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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 R2,778 ZAR.
π€ Main Member Contribution | R2,778 |
π₯ Adult Dependent Contribution | R1,716 |
πΌ Child Dependent Contribution | R854 |
π International Cover | βοΈ Yes |
π Gap Cover | β Yes |
π Hospital Cover | Unlimited |
β‘οΈ Oncology Cover | R169,000 |
π Prescribed Minimum Benefits | βοΈ Yes |
πΆ Medical Savings Account | β Yes |
π Maternity Benefits | βοΈ Yes |
The KeyHealth Equilibrium medical aid plan is one of 6, starting from R2, 778 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.Β Gap Cover 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:
π€ Main Member | π₯ Adult Dependent | πΌ Child Dependent |
R2,778 | R1,716 | R854 |
π€ Main Member | π₯ Adult Dependent | πΌ Child Dependent |
R2,424 | R1,500 | R744 |
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π Varicose vein surgery Reflux surgery | Only PMB. |
π₯ 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. |
π State Hospital Admissions | Unlimited cover of up to 100% of the agreed tariff. |
π©Ί Specialist and Anesthetist Services | Covered up to 100% of the medical scheme tariff. Unlimited cover, subject to using a DSP. |
π Medication upon discharge | Limited to R575 per admission. Covered up to 100% of the medical scheme tariff. |
πΆ Maternity | Covered up to 100% of the medical scheme tariff. Private ward access for three days for natural birth. |
βοΈ 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. |
β€οΈ 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. |
π§ͺ 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. |
β‘οΈ Oncology | Covered up to 100% of the medical scheme tariff. Covered up to R169,000 per family per year. Pre-approval is needed. Subject to case management and scheme protocols. Must use a DSP for treatment. |
π 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. |
β 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. |
βοΈ MRI and CT scans | Limited to R17,800 per family per year. Combined in and out-of-hospital cover. |
β X-Rays | Unlimited cover. |
π Pathology | Covered up to 100% of the medical scheme tariff. Unlimited cover. Not covered if admission is for investigative purposes. |
π Day-to-Day Benefits Routine Medical Expenses GP and Specialist Consultations Radiology Prescribed and OTC medicine Optical and Auxiliary services | Covered up to 100% of the medical scheme tariff. Annual Medical Savings available: Main Member β R2,064 per year Adult Dependent β R1,272 per year Child Dependent β R636 per year Additional day-to-day benefits: Main Member β R3,090 per year Adult Dependent β R2,125 per year Child Dependent β R945 per year |
π 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. |
π Over-the-counter reading glasses | Limited to R120 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. |
βοΈ 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. |
π€ Optical Services | Covered up to 100% of the medical scheme tariff. Optical management will apply. Confirmation of benefit is required. |
βοΈ Frames | Covered up to 100% of the medical scheme tariff. Paid from Medical Savings Account (MSA). Subject to the day-to-day benefit and limit. |
β 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. |
π Contact 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. |
π¦· Conservative Dentistry | Subject to DENIS protocols. Managed care interventions and Scheme rules apply. Scheme Exclusions will apply. |
πͺ₯ Dentistry: Consultations | Covered up to 100% of the medical scheme tariff. One check-up per beneficiary per year. Three specific (emergency) consultations per beneficiary per year. |
β‘οΈ Intra-oral X-Rays | Four intra-oral radiographs per beneficiary per year. Covered up to 100% of the medical scheme tariff. |
β Extra-oral X-Rays | One extra-oral x-ray per beneficiary per year. Covered up to 100% of the medical scheme tariff. |
π· Preventative Care | One scale and polish treatment per beneficiary per year. Covered up to 100% of the medical scheme tariff. |
𧑠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. |
π 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. |
π Plastic Dentures | One set per beneficiary per year. DENIS pre-approval is required. |
π 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. |
π 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. |
β‘οΈ 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. |
π€ 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. |
π΄ Hospitalization and Anaesthesia | DENIS protocols and Scheme rules apply. Subject to managed care interventions. Specific exclusions will apply according to scheme rules. |
β³οΈ Hospitalization and general anesthesia | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is required. Only covers the removal of impacted teeth. |
π °οΈ 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. |
π ±οΈ 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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π °οΈ 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. |
π ±οΈ Category B (Other) | Covered up to 100% of the medical scheme tariff. Additional 3 non-PMB / CDL conditions are covered for children up to 21. |
The Equilibrium Plan falls within Category A of the CDL of KeyHealth and covers a selection of conditions including :
The Equilibrium Plan covers the following additional non-PMB/CDL conditions:
π Psychiatric Treatment | Limited to R21,500 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. |
π©Έ Blood Transfusions | Unlimited cover. Covered up to 100% of the medical scheme tariff. Pre-approval required. |
𦡠Prostheses Internal External Fixation Devices Implanted Devices | Limited to R3,500 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. |
βοΈ 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. |
π· HIV/AIDS | Unlimited cover. Covered up to 100% of the medical scheme tariff. Must be registered with the Chronic Disease Risk Program (LifeSense) |
π Ambulance Services | Subject to protocols. Covered up to 100% of the medical scheme tariff. |
π©π»βπ¦Ό Medical Appliances Wheelchairs Orthopaedic Appliances Incontinence Equipment | Limited to R7,900 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. |
π©Ί Medical Appliances Oxygen Nebulizers Glucometer Blood Pressure Monitor | Pre-approval is required and will be subject to approval. |
βοΈ Endoscopic Procedures (Scopes) | Covered up to 100% of the medical scheme tariff. |
βοΈ 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. |
𧑠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. |
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.
