyCare network. You must pay the first R500. You need to get preauthorisation for a casualty visit.
📍 Medical Equipment	On KeyCare Plus, we cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R6,050 per family per year.
➡️ Specialist Benefit	Covered visits to a specialist up to R5,550 annually. Your nominated network GP must refer you to a specialist and you need a reference number from us before your consultation with the specialist. On KeyCare Plus, if you need to see a maxillo-facial surgeon, periodontist, ophthalmologist or a specialist for maternity care, you do not need a referral from your GP or a reference number from us. Out-of-hospital MRI and CT scans are paid up to the Specialist Benefit limit. Claims are covered from the Specialist Benefit at the agreed rate or up to 100% of the Discovery Health Rate for specialists we don’t have a payment arrangement with.
↪️ 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 Discovery Health KeyCare Plus, 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 each child from birth until they are two years old.

 

Discovery Health Maternity Benefit covers the following:

✅ 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’s prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.

 

 

Discovery Health 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 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 Plus 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

 

and many more.

 

Chronic Medicine

On KeyCare Plus, you can get your medication from over 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 Plus

 

✅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 Program

• ✅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 Programs

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 optimally maintain your health over time.

 

1️⃣ Discovery Health Disease Prevention Program	If you are identified as being at risk of cardiometabolic syndrome, your nominated Premier Plus GP can enrol you on the Disease Prevention Programme. Your Premier Plus GP, dietitian and health coach will help coordinate your care. We provide condition-specific care programmes for diabetes, mental health, HIV and heart conditions. Our preventive and condition specific Care programmes help you to manage diabetes, HIV, mental health and heart-related medical conditions. You have to be registered on these Care programmes to unlock their extra benefits and services. Cover is subject to the Scheme’s clinical entry criteria, treatment guidelines and protocols. Enrolled members can access a defined basket of care, which includes cover for consultations, certain pathology tests and medicine, where appropriate. You will also have access to health coaching sessions, to help you manage your condition from day to day.
2️⃣ Discovery Health Mental Health Care Program	GPs can enroll cardiometabolic risk syndrome patients in the Disease Prevention Program. Dietitians, health coaches, and GPs coordinate care. Enrolled members receive medicine, pathology, and consultations. Health coaching assists with daily management.
3️⃣ Discovery Health Diabetes Care Program	Your KeyCare Plus GP can enroll you in the Diabetes Care Program 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.
4️⃣ Discovery Health HIV Care Program	KeyCare 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.
5️⃣ Discovery Health Cardio Care Program	If referred by your KeyCare Plus GP and enrolled in the Cardio Care Program, 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.

 

The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.

 

 

Discovery Health Comprehensive Cancer Cover

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

 

➡️ Discovery Health Prescribed Minimum Benefits (PMB)	PMB cancer treatment is always covered in full.
🎗️ Discovery Health Oncology Benefit	After Discovery Health approves your cancer treatment, the Oncology Care Program covers you. We pay for approved cancer treatment over a 12-month cycle. 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.
💊 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.
↪️ 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

KeyCare Plus includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by Hospital Benefits.

 

• ✅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 with KeyCare Plus.

 

🏥 Full Cover Hospital Network	Discovery will pay a 100% Discovery Health Rate (DHR). You can use any KeyCare Network-approved hospital.
📌 List of procedures that can be performed in a Day Surgery Network	KeyCare Day Surgery Network-covered.
📍 Defined List of procedures that can be performed in specialist rooms	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).
➡️ Cover for Specialists and Healthcare Providers in the Discovery Health network	Full cover provided.
↪️ 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.
📉 Radiology and Pathology Accounts	According to the Discovery Health Rate (DHR).
📈 Cover for scopes	KeyCare 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.
🧠 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. If you go elsewhere, Discovery Health will pay up to 80% of the Discovery Health Rate (DHR) for your hospital bill.

 

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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. 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

 

and many more.

 

 

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.
• ✅During the year that the trauma occurs 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 the Hospital Benefit pays it.

 

✅ 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 Plus Value-Added Offers

• ✅ Healthy Care at Clicks or Dis-Chem offers discounts on personal and family 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 Plus 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 Plus 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.

