Overall, the Discovery Health KeyCare Start Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and a range of basic healthcare benefits to up to its Family Members. The Discovery Health KeyCare Start Medical Aid Plan starts from R1,331 ZAR.
| 🔎 Medical Aid Plan | 🥇 Discovery Health KeyCare Start |
| 👤 Main Member Contribution | R1,331 – R3,488 |
| 👤 Adult Dependent Contribution | R1,331 – R3,488 |
| 🍼 Child Dependent Contribution | R811 – R949 |
| 🔁 Gap Cover | ✅ Yes |
| 📈 Annual Limit | Unlimited Hospital Cover |
| ➡️ Hospital Cover | KeyCare Hospital Network – Unlimited |
| 🎗️ Oncology Cover | Up to 100% of the Discovery Health Rate (DHR) |
| 😷 Screening and Prevention | ✅ Yes |
| 💷 Medical Savings Account | None |
💙 The Discovery Health KeyCare Start starts from R1,331 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:
💙 KeyCare Start is an affordable medical aid plan that offers a range of basic healthcare benefits, including basic dentistry and optometry, oncology covering up to 100% of the DHR, pre and postnatal care, screening, and prevention.
💙 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.
| 💵 Income Level | 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R24,251+ | R3,488 | R3,488 | R949 |
| R15,951 – R24,250 | R3,063 | R3,063 | R919 |
| R10,551 – R15,950 | R1,952 | R1,952 | R878 |
| R0 – R10,550 | R1,331 | R1,331 | R811 |
| 🟥 Day-to-Day Cover | Day-to-day cover at your nominated KeyCare Start Network GP. Medicine from our medicine list is covered if you use a network pharmacy. Two specialist visits 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 R2,780 per person per year. You must be referred by your nominated KeyCare Start Network GP and get a reference number from us before your consultation with the specialist. |
| 🟧 Non-Emergency Casualty Visits | Your KeyCare Start Network GP or provider provides after-hours care. |
| 🟨 Chronic Medicine Prescriptions | State facilities cover chronic medication. |
| 🟩 Cancer | Your treatment in a state facility is covered. |
| 🟦 Chronic Dialysis | Your treatment in a state facility is covered. |
| 🟪 Full Cover on the Hospital Network | Your KeyCare Start Network Hospital receives the Discovery Health Rate (DHR). |
| ⬛ Partial Cover on the Hospital Network | 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 Start Day Surgery Network. |
💙 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:
💙 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:
💙 To qualify for coverage, your medical condition must be on the Prescribed Minimum Benefit (PMB) conditions list. 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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💙 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 Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.
| 🩺 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 | As a member, you can take advantage of a wellness visit for your children, which includes assessments of their growth and developmental milestones performed by a professional such as an occupational therapist, speech therapist, or physiotherapist. |
| ➡️ Medical Monitoring Devices | You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar. |
💙Personal Health Pathways leverages a sophisticated digital health platform that combines actuarial and lifestyle data with behavioral science to engage you in a personalized programme that drives you
towards healthier habits and behavior change.
💙 Personal Health Pathways is a new, innovative personalized care programme designed to help everyone achieve better health. It combines data with actuarial and behavioral science to create a personalized pathway (a plan of what you must do) for each member. Your pathway consists of curated sequence of health and lifestyle actions, tailored to your unique needs, encouraging you to healthier habits and
positive behavior changes.
💙 Your healthcare pathway is personalized for you. For a member with 12 actions, there are more than 7 million possible pathways to completing those actions.
💙 By leveraging sophisticated data-science and machine-learning models, these actions have been personalized for you based on your unique health status and engagement patterns.
💙 Actions are clinically relevant, shown at the right time and in the right sequence, and automatically update and adjust based on your changing healthcare needs.
💙 You can access your personalized health pathway through the Discovery Health app making it easy for you to seamlessly navigate
the healthcare system and to know what will have the biggest impact on your health.
💙 Completing these health and exercise actions
will not just have a positive impact on your health but you can get rewarded along the way. You don’t have to be a Discovery Vitality
member to access these rewards.
💙 You can also unlock additional healthcare benefits when you complete your health and exercise
next best actions.
💙 The Personal Health Fund is a new category of healthcare funding which you can accumulate as you engage in your Personal Health Pathway
and complete your next best health actions. The fund can be used for day-to-day medical expenses.
💙 Following the success of the WELLTH Fund in 2023 and 2024, all new joining members will continue to get a
once-per-lifetime benefit, built into the Personal Health Fund in 2025
💙 You will accumulate additional value in your annual Personal Health Fund by completing your next best actions indicated on Personal Health Pathways. The amount available in additional day-to-day funding is defined by your membership.
