Equilibrium
About this plan
🥇 Best suited for individuals, couples, and families who want comprehensive hospital cover with the flexibility of a Medical Savings Account.
Principal Member
From
R3,296
per month
Adult Dependant
From
R2,035
per month
Child Dependant
From
R1,014
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Equilibrium
KeyHealth Equilibrium Medical Aid Plan (🇿🇦 2026)
Overall, the KeyHealth Equilibrium Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers a medical savings account and medical emergency assistance to up to 3 Family Members. The KeyHealth Equilibrium Medical Aid Plan starts from R3,296 ZAR.| 👤 Main Member Contribution | R3,296 |
| 👥 Adult Dependent Contribution | R2,035 |
| 🍼 Child Dependent Contribution | R1,014 |
| 🌎 International Cover | ☑️ Yes |
| 🔁 Gap Cover | No |
| 💙 Hospital Cover | Unlimited |
| ➡️ Oncology Cover | R205,000 |
| 📉 Prescribed Minimum Benefits | ☑️ Yes |
| 💶 Medical Savings Account | ✅ Yes |
| 🙂 Maternity Benefits | ☑️ Yes |
KeyHealth Equilibrium - Key Point Quick Overview
- ☑️ KeyHealth Equilibrium Plan Overview
- ☑️ KeyHealth Equilibrium Plan Contributions and Medical Savings
- ☑️ Equilibrium Plan Benefits and Cover Comprehensive Breakdown
- ☑️ Equilibrium Chronic Benefits
- ☑️ Equilibrium Supplementary Benefits
- ☑️ Equilibrium Health Booster
- ☑️ Equilibrium Smart Baby Program
- ☑️ Equilibrium Plan Exclusions and Waiting Periods
- ☑️ KeyHealth Equilibrium Plan vs. Similar Plans from other Medical Schemes
- ☑️ Our Verdict on The Equilibrium Plan
- ☑️ Equilibrium Plan Frequently Asked Questions
KeyHealth Equilibrium Plan Overview
The KeyHealth Equilibrium medical aid plan is one of 6, starting from R3,296 and includes a medical savings account, out-of-hospital benefits, day-to-day benefits for out-of-hospital medical procedures and treatments, psychiatric treatment, and more. Savings is available on the KeyHealth Equilibrium Plan, along with 24/7 medical emergency assistance. According to the Trust Index, KeyHealth has a trust rating of 4.1.
KeyHealth offers 6 medical aid plans:
- 📌 KeyHealth Essence Medical Aid Plan
- 📌 KeyHealth Origin Medical Aid Plan
- 📌 Keyhealth Equilibrium Medical Aid Plan
- 📌 Keyhealth Silver Medical Aid Plan
- 📌 Keyhealth Gold Medical Aid Plan
- 📌 Keyhealth Platinum Medical Aid Plan
KeyHealth Equilibrium Plan Contributions and Medical Savings
Contributions (excluding savings contribution)
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R3,056 | R1,887 | R940 |
Medical Savings per year
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R2880 | R1776 | R888 |
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Equilibrium Plan Benefits and Cover Comprehensive Breakdown
Equilibrium Major Medical Benefits
| 📌 Varicose vein surgery Reflux surgery | Only PMB. |
| 🏥 Private Hospital Admissions | Unlimited cover. Covered up to 100% of the agreed tariff. Subject to using DSP hospitals. A 30% co-payment will apply when using a non-DSP hospital. |
| 🚑 State Hospital Admissions | Unlimited cover of up to 100% of the agreed tariff. |
| 🩺 Specialist and Anesthetist Services | Covered up to 100% of the medical scheme tariff. Unlimited cover, subject to using a DSP. |
| 💊 Medication upon discharge | Limited to R695 per admission. Covered up to 100% of the medical scheme tariff. |
| 👶 Maternity | Covered up to 100% of the medical scheme tariff. Private ward access for three days for natural birth. |
| ☑️ Sub-acute facilities and wound care Hospice Private Nursing Rehabilitation Step-down Facilities Wound Care | Covered up to 100% of the medical scheme tariff. Pre-approval is needed. Subject to case management and scheme protocols. Only PMBs are covered. |
| ❤️ Organ Transplants (Solid Organs, Tissue, and Corneas) Hospitalization Harvesting Drugs for Immuno-Suppressive Therapy | Covered up to 100% of the medical scheme tariff. Pre-approval is needed. Subject to case management. Only PMBs are covered in DSP hospitals. |
| 🧪 Renal Dialysis | Covered up to 100% of the medical scheme tariff. Pre-approval is needed. Subject to case management and scheme protocols. Only PMBs are covered. |
| ➡️ Oncology | Covered up to 100% of the medical scheme tariff. Covered up to R197,500 per family per year. Pre-approval is needed. Subject to case management and scheme protocols. Must use a DSP for treatment. |
