Gold
About this plan
🥇 Best suited for professionals and higher-income earners seeking comprehensive cover and greater financial protection.
Principal Member
From
R8,675
per month
Adult Dependant
From
R5,867
per month
Child Dependant
From
R1,705
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
Gold
KeyHealth Gold Medical Aid Plan (🇿🇦 2026)
Overall, the KeyHealth Gold Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and covers 44 chronic medical conditions for up to 3 Family Members. The KeyHealth Gold Medical Aid Plan starts from R8,675 ZAR.| 👤 Main Member Contribution | R8,675 |
| 👥 Adult Dependent Contribution | R5,867 |
| 🍼 Child Dependent Contribution | R1,705 |
| 🌎 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 | ☑️ Yes |
| 👶 Maternity Benefits | ☑️ Yes |
| ⚕️ Hospital Cover | Unlimited |
KeyHealth Gold Plan - 9 Key Point Quick Overview
- ☑️ KeyHealth Gold Plan Overview
- ☑️ KeyHealth Gold Plan Contributions and Medical Savings
- ☑️ Gold Plan Benefits and Cover Comprehensive Breakdown
- ☑️ KeyHealth Health Booster
- ☑️ KeyHealth Smart Baby Program
- ☑️ Gold Plan Exclusions and Waiting Periods
- ☑️ KeyHealth Gold Plan vs. Similar Plans from other Medical Schemes
- ☑️ Our Verdict on The Gold Plan
- ☑️ Gold Plan Frequently Asked Questions
KeyHealth Gold Plan Overview
The KeyHealth Gold medical aid plan is one of 6, starting from R8,675 and includes a medical savings account, cover for 44 chronic medical conditions, out-of-hospital mental health cover, higher day-to-day limits, and more. The KeyHealth Gold Plan comes 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 Gold Plan Contributions and Medical Savings
Contributions
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R8,675 | R5,867 | R1,705 |
Medical Savings
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R763 per month | R516 per month | R150 per month |
| R9,156 per year | R6,192 per year | R1,800 per year |
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Gold Plan Benefits and Cover Comprehensive Breakdown
Gold Plan Major Medical Benefits
| 📌 Hospitalization Varicose vein surgery Facet joint injections Hysterectomy Rhizotomy Reflux surgery Back and Neck Surgery (including spinal fusion) Joint Replacement | Unlimited cover up to 100% of the agreed tariff. |
| 🏥 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 | 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. |
| ⚕️ Major Medical Occurrences Sub-acute facilities and wound care Hospice Private Nursing Rehabilitation Step-down Facilities Wound Care | Limited to R52,900 per family per year. Covered up to 100% of the medical scheme tariff. Pre-approval is needed. Subject to case management and scheme protocols. Wound care is included up to R17,400 as a combined in and out-of-hospital benefit. 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 R527,000 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 R22,900 per family per year. Combined in and out-of-hospital cover. R1 710 co-payment per scan in- or out-of-hospital (except for confirmed PMB |
| ❎ X-Rays | Unlimited cover. |
| ➡️ PET scans | Two scans per beneficiary per year. Limited to R52,100 per scan. |
| 📊 Pathology | Covered up to 100% of the medical scheme tariff. Unlimited cover. |
Gold Plan Out-of-Hospital 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 – R9,156 Adult Dependent – R6,192 per year Child Dependent – R1,800 per year Additional day-to-day benefits: Main Member – R6,255 per year Adult Dependent – R4,655 per year Child Dependent – R1,495 per year |
| 💊 Over-the-counter medicine | Limited to R2,670 per family per year. 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 R245 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. Subject to the day-to-day benefit and limit. |
| 🤓 Optical Services | Limited to R4,100 per family every two years. Subject to the MSA and day-to-day benefits. Covered up to 100% of the medical scheme tariff. Optical management will apply. Confirmation of benefit is required. |
| ☑️ Materials / components | Pbp2a total optical benefit. Subject to MSA / day-to-day benefit and optical |
| 👁️ Refractive Surgery | Pre-authorisation compulsory. Subject to overall optical benefit |
| 🦷 Conservative Dentistry | Subject to DENIS protocols. Managed care interventions and Scheme rules apply. Scheme Exclusions will apply. |
| 👨⚕️ Consultations | Covered up to 100% of the medical scheme tariff. Two check-ups per beneficiary per year. Three specific (emergency) consultations 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 | Two scale and polish treatments 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. |
| 📍 Partial Chrome Cobalt Frame Dentures | Limited to 1 partial metal frame per beneficiary every 5 years. DENIS pre-approval is required. Covered up to 100% of the medical scheme tariff. |
| 👑 Crowns and Bridges | Limited to 1 tooth per beneficiary every 5 years. DENIS pre-approval is required. Covered up to 100% of the medical scheme tariff. |
| ➡️ Implants | Paid from funds available in the MSA. |
| 📊 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 | DENIS pre-authorization is required. |
| 😴 Hospitalization and Anaesthesia | DENIS protocols and Scheme rules apply. Subject to managed care interventions. Certain 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. Only covers the removal of impacted teeth. Limited to extensive dental treatment for children <5. |
| ☑️ Inhalation sedation in dental rooms | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is not required. |
| ✅ Moderate/deep sedation in dental rooms | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is required. Limited to extensive dental treatment. |
