Essence
About this plan
🥇 Best suited for individuals, couples, and small families who want comprehensive hospital cover with a modest day-to-day benefit.
Principal Member
From
R2,393
per month
Adult Dependant
From
R1,918
per month
Child Dependant
From
R862
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
Essence
KeyHealth Essence Medical Aid Plan (🇿🇦 2026)
Overall, the KeyHealth Essence Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and unlimited cover in private and state hospitals to up to 3 Family Members. The KeyHealth Essence Medical Aid Plan starts from R2,393 ZAR for 2026.| 👤 Main Member Contribution | R2,393 |
| 👥 Adult Dependent Contribution | R1,918 |
| 🍼 Child Dependent Contribution | R862 |
| 🌎 International Cover | KeyHealth Medical Scheme’s travel benefit covers out-of-hospital medical expenses for registered beneficiaries while traveling outside of South Africa for up to 90 days per journey. International SOS manages the benefit and provides medical assistance to members while traveling |
| 🔁 Gap Cover | No |
| 💶 Prescribed Minimum Benefits | ☑️ Yes |
| 📉 Screening and Prevention | ☑️ Yes |
| 💙 Medical Savings Account | None |
| 🏥 Hospital Cover | Unlimited |
| 👶 Maternity | Female beneficiaries. Pre-notification of and pre-authorisation by the Scheme compulsory. 12 visits. Subject to use of DSP |
KeyHealth Essence Plan - 8 Key Point Quick Overview
- ☑️ KeyHealth Essence Plan Overview
- ☑️ KeyHealth Essence Plan Contributions
- ☑️ Essence Plan Benefits and Cover Comprehensive Breakdown
- ☑️ Essence Smart Baby Program
- ☑️ Essence Plan Exclusions and Waiting Periods
- ☑️ KeyHealth Essence Plan vs. Similar Plans from other Medical Schemes
- ☑️ Our Verdict on The Essence Plan
- ☑️ Essence Plan Frequently Asked Questions
KeyHealth Essence Plan Overview
The KeyHealth Essence medical aid plan is one of 6, starting from R2,393, and includes unlimited cover in private and state hospitals, organ transplants, oncology, palliative care, and more. On the KeyHealth Essence Plan is 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 Essence Plan Contributions
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R2,393 | R1,918 | R862 |
Essence Plan Benefits and Cover Comprehensive Breakdown
Essence Plan Major Medical Benefits
| 🔍 Hospitalization Varicose vein surgery Facet joint injections Rhizotomy Reflux surgery Back and neck surgery (incl. spinal fusion) Joint replacement | PMB level of care / entitlement only All other procedures will be covered at 100% of agreed tariff, subject to case management, use of DSP and Scheme protocols |
| 🏥 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 covers 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 | Covered up to 100% of the medical scheme tariff. Limited to R695 per admission. |
| ➡️ 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 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 R205,500 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. Not covered if hospitalization admission is for investigative purposes. |
| 📉 MRI and CT scans | Limited to R21,700 per family per year. Combined in and out-of-hospital cover. |
| ❎ X-Rays | Unlimited cover. |
| 🩺 Pathology | Covered up to 100% of the medical scheme tariff. Unlimited cover. Not covered if admission is for investigative purposes. |
Essence Plan Out-of-Hospital Benefits
| 🅰️ Day-to-Day Benefits: Routine Medical Expenses | Covered up to 100% of the medical scheme tariff. Unlimited cover but only for PMB. |
| 🅱️ Day-to-Day Benefits: Pathology | Covered up to 100% of the medical scheme tariff. Only PMBs are covered. |
| 👨⚕️ Antenatal Visits to a GP, Gynaecologist, or midwife and a Urine Test | Female beneficiaries. Pre-notification of and pre-authorisation by the Scheme compulsory. 12 visits. Additional screening tests. Subject to use of DSP |
| 📈 Ultrasounds – one before the 24th week and one after | Female beneficiaries. Pre-notification of and pre-authorisation by the Scheme compulsory. 2 pregnancy scans. Subject to use of DSP Limited to two scans per pregnancy. |
| 💶 Short Payments / Co-payments for services rendered and birthing fees | Covered up to R1,570 per pregnancy. |
| 💊 Antenatal Vitamins | Covered up to 100% of the medical scheme tariff. Limited to R2,650 per pregnancy. |
| 📍 Antenatal Classes | Covered up to 100% of the medical scheme tariff. Limited to R2,650 for the first pregnancy. |
| 🦷 Conservative Dentistry: Consultations | Covered up to 100% of the medical scheme tariff. One check-up per beneficiary yearly. Two infection control treatments. One sterilized instrumentation benefit per beneficiary yearly. |
| ❎ Conservative Dentistry: Intra-oral X-Rays | Covered up to 100% of the medical scheme tariff. Limited to four intra-oral radiographs (periapical or bitewing) |
| ✅ Specialised Dentistry | Covered up to 100% MST of the medical scheme tariff. |