| 🔁 Palliative Care | Covered up to 100% of the medical scheme tariff. Available instead of hospitalization. Pre-approval is needed. Subject to case management and scheme protocols. |
| ➕ Radiology | Covered up to 100% of the medical scheme tariff. Pre-approval is needed for specialized radiology (MRI, CT) Hospitalization is not covered if hospitalization admission is for investigative purposes. Day-to-day benefits cover investigative admissions. |
| ⚕️ MRI and CT scans | Limited to R23,000 per family per year. Combined in and out-of-hospital cover. R1,650 co-payment per scan in- or out-of-hospital (except for confirmed PMBs). |
| ❎ X-Rays | Unlimited cover. |
| 📍 Pathology | Covered up to 100% of the medical scheme tariff. Unlimited cover. Not covered if admission is for investigative purposes. |
Equilibrium Out-of-Hospital Benefits
| 📌 Day-to-Day Benefits Routine Medical Expenses GP and Specialist Consultations Radiology Prescribed and OTC medicine Optical and Auxiliary services | Annual Medical Savings Account (MSA) Principal Member: R2 880 pa Adult Dependant: R1 776 pa Child Dependant: R888 pa Additional day-to-day benefits Principal Member: R3 755 pa Adult Dependant: R2 585 pa Child Dependant: R1 150 pa |
| 📍 Over-the-counter medicine | Covered up to 100% of the medical scheme tariff. Paid from Medical Savings Account (MSA). Subject to the day-to-day benefit and limit. |
| 👓 Over-the-counter reading glasses | Limited to R145 per family per year. Limited to one pair per year. Paid from Medical Savings Account (MSA). Subject to the day-to-day benefit and limit. |
| ☑️ Pathology | Covered up to 100% of the medical scheme tariff. Paid from Medical Savings Account (MSA). Subject to the day-to-day benefit and limit. |
| 🤓 Optical Services | Covered up to 100% of the medical scheme tariff. Optical management will apply. Confirmation of benefit is required. Eye test Benefit of R600 |
| ☑️ Frames | Covered up to 100% of the medical scheme tariff. Benefit of R1550 per every two years Paid from Medical Savings Account (MSA). Subject to the day-to-day benefit and limit. |
| ✅ Lenses | Covered up to 100% of the medical scheme tariff. Paid from Medical Savings Account (MSA). Subject to the day-to-day benefit and limit. |
| 😊 Contact Lenses | Subject to overall optical benefit |
| 🦷 Conservative Dentistry | Subject to DENIS protocols. Managed care interventions and Scheme rules apply. Scheme Exclusions will apply. |
| 🪥 Dentistry: Consultations | Covered up to 100% of the medical scheme tariff. One check-up per beneficiary per year. |
| ➡️ Intra-oral X-Rays | Four intra-oral radiographs per beneficiary per year. Covered up to 100% of the medical scheme tariff. |
| ❎ Extra-oral X-Rays | One extra-oral x-ray per beneficiary per year. Covered up to 100% of the medical scheme tariff. |
| 😷 Preventative Care | One scale and polish treatment per beneficiary per year. Covered up to 100% of the medical scheme tariff. |
| 🧡 Fillings | One per tooth every 720 days. Covered up to 100% of the medical scheme tariff. Multiple fillings require a treatment plan and X-rays. Retreatment is subject to clinical protocols. |
| 📈 Tooth Extractions and root canal treatment | Root canal therapy on primary (milk) teeth, wisdom teeth (third molars), and direct or indirect pulp capping is excluded from treatment on this benefit. Covered up to 100% of the medical scheme tariff. |
| 📉 Plastic Dentures | One set per beneficiary per year. DENIS pre-approval is required. |
| 📊 Orthodontics (non-cosmetic and only treatment) | Covered up to 100% of the medical scheme tariff. DENIS approval is required. Cases are assessed using orthodontic indices where the function is impaired. Only one beneficiary per family can receive treatment once a year. Limited to beneficiaries between 9 and 18. |
| 🙂 Maxillo-Facial and Oral Surgery | Covered up to 100% of the medical scheme tariff. DENIS protocols and Scheme rules apply. Exclusions will apply according to scheme rules. |
| ➡️ Surgery in Dental Chair | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is required. Only covers the removal of impacted teeth. |
| 💤 Surgery in-hospital with general anesthesia | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is required. Only covers the removal of impacted teeth. |
| 😴 Hospitalization and Anaesthesia | DENIS protocols and Scheme rules apply. Subject to managed care interventions. Specific exclusions will apply according to scheme rules. |