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KeyHealth Gold 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. |
| 🅱️ Category B (Other) | Covered up to 100% of the medical scheme tariff. Limited to R11,200 per family per year. Subject to the chronic benefit. |
- ✅ Addison’s Disease
- ✅ Ulcerative colitis
- ✅ Asthma
- ✅ Bipolar Mood Disorder
- ✅ Bronchiectasis
- ✅ Cardiac Failure
- ✅ Cardiomyopathy Disease
- ✅ Chronic Renal Disease
- ✅ Coronary Artery Disease
- ✅ Crohn’s Disease
- ✅ Chronic Obstructive Pulmonary Disorder
- 👍🏽Acne
- 👍🏽 Allergic Rhinitis
- 👍🏽 Benign Prostatic Hypertrophy
- 👍🏽 Diverticulitis and Irritable Bowel Syndrome
- 👍🏽 Gastroesophageal Reflux Disease
- 👍🏽 Hypoparathyroidism
- 👍🏽 Hyperkinesis (attention deficit disorder)
- 👍🏽 Hyperthyroidism
- 👍🏽 Iron deficiency anemia
- 👍🏽 Major Depression
Gold Plan Supplementary Benefits
| 📌 Psychiatric Treatment | Limited to R52,900 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 up to R20,900. |
| 🩸 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 R61,400 per family 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 R11,700 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. |
| 🫁 Oxygen Nebulizers Glucometer Blood Pressure Monitor | Pre-approval is required and will be subject to approval. |
| 🦻 Hearing Aids | Limited to R20,950 per beneficiary every 5 years. Covered up to R10,500 maximum per ear. Covered up to 100% of the medical scheme tariff. |
| 💛 Hearing Aid Maintenance | Covered up to R1320 per beneficiary per annum |
| ⬇️ Endoscopic Procedures (Scopes) | All scopes are covered in full if done at a DSP hospital – any Life Healthcare and Netcare hospitals nationally and selected Mediclinic hospitals in the Western Cape, Bloemfontein, and Polokwane and other selected hospitals (DSP hospital network) or if done in the doctor’s rooms, subject to the use of a KeyHealth Specialist. |
| ☑️ 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. |
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KeyHealth 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.| 🍼 Child 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. |
| 👶Child Growth Assessment | 3 baby growth assessments per year at a pharmacy / baby clinic for beneficiaries aged 0-35 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 |
| 🅰️ 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. |
| 💛 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 are 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 1,570 per pregnancy. |
| 🚼 Paediatrician Visits | The baby must be registered on the scheme. Limited to 2 visits within the baby’s first year and one in the second year. |
| 🩺 Antenatal Vitamins | Limited to R2,650 per pregnancy. |
| 🧡 Antenatal Classes | Limited to R2,650 for the first pregnancy. |
KeyHealth 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. 1 visit in baby’s 2nd year |
| 🧡 Antenatal vitamins | Limited to R2,650 per pregnancy. |
| ➡️ Antenatal classes | Limited to R2,650 per pregnancy. |
| 💵 Short Payments | R1 570 per pregnancy |
Gold Plan Exclusions and Waiting Periods
Exclusions
The KeyHealth Gold Plan has specific exclusions, including:- 📌 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
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.
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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:- 📌 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.
Medical Aid Comparisons : KeyHealth Gold Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 KeyHealth Gold | 🥈 Momentum Extender (2026) | 🥉 Bonitas BonComplete |
| 👤 Main Member Contribution | R8,675 | R7,215 - R10,381 | R6,614 |
| 👥 Adult Dependent Contribution | R5,867 | R5,472 - R8,361 | R5,298 |
| 🍼 Child Dependent Contribution | R1,705 | R2,121 - R2,977 | R1,794 |
| 🔁 Gap Cover | No | No | YES |
| ⚕️ Hospital Cover | Unlimited | Unlimited | Unlimited |
| 📉 Prescribed Minimum Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
| 💳 Medical Savings Account | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 👶 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
| 🩺 Oncology Cover | R527,000 | R500,000 | R280,100 |
Our Verdict on The Gold Plan
KeyHealth Gold is a comprehensive medical insurance plan offered by KeyHealth Medical Scheme in South Africa. The plan provides extensive coverage for both in-hospital and out-of-hospital medical expenses, including chronic medication and wellness benefits. One of the main advantages of KeyHealth Gold is its high level of benefits, which includes unlimited hospital coverage and generous day-to-day benefits for consultations, medication, and pathology tests. The plan also offers a range of additional benefits, such as maternity benefits, preventative care, and emergency medical evacuation. Another advantage of KeyHealth Gold is its flexibility. Members can choose from various optional benefits and tailor their cover to suit their needs. Members also have access to a network of healthcare providers, which can help to reduce out-of-pocket expenses. However, one notable drawback of KeyHealth Gold is its cost, as it is one of the more expensive medical insurance plans offered by KeyHealth. Additionally, some members may find the plan’s high level of benefits unnecessary for their needs and may prefer a more affordable plan with lower benefits. In conclusion, KeyHealth Gold offers comprehensive medical insurance coverage with a wide range of benefits and the flexibility to tailor coverage to individual needs.
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