💙 The Personal Health Fund represents a new category of healthcare funding giving you access to up to R1000 in day-to-day, risk-funded benefits for medical expenses each year.
The benefit works in three simple steps:
👉 Step 1
💙 Download the Discovery Health App and understand your next best actions.
💙 You can view your next best actions on the Personal Health Pathways programme, available on the Discovery Health App and Discovery website.
👉 Step2
💙 Complete the recommended health actions and build up the Personal Health Fund, up to the maximum annual limit.
💙 For every completed next best action on Personal Health Pathways, you accumulate R500 into your Personal Health Fund.
💙 You can continue to accumulate funds up to a maximum limit each year, based on the family structure of the membership.
💙 Any unused funds in the Personal Health Fund expire at the end of a benefit year and do not carry over to the next benefit year.
👉 Step3
💙 You can use available funds on any day-to-day medical expenses, such
as GP visits, specialist consultations, physiotherapy and medicine.
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💙 The Discovery Health app gives you access to a truly personalized health experience and allows you to navigate the healthcare system easily. Access the advice and healthcare support that you need, 24/7, through the app’s innovative features.
💙 KeyCare Start Regional provides cover for healthcare services in
selected regions through the integrated healthcare platform, KeyCare Online Practice.
💙 The KeyCare Online Practice gives you convenient access to online and face-to-face GP consultations, medicine, basic x-rays, blood tests, specialist referrals and in-hospital treatment.
| ❤️ 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. |
💙 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.
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💙 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 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.
💙 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.
| 🔴 General Practitioner (GP) Visits | Medically necessary GP consultations are unlimited. You must choose a KeyCare Start GP when joining. Discovery Health will cover consultations and minor procedures at your chosen GP. Pre-authorization is needed after 15 GP visits. |
| 🟠 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. However, your network GP must order X-rays. |
| 🔵 Out-of-Network GP Visits | KeyCare Start allows out-of-network visits to any KeyCare Network GP. The Discovery Health Rate covers up to two out-of-network GP visits per year on KeyCare Start. The Discovery Health 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 | Your KeyCare Start GP or network provider can provide after-hours care. Casualty visits require pre-authorization. |
| 🟡 Specialist Benefit | Limited to two visits to a specialist up to R2,780 annually. Before seeing a specialist, your network GP must refer you and provide a reference number. 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. |
💙 With Discovery Health KeyCare Start, 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.
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Discovery Health Maternity Benefit covers the following:
During Pregnancy:
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After giving birth, Discovery Health covers the following:
💙 Discovery Health’s prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.
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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 Start Full List of conditions covered:
💙 On KeyCare Start Regional, you can get your medication from over 2,500 pharmacies in the Scheme’s pharmacy network.
💙 They cover you in full for approved chronic medicine on our medicine list (formulary). For medicine that is not on our list, we cover you up to the
therapeutic reference price of the equivalent medicine or group of medicines.
✅ Additional Chronic Benefits on the KeyCare Start
✅ 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
✅ 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 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. The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.
| 🅰️ Discovery Health Disease Prevention Program | KeyCare Start GPs can enroll you in the Disease Prevention Program 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 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. |
| 🚩 Discovery Health Diabetes Care Program | Your KeyCare Start 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. |
| 📌Depression Risk Management Programme | If you are identified as being at risk of depression, you will have access to a 6-month long care programme with a defined basket of care. This includes a consultation with a Premier Plus GP or network psychologist, coaching sessions with a social worker to coordinate your care, consultations with a dietitian, and a clinically appropriate digital mental wellbeing course. Cover is subject to clinical entry criteria treatment guidelines and protocols. |
| 📌 Discovery Health HIV Care Program | KeyCare Start 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 Program | If referred by your KeyCare Start 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. |
You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
| 💛 Discovery Health Prescribed Minimum Benefits (PMB) | PMB cancer treatment is always covered. KeyCare Start covers cancer treatment in the network or at a state facility. Discovery Health will only cover 80% of the Discovery Health Rate (DHR) if you use another provider. |
| 🎗️ Discovery Health Oncology Benefit | After Discovery Health approves your cancer treatment, the Oncology Care Program covers you. Discovery Health Rate covers 100% of cancer-related healthcare services. If you do not use the DSP or your doctor charges more, you might have to pay a co-payment. KeyCare Start covers cancer treatment in the network or at a state facility. Discovery Health will cover 80% of the DHR if you use another provider. |
| 🟡 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. Oncology medicine is paid up to 100% of the Discovery Health Rate or up to the Oncology Reference Price, whichever is applicable. |
| 🟨 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. |
KeyCare Start includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by Hospital Benefits.