| ✳️ Hospitalization and general anesthesia | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is required. DENIS pre-authorisation compulsory. Limited to extensive dental treatment for children <5 years and the removal of impacted teeth. R2 060 co-payment per hospital admission (no co-payment for day hospitals |
| 🅰️ Inhalation sedation in dental rooms | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is not required. Only covers the removal of impacted teeth. Limited to extensive dental treatment for children <5. |
| 🅱️ Moderate/deep sedation in dental rooms | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is required. Only covers the removal of impacted teeth. |
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Equilibrium Chronic Benefits
Chronic Medication
| 🅰️ Category A CDL | Covered up to 100% of the medical scheme tariff. Unlimited cover. Subject to reference pricing and protocols. Beneficiaries must register on the Disease Risk Program. |
| 🅱️ Category B (Other) | Covered up to 100% of the medical scheme tariff. Additional 4 non-PMB / CDL conditions are covered for children up to 21. |
- ✅ Addison’s Disease
- ✅ Asthma
- ✅ Bipolar Mood Disorder
- ✅ Bronchiectasis
- ✅ Cardiac Failure
- ✅ Cardiomyopathy Disease
- ✅ Chronic Renal Disease
- ✅ Coronary Artery Disease
- ✅ Crohn’s Disease
- ✅ Chronic Obstructive Pulmonary Disorder
- ✅ Glaucoma
- Acne
- Hyperkinesis or ADD (attention deficit disorder)
- Rhinitis
Equilibrium Supplementary Benefits
| 📌 Psychiatric Treatment | Limited to R26,100 per family per year. Covered up to 100% of the medical scheme tariff. Pre-approval is required. Subject to case management. Out-of-hospital is only covered for PMB. |
| 🩸 Blood Transfusions | Unlimited cover. Covered up to 100% of the medical scheme tariff. Pre-approval required. |
| 🦵 Prostheses Internal External Fixation Devices Implanted Devices | Limited to R4,300 per beneficiary per year. Covered up to 100% of the medical scheme tariff. Pre-approval is required, and it is subject to case management. Covered according to reference pricing. Scheme protocols will apply, and beneficiaries must use a preferred provider. |
| ⚕️ Document-Based Care (DBC) for back and neck | Covers conservative back and neck treatment instead of surgery. Covered up to 100% of the medical scheme tariff. Requires pre-authorization and will be subject to case management and scheme protocols. Only approved DBC facilities can be used. Only PMBs are covered. |
| 😷 HIV/AIDS | Unlimited cover. Covered up to 100% of the medical scheme tariff. Must be registered with the Chronic Disease Risk Program (LifeSense) |
| 🚑 Ambulance Services | Subject to protocols. Covered up to 100% of the medical scheme tariff. |
| 👩🏻🦼 Medical Appliances Wheelchairs Orthopaedic Appliances Incontinence Equipment | Limited to R9,550 per family per year. Covered up to 100% of the medical scheme tariff. Combined benefits for in and out-of-hospital. Subject to quantities and protocols. |
| 🩺 Medical Appliances Oxygen Nebulizers Glucometer Blood Pressure Monitor | Pre-approval is required and will be subject to approval. |
| ⚙️ Endoscopic Procedures (Scopes) | Covered up to 100% of the medical scheme tariff. |
| ✔️ Colonoscopy or gastroscopy | Pre-approval is required. Co-payments do not apply when using a DSP hospital and specialist for out-of-hospital services for PMB. |
| 🧡 All other procedures | Pre-approval is required. Co-payments do not apply when using a DSP hospital and specialist for out-of-hospital services for PMB. |
Equilibrium Health Booster
The KeyHealth health booster provides members additional benefits for preventative treatment. This includes free screening tests, among several other features, as seen in the benefits table below.| 🍼 Baby Immunisation | Child dependents <6 years. According to the Department of Health schedule. |
| 💉 Flu Vaccination | All beneficiaries are covered. |
| 😷 COVID-19 Vaccination | All beneficiaries are covered. |
| ⚕️ Tetanus-Diphtheria Injection | All beneficiaries are covered when needed. |
| 📌 Pneumococcal Vaccination | All beneficiaries are covered. |
| 📍 Malaria Medication | All beneficiaries are covered. Limited to R500 per year. |
| ☑️ HPV vaccination | Two doses per lifetime for female beneficiaries between 9 and 14. |