| ⬇️ 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) Digital Health Assessment (DHA): Blood pressure measurement, heart rate, respiration rate | Once per year. All beneficiaries are covered. Beneficiaries aged ≥ 18 – once per year |
| 👶 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. |
| ✔️ Pneumococcal Vaccination | All beneficiaries are covered. |
| 🦟 Malaria Medication | All beneficiaries are covered. Limited to R500 per year. |
| 🚼 Baby Growth Assessment | Three yearly assessments at a pharmacy or baby clinic for babies <35 months. |
| 🚸 Contraceptive Medication – Tablets and Patches | Limited to R190 every 20 days. Female beneficiaries 16> (Silver, Equilibrium and Origin options only) |
| 🚸 Contraceptive Medication – Injectables | Limited to R295 every 72 days. Female beneficiaries 16> (Silver, Equilibrium and Origin options only) |
| ⚖️ 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. |
Essence Plan Chronic Benefits
| 🅰️ 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. |
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Essence Plan falls within Category A of the CDL of KeyHealth and covers a selection of conditions, including:- ✅ 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
Essence Plan 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 | Covered up to 100% of the medical scheme tariff. Unlimited cover. Pre-approval required. |
| 🦵 Prostheses Internal External Fixation Devices Implanted Devices | Pre-authorisation compulsory and subject to case management, reference pricing, use of DSP, and Scheme protocols. PMB level of care / entitlement only |
| 😷 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. For emergency transport contact 082 911 |
| 👩🏻🦼 Wheelchairs Orthopaedic Appliances Incontinence Equipment | Covered up to 100% of the medical scheme tariff. Limited to R9,550 per family per year. Combined benefits for in and out-of-hospital. Subject to quantities and protocols. |
| 🫁 Oxygen Nebulizers Glucometer Blood Pressure Monitor | Pre-approval is required and will be subject to approval. |
| ☑️ Colonoscopy or gastroscopy | Covered up to 100% of the medical scheme tariff. Pre-approval is required. Co-payments do not apply when using a DSP hospital and specialist for out-of-hospital services for PMB. |
| ✅ Endoscopic Procedures (Scopes): All other procedures | Covered up to 100% of the medical scheme tariff. Pre-approval is required. Co-payments do not apply when using a DSP hospital and specialist for out-of-hospital services for PMB. |
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Essence 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.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.
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. |
| 💊 Antenatal vitamins | Limited to R2,650 per pregnancy. |
| ☑️ Antenatal classes | Limited to R2,650 per pregnancy. |
| 💵 Short Payments | R1,570 per pregnancy |
Additional Screening Tests
- Haemoglobin (Hb) level at the first antenatal visit and repeated between 28-32 weeks and 36 weeks for gestation.
- Bacterluria at first visit or at 12-16 Weeks
- Gestational diabetes, screened at fisrst antenatal visit and again at 28 weeks.
- Syphills test at first visit.
- Chlamydia test at first visit.
- Hepatitis B in the first trimester
- Rh incompatibility for the first pregnancy between 24-48 weeks.
Essence Plan 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.
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KeyHealth Essence Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 KeyHealth Essence (2026) | 🥈 Fedhealth FlexiFED 1 Elect (2026) | 🥉 Bestmed Beat 1 (2026) |
| 👤 Main Member Contribution | R2,393 | R1,953 | R2,347 |
| 👥 Adult Dependent Contribution | R1,918 | R1,526 | R1,822 |
| 🍼 Child Dependent Contribution | R862 | R711 | R987 |
| 🌎 International Cover | YES | None | R5 million |
| 🚑 Hospital Cover | Unlimited | Unlimited | Subject to scheme rules |
| 💶 Prescribed Minimum Benefits | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 📉 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| 💳 Medical Savings Account | None | None | None |
| 👶 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
Our Verdict on The Essence Plan
KeyHealth Essence is a medical aid plan offered by KeyHealth, a registered medical aid scheme in South Africa. The plan is one of six available and starts at a monthly contribution of R2,393 for the main member, with unlimited cover in private and state hospitals, organ transplants, oncology, palliative care, and more. The plan offers additional benefits through the Smart Baby Program, which provides expecting mothers and fathers with general guidance and support on health and well-being throughout the pregnancy while ensuring peace of mind. The plan has specific exclusions, such as hospitalization benefits for specific procedures and waiting periods for new members. Overall, KeyHealth Essence offers comprehensive medical coverage for individuals and families at competitive prices.
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