The following table summarizes how Discovery Health pays for approved hospital admissions with KeyCare Start.
| 🏥 Full Cover Hospital Network | Fully covered at your preferred KeyCare Start Network hospital. It would help if you visited your chosen KeyCare Start Network Hospital. You will be responsible for all costs if you do not utilize a network hospital. These conditions do not apply in an emergency. |
| 📌 Defined list of procedures that can be performed in a Day Surgery Network | The KeyCare Start Day Surgery Network is covered. |
| 📍 Defined List of procedures that can be performed in specialist rooms | According to 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 at a KeyCare Start Network Hospital contracted provider. |
| 📊 Cover for Specialists and Healthcare Providers, not in the Discovery Health network | 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). |
| ↪️ Cover for scopes | Prescribed Minimum Benefit cover in the KeyCare Start Day Surgery Network. Authorised scopes done in the doctor’s rooms will be covered from your Hospital Benefit. |
| 🍹 Alcohol and Drug Rehabilitation | Discovery Health covers 21 days of rehabilitation per person per year. Three days for detoxification per approved admission. |
| Cataract Surgery at a network provider | We pay the full account at the agreed rate at a network facility for cataract surgery. On KeyCare Start and KeyCare Start Regional, you need to pay an upfront payment of R6,000 at any other facility. |
| 🧠 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. |
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:
and more.
✅ International Second Opinion Services
✅ Claims Relating to Traumatic Events
✅ In-Room Procedures
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✅ Advanced Illness Benefit
Your palliative care treatment plan includes GP consultations.
✅ Exclusions include the following:
✅ Additional exclusions that only apply to the KeyCare Start include hospitalizations caused by the following, among other things:
and many more.
✅ Discovery Health’s waiting periods are as follows:
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 Plan | 🥇 Discovery Health KeyCare Start | 🥈 KeyHealth Origin | 🥉 Fedhealth FlexiFED 1 |
| 👤 Main Member Contribution | R1,331 – R3,488 | R2,451 | R1,953 – R2,505 |
| 👤 Adult Dependent Contribution | R1,331 – R3,488 | R1,746 | R1, 526 – R1,963 |
| 🍼 Child Dependent Contribution | R811 – R949 | R799 | R 711 – R917 |
| 🔁 Gap Cover | ✅ Yes | ✅ Yes | None |
| 📈 Annual Limit | Unlimited Hospital Cover | None | Unlimited Hospital Cover |
| ➡️ Hospital Cover | KeyCare Hospital Network – Unlimited | Unlimited | Unlimited |
| 🎗️ Oncology Cover | Up to 100% of the Discovery Health Rate (DHR) | R197,500 | Unlimited at cost at PMB level of care at DSP |
| 😷 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| 💷 Medical Savings Account | None | None | ✅ Yes |
KeyCare Start is a medical aid plan offered by Discovery Health Medical Scheme, designed for individuals who require basic healthcare coverage at an affordable price. The plan offers a range of benefits, including basic dentistry and optometry, oncology covering up to 100% of the DHR, pre and postnatal care, screening, and prevention.
One of the key advantages of KeyCare Start is its affordable cost, making it an attractive option for those who need basic healthcare coverage without breaking the bank. Additionally, the plan offers a range of benefits that can help members stay healthy and access the care they need when they need it.
However, there are some drawbacks to consider when evaluating KeyCare Start. One major limitation of the plan is that it does not offer a medical savings account, which can be an important tool for managing healthcare costs. Additionally, the plan does not include an advanced dentistry benefit, which may concern those requiring more comprehensive dental care. Finally, the plan does not offer international coverage, which may be a significant drawback for those who travel frequently.
💙You might be interested in other Discovery Health KeyCare Options:
Discovery Health KeyCare Start Regional
KeyCare Start provides oncology cover up to 100% of the DHR, which includes chemotherapy and radiation treatments, as well as some supportive care services.
KeyCare Start covers a range of pre and postnatal care services, including antenatal classes, prenatal consultations, postnatal consultations, and newborn hearing screenings.
KeyCare Start covers basic dentistry services, such as consultations, extractions, fillings, and scaling and polishing.
KeyCare Start covers optometry services, such as comprehensive eye exams, basic lenses and frames, and contact lenses.
KeyCare Start covers a range of screening and prevention services, including mammograms, pap smears, prostate-specific antigen (PSA) tests, and HIV tests.
No, KeyCare Start does not offer a medical savings account as part of its benefits package.
No, KeyCare Start does not include an advanced dentistry benefit, such as orthodontics or oral surgery.
No, KeyCare Start does not offer international cover for medical expenses incurred outside of South Africa.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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