| 👶 Baby Growth Assessment | 3 baby growth assessments per year at a pharmacy / baby clinic for beneficiaries aged 0-7 years |
| 🩹 Contraceptive Medication – Tablets and Patches | Limited to R190 every 20 days. Female beneficiaries 16> |
| ❎ Contraceptive Medication – Injectables | Limited to R295 every 72 days. Female beneficiaries 16> |
| 📈 Pap Smear (Pathology) | Once per year. Female beneficiaries 15> |
| 📉 Pap Smear Consultation Pelvic Organs Ultrasound | Once per year. Female beneficiaries 15> |
| 📊 Mammogram | Once per year. Female beneficiaries 40> |
| 👩⚕️ Prostate Specific Antigen (PSA) | Once per year. Male beneficiaries 40> |
| 👨⚕️ HIV/AID Tests | Once per year. All beneficiaries are covered. |
| 😊 Health Assessment Body Mass Index (BMI) Blood Pressure Measurement Cholesterol Test (Finger prick) Blood Sugar Test (Finger prick) PSA (Finger Prick) AND / OR Digital Health Assessment (DHA): Blood pressure measurement, heart rate, respiration rate | Once per year. All beneficiaries are covered. Beneficiaries aged ≥ 18 – once per year |
| 🔁 Weight Loss Program | Beneficiaries with a BM of 30> will receive the following: Three dietician consultations (one per week) One biokinetics consultation. Three additional dietician consultations per week if a weight loss chart was received, proving weight loss after the first three weeks. One follow-up with biokinetics. |
| 🚼 Antenatal Visits to a GP, Gynaecologist, or midwife and a Urine Test | Pre-notification and pre-approval are needed. Twelve visits covered. |
| ⏰ Ultrasounds – one before the 24th week and one after | Pre-notification and pre-approval are needed. Limited to two scans per pregnancy. |
| 💶 Short Payments / Co-payments for services rendered and birthing fees | Covered up to R1,570 per pregnancy. |
| 🍼 Paediatrician Visits | Confirm with Key health Support. |
| 💊 Antenatal Vitamins | Limited to R2,650 per pregnancy. |
| 📍 Antenatal Classes | Limited to R2,650 for the first pregnancy. |
Equilibrium Smart Baby Program
The Smart Baby Programme by KeyHealth provides expecting mothers and fathers with general guidance and support on health and well-being throughout the pregnancy while ensuring peace of mind.💙 Try our free Menstrual Cycle Calculator
Smart Baby Program Features
- ✅ Coverage under Health Booster for antenatal visits (GP, gynecologist, or midwife), scans, and birthing fees that require short/co-payments.
- ✅ Provision of KeyHealth’s maternity benefits and instructions on how to access them.
- ✅ The New Baby and Childcare Handbook, authored by Marina Petropulos, is specifically for first-time parents.
- ✅ Information on the initial year of the baby’s life, including vaccinations, Easy-ER, and other details.
- ✅ Availability of Netcare 911’s 24-hour Health-on-Line service at 082 911 for medical advice and insights from a registered nurse.
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Smart Baby Program Benefits
The Smart Baby Programme benefits accessible to women (and babies) are distinct from day-to-day benefits and medical savings accounts.| 📌 Antenatal visits | Twelve visits, one of which is after the birth. |
| 📍 Ultrasounds | Limited to two pregnancy ultrasounds. |
| 🍼 Paediatrician Visits (after the baby is a registered beneficiary) | Limited to two visits in the baby’s first year. 1 visit in baby's second year. |
| 💊 Antenatal vitamins | Limited to R2,650 per pregnancy. |
| ❤️Antenatal classes | Limited to R2,650 per pregnancy. |
| 💵 Short Payments | R1 570 per pregnancy |
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Equilibrium Plan Exclusions and Waiting Periods
Exclusions
The KeyHealth Equilibrium Plan has the following specific exclusions:- ⛔ Acupuncture
- ⛔ Bio-stress assessments
- ⛔ Colonic irrigation
- ⛔ Conservative back/neck treatment in the hospital
- ⛔ Cosmetic / non-functional procedures
- ⛔ DNA testing
- ⛔ Gender reassignment
- ⛔ Industrial and educational psychologists
- ⛔ IQ tests and learning or educational problems
- ⛔ Music and water therapy
- ⛔ Obesity and weight loss surgery (excluding benefits available on the Health Booster)
- ⛔ Polysomnogram and titration (sleep study)
- ⛔ Reversal of sterilization
- ⛔ Reversal of vasectomy
- ⛔ Sclerotherapy of varicose veins
- ⛔ Sonography and sonographer
- ⛔ Therapeutic reflexology
- ⛔ VAC instillation therapy, including Pico and Prevena dressings.
