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 R2,187 ZAR for 2025.
| 👤 Main Member Contribution | R2,187 |
| 👥 Adult Dependent Contribution | R1,753 |
| 🍼 Child Dependent Contribution | R788 |
| 🌎 International Cover | None |
| 🔁 Gap Cover | ☑️ Yes |
| 💶 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 |
The KeyHealth Essence medical aid plan is one of 6, starting from R2,187, and includes unlimited cover in private and state hospitals, organ transplants, oncology, palliative care, and more. Gap Cover is available on the KeyHealth Essence 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:
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R2,187 | R1,753 | R788 |
| 🔍 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 R670 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 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. Not covered if hospitalization admission is for investigative purposes. |
| 📉 MRI and CT scans | Limited to R20,900 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. |
| 🅰️ 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 | Covered up to 100% of the medical scheme tariff. Pre-notification and pre-approval are needed. Twelve visits were covered. |
| 📈 Ultrasounds – one before the 24th week and one after | Covered up to 100% of the medical scheme tariff. 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 R1,510 per pregnancy. |
| 🍼 Paediatrician Visits | Covered up to 100% of the medical scheme tariff. The baby must be registered on the scheme. Limited to 2 visits (one within the first and one in the second year) |
| 💊 Antenatal Vitamins | Covered up to 100% of the medical scheme tariff. Limited to R2,550 per pregnancy. |
| 📍 Antenatal Classes | Covered up to 100% of the medical scheme tariff. Limited to R2,550 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) |
| ⬇️ 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) | Once per year. All beneficiaries are covered. |
| 👶 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 R480 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 R185 every 20 days. Female beneficiaries 16> |
| 🚸 Contraceptive Medication – Injectables | Limited to R285 every 20 days. Female beneficiaries 16> |
| ⚖️ 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. |
| 🅰️ 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:
| 📌 Psychiatric Treatment | Limited to R25,100 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 | Only PMBs are covered. 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. |
| 😷 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. |
| 👩🏻🦼 Wheelchairs Orthopaedic Appliances Incontinence Equipment | Covered up to 100% of the medical scheme tariff. Limited to R9,200 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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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.
💙 READ more: 5 Best Medical Aids for Babies in South Africa
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 R2,550 per pregnancy. |
| ☑️ Antenatal classes | Limited to R2,550 per pregnancy. |
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:
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| 🔎 Medical Aid Plan | 🥇 KeyHealth Essence (2025) | 🥈 Fedhealth FlexiFED 1 (2025) | 🥉 Bestmed Beat 1 (2025) |
| 👤 Main Member Contribution | R2,187 | R1,953 | R2,347 |
| 👥 Adult Dependent Contribution | R1,753 | R1,953 | R1,822 |
| 🍼 Child Dependent Contribution | R788 | R917 | R987 |
| 🌎 International Cover | None | 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 | ☑️ Yes | None |
| 👶 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
💙 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 R2,187 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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You might also like: KeyHealth Gold
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KeyHealth Essence is a low-cost medical aid option offering members essential healthcare coverage.
The Keyhealth Essence medical aid plan offers a range of benefits including hospitalization, chronic medication, day-to-day medical expenses, and preventative care services such as child immunizations and cancer screenings.
Yes, you have the flexibility to choose your own healthcare providers under the Keyhealth Essence medical aid plan. However, using in-network providers may result in lower out-of-pocket costs.
Yes, pre-existing medical conditions are covered under the Keyhealth Essence medical aid plan, subject to waiting periods and other policy terms and conditions.
To make a claim under the Keyhealth Essence medical aid plan, you can submit a claim online, via email, or by mail. Claims will be processed within a specified timeframe and reimbursed according to the plan benefits.
Yes, there are certain exclusions and limitations to the Keyhealth Essence medical aid plan benefits, such as cosmetic surgery, experimental treatments, and non-essential medical procedures. It is important to review the policy terms and conditions carefully to understand the full scope of coverage.
The Keyhealth Essence plan provides unlimited hospitalization cover for up to three family members in both private and state hospitals.
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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