πΌ Baby Immunisation | Child dependents <6 years. According to the Department of Health schedule. |
π Flu Vaccination | All beneficiaries are covered. |
π· COVID-19 Vaccination | All beneficiaries are covered. |
βοΈ Tetanus-Diphtheria Injection | All beneficiaries are covered when needed. |
π Pneumococcal Vaccination | All beneficiaries are covered. |
π Malaria Medication | All beneficiaries are covered. Limited to R440 per year. |
βοΈ HPV vaccination | Two doses per lifetime for female beneficiaries between 9 and 14. |
πΆ Baby Growth Assessment | Three yearly assessments at a pharmacy or baby clinic for babies <35 months. |
π©Ή Contraceptive Medication β Tablets and Patches | Limited to R175 every 20 days. Female beneficiaries 16> |
β Contraceptive Medication β Injectables | Limited to R270 every 20 days. Female beneficiaries 16> |
π Pap Smear (Pathology) | Once per year. Female beneficiaries 15> |
π Pap Smear Consultation Pelvic Organs Ultrasound | Once per year. Female beneficiaries 15> |
π Mammogram | Once per year. Female beneficiaries 40> |
π©ββοΈ Prostate Specific Antigen (PSA) | Once per year. Male beneficiaries 40> |
π¨ββοΈ HIV/AID Tests | Once per year. All beneficiaries are covered. |
π Health Assessment Body Mass Index (BMI) Blood Pressure Measurement Cholesterol Test (Finger prick) Blood Sugar Test (Finger prick) PSA (Finger Prick) | Once per year. All beneficiaries are covered. |
π 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. |
πΌ Antenatal Visits to a GP, Gynaecologist, or midwife and a Urine Test | Pre-notification and pre-approval are needed. Twelve visits were covered. |
β° Ultrasounds β one before the 24th week and one after | Pre-notification and pre-approval are needed. Limited to two scans per pregnancy. |
πΆ Short Payments / Co-payments for services rendered and birthing fees | Covered up to 1,290 per pregnancy. |
πΌ Paediatrician Visits | The baby must be registered on the scheme. Limited to 2 visits within the babyβs first year and one in the second year. |
π Antenatal Vitamins | Limited to R2,180 per pregnancy. |
π Antenatal Classes | Limited to R2,180 for the first pregnancy. |
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.
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The Smart Baby Programme benefits accessible to women (and babies) are distinct from day-to-day benefits and medical savings accounts.
π Antenatal visits | Twelve visits, one of which is after the birth. |
π Ultrasounds | Limited to two pregnancy ultrasounds. |
πΌ Paediatrician Visits (after the baby is a registered beneficiary) | Limited to two visits in the babyβs first year. |
π Antenatal vitamins | Limited to R2,320 per pregnancy. |
β€οΈAntenatal classes | Limited to R2,320 per pregnancy. |
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The KeyHealth Equilibrium Plan has the following specific exclusions:
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:
If an individual who applies for membership or admission as a dependent was previously a beneficiary of a medical scheme for a continuous period of up to 24 months, which ended less than 90 days before the application date, Keyhealth could impose the following:
If the previous medical scheme had imposed a general or condition-specific waiting period on such an individual, and the waiting period had not expired at the time of termination, Keyhealth could impose a waiting period for the remaining duration as imposed by the previous medical scheme.
However, any child born into the Scheme during membership will not be subject to waiting periods.
Furthermore, Keyhealth can impose the following:
π Medical Aid Plan | π₯ KeyHealth Equilibrium | π₯ Bonitas Primary Select Plan | π₯ Discovery Essential Core |
π International Cover | None | R10 million | R5 million |
π€ Main Member Contribution | R2,778 | R2,619 | R2,855 |
π₯ Adult Dependent Contribution | R1,716 | R2,048 | R2,141 |
πΌ Child Dependent Contribution | R854 | R832 | R1,146 |
π Gap Cover | β Yes | β Yes | β Yes |
πΆ Prescribed Minimum Benefits | β Yes | β Yes | β Yes |
π Screening and Prevention | β Yes | β Yes | β Yes |
βοΈ Oncology Cover | R169,000 | R250,000 | R250,000 |
βοΈ Hospital Cover | Unlimited | Unlimited | Unlimited |
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 planβs 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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KeyHealth Equilibrium is a comprehensive medical insurance plan offered by KeyHealth that covers hospitalization, chronic medication, and day-to-day medical expenses, among others.
Yes, KeyHealth Equilibrium covers pregnancy and related medical expenses, subject to the policy terms and conditions.
Yes, KeyHealth Equilibrium covers advanced dentistry procedures, subject to the policy terms and conditions.
Yes, KeyHealth Equilibrium covers child immunization as part of its preventative healthcare benefits.
Yes, KeyHealth Equilibrium covers HIV/AIDS treatment and related medical expenses, subject to the policy terms and conditions.
Yes, KeyHealth Equilibrium covers oncology treatment and related medical expenses, subject to the policy terms and conditions.
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