 

and many more.

 

✅ 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.

 

 

Medical Aid Comparisons : Discovery Health KeyCare Plus Plan vs Similar Low Cost Medical Aid Plans

🔎 Medical Aid Plan	🥇 KeyCare Plus (2025)	🥈 Platinum Health PlatCap (2025)	🥉 Bonitas BonStart (2025)
👤 Main Member Contribution	R1,817 – R3,687	R1 909	R1,498
👥 Adult Dependent Contribution	R1,817 – R3,687	R1 909	R1,498
🍼 Child Dependent Contribution	R661 – R986	R646	R1,498
🔁 Gap Cover	✅ Yes	None	✅ Yes
📉 Annual Limit	Unlimited Hospital Cover	Unlimited Hospital and other benefits	Unlimited Hospital Cover
📈 Above Threshold Benefit (ATB)	None	None	None
🌎 International Cover	None	None	R10 million
😷 Screening and Prevention	✅ Yes	None	✅ Yes
💙 Medical Savings Account	None	None	None

 

💙You might consider reading more about Health Insurance

 

 

Our Verdict on Discovery Health KeyCare Plus

KeyCare Plus is a medical aid plan offered by the Discovery Health Medical Scheme in South Africa. It is designed to provide affordable healthcare to members through a network of hospitals and healthcare providers. One of the main features of KeyCare Plus is its unlimited coverage in the KeyCare Hospital Network, which includes private hospitals and day clinics across South Africa.

 

As a result, members have access to various healthcare services, including specialist consultations, radiology, pathology, and hospitalization. In addition to hospital cover, KeyCare Plus also includes benefits for optometry and dental services. Members can enjoy a range of preventative and basic dental treatments, including annual check-ups, cleaning, and fillings.

 

The optometry benefit covers eye tests, frames, lenses, and certain contact lenses. These benefits can help members maintain good eye and dental health and prevent more serious health issues from developing. However, members should be aware of some drawbacks to the KeyCare Plus plan. Firstly, maternity coverage is limited and only covers the cost of childbirth in a KeyCare Hospital. There is no cover for postnatal care or any complications that may arise during pregnancy or childbirth.

 

Secondly, the plan does not include a medical savings account, meaning members must pay for certain out-of-hospital expenses out of their own pockets. Finally, the plan does not cover the cost of internal or external prostheses, such as hearing aids or artificial limbs.

 

You might be interested in other Discovery Health KeyCare Options:

🚩 Discovery Health Keycare Core
🚩 Discovery Health KeyCare Start
🚩 Discovery Health KeyCare Start Regional

 

 

Discovery Health KeyCare Plus Frequently Asked Questions

 

What is the KeyCare Hospital Network?

The KeyCare Hospital Network is a network of private hospitals and day clinics across South Africa that provide unlimited coverage for KeyCare Plus members. This means that members can receive hospitalization and related medical services at any of these facilities without worrying about exceeding their benefit limits.

 

What optometry benefits are included in KeyCare Plus?

KeyCare Plus includes benefits for basic optometry services such as eye tests, frames, lenses, and certain contact lenses. Members can visit any provider in the KeyCare Network for these services.

 

What dental benefits are included in KeyCare Plus?

KeyCare Plus includes benefits for preventative and basic dental treatments, including annual check-ups, cleaning, and fillings. Members can visit any provider in the KeyCare Network for these services.

 

What is the maternity cover in KeyCare Plus?

KeyCare Plus provides limited maternity cover that covers the cost of childbirth in a KeyCare Hospital. However, there is no cover for postnatal care or any complications that may arise during pregnancy or childbirth.

 

Does KeyCare Plus include a medical savings account?

No, KeyCare Plus does not include a medical savings account. Unfortunately, this means that members must pay for certain out-of-hospital expenses out of their own pockets.

 

Does KeyCare Plus cover the cost of prostheses?

No, KeyCare Plus does not cover the cost of internal or external prostheses such as hearing aids or artificial limbs. Members must pay for these items out of their own pockets or through other benefits or plans.