- ⛔ Artificial insemination
- ⛔ Delivery
- ⛔ Gestational surrogacy (GS) and donor sperm (DS)
- ⛔ Maternity benefits (day-to-day or Health Booster)
- ⛔ Bath transfer benches
- ⛔ Bath and toilet railings
- ⛔ Continuous glucose monitoring system
- ⛔ Commodes
- ⛔ Compression pants
- ⛔ Cosmetic improvement to the appearance of prosthetic/artificial limb
- ⛔ CPAP machines and accessories
- ⛔ Cryo-cuff or similar products for compression, hot and cold therapy
- ⛔ Cushions (any sort)
- ⛔ Elevation devices/equipment, and more.
Waiting Periods
If a Principal Member or their dependent is diagnosed with a specific illness, the Scheme reserves the right to exclude benefits for this condition for 12 months. Subject to the regulations, KeyHealth can impose waiting periods on an individual who applies for membership or admission as a dependent and has not been a beneficiary of a medical scheme for a minimum of 90 days before the application date. Such waiting periods may include the following:- ✅ A general waiting period of up to 3 months also encompasses PMB conditions.
- ✅ A condition-specific waiting period of up to 12 months, including PMB conditions.
- ✅ A condition-specific waiting period of up to 12 months, except for any treatment or diagnostic procedures covered within PMB conditions.
- ✅ A general waiting period of up to 3 months, except for any treatment or diagnostic procedures covered within PMB conditions, on any person who applies for membership or admission as a dependent and was previously a beneficiary of a medical scheme for a continuous period of more than 24 months, which ended less than 90 days before the application date.
KeyHealth Equilibrium Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 KeyHealth Equilibrium (2026) | 🥈 Bonitas Primary Plan (2026) | 🥉 Discovery Essential Core (2026) |
| 🌎 International Cover | ✅ Yes | R2.5 million | R5 million |
| 👤 Main Member Contribution | R3,296 | R3,588 | R3,138 |
| 👥 Adult Dependent Contribution | R2,035 | R2,807 | R2,354 |
| 🍼 Child Dependent Contribution | R1,014 | R1,141 | R1,260 |
| 🔁 Day-to-Day Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
| 💶 Prescribed Minimum Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
| 📉 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| ☑️ Oncology Cover | R205,000 | R224,100 | R250,000 |
| ⚕️ Hospital Cover | Unlimited | Unlimited | Unlimited |
Our Verdict on The Equilibrium Plan
The KeyHealth Equilibrium plan is a comprehensive health insurance policy designed to meet the needs of individuals and families in South Africa. It provides a range of features and benefits aimed at helping people manage their health and well-being cost-effectively and efficiently. One of the key advantages of this plan is its affordability, as it offers a range of options that cater to different budgets and needs. Another significant advantage of the KeyHealth Equilibrium plan is its wide range of benefits. These include cover for hospitalization, chronic medication, and day-to-day medical expenses. Additionally, the plan includes access to a network of healthcare providers, including doctors, hospitals, and specialists, who have agreed to charge lower rates for KeyHealth members. However, like any insurance policy, the KeyHealth Equilibrium plan has some drawbacks. One of the most significant drawbacks is that the plan has a waiting period before members can claim certain benefits. This means new members may have to wait for a specified period before claiming certain medical procedures or conditions. Another potential disadvantage is that the plan may not cover certain medical procedures or treatments, depending on the policy terms and conditions. Despite these drawbacks, the KeyHealth Equilibrium plan remains attractive for individuals and families looking for affordable and comprehensive health insurance. The plan’s features and benefits are designed to help people manage their health and well-being effectively, and including a network of healthcare providers helps ensure that members have access to quality care at a reasonable cost.
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