Overall, the KeyHealth Platinum Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in and out hospital procedures to up to 3 Family Members. The KeyHealth Platinum Medical Aid Plan starts from R12,779 ZAR.
| 👤 Main Member Contribution | R12,779 |
| 👥 Adult Dependent Contribution | R8,960 |
| 🍼 Child Dependent Contribution | R2,699 |
| 🔁 Self funding Gap Cover | ☑️ Yes |
| 🧠 Mental Healthcare Program | ☑️ Yes |
| ⚕️ Hospital Cover | Unlimited |
| 📉 Prescribed Minimum Benefits | ☑️ Yes |
| 😷 Screening and Prevention | ☑️ Yes |
| 💳 Day to Day Benefits | ☑️ Yes |
| 💙 Home Care | None |
The KeyHealth Platinum medical aid plan is one of 6, starting from R12,779 and includes higher day-to-day limits, additional cover in and out-of-hospital, comprehensive and unlimited coverage for oncology, pathology, and more. GAP cover is available on the KeyHealth Platinum 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:
👉🏾 Download Platinum Plan for 2025 from KeyHealth Medical Scheme.
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R12,779 | R8,960 | R2,699 |
| 📌 Hospitalization Varicose vein surgery Facet joint injections Hysterectomy Rhizotomy Reflux surgery Back and Neck Surgery (including spinal fusion) Joint Replacement | Unlimited covers up to 100% of the negotiated 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 R670 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 | Limited to R62,700 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 but limited to R21,700. This benefit is combined in and out-of-hospital. |
| ❤️ Organ Transplants (Solid Organs, Tissue, and Corneas) Hospitalization Harvesting Drugs for Immuno-Suppressive Therapy | Covered up to 100% of the medical scheme tariff. Unlimited cover provided. Pre-approval is needed. Subject to case management. |
| ⚠️ Renal Dialysis | Unlimited cover provided. Covered up to 100% of the medical scheme tariff. Pre-approval is needed. Subject to case management and scheme protocols. |
| ☑️ Oncology | Covered up to 100% of the medical scheme tariff. Unlimited cover provided. 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 needed for specialized radiology (MRI, CT, PET scans) Hospitalization is not covered if hospitalization admission is for investigative purposes. Day-to-day benefits cover investigative admissions. |
| ✔️ MRI and CT scans | Limited to R31,200 per family per year. Combined in and out-of-hospital cover. |
| ❎ X-Rays | Unlimited cover. |
| ✳️ PET scans | Limited to two scans per beneficiary yearly and a maximum of R29,400 per scan. |
| 🔍 Pathology | Covered up to 100% of the medical scheme tariff. Unlimited cover. |
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| 🩺 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. Day-to-day benefits available: Main Member – R13,665 per year Adult Dependent – R13,260 per year Child Dependent – R3,245 per year |
| 🔁 Self-funding gap (SFG) | Members must pay all day-to-day expenses as follows: Main Member – R4,785 Adult Dependent – R4,255 Child Dependent – R1,570 Expenses that are paid will accumulate to the SFG at medical scheme rates. Once the SFG is bridged, the member enters the threshold zone. |
| 📈 Threshold Zone | Further routine benefits, excluding physiotherapy, pathology and prescribed medication. The following limits apply: Threshold zone: Principal Member – R18 450, Adult Dependent – R17 515, Child Dependent – R4 815 Prescribed medication: PM – R11 280 AD – R5 090 CD – R2 510 – Physiotherapy: R17 850 per family per year. – Pathology: R17 850 per family per year. |
| 💊 Over-the-counter medicine | Limited to R3,840 per family per year. Covered up to 100% of the medical scheme tariff. Subject to the day-to-day benefit and threshold zone. |
| 📉 Over-the-counter reading glasses | Limited to R260 per family per year. Limited to one pair per year. Subject to the OTC medicine sub-limit. |
| 📊 Pathology | Covered up to 100% of the medical scheme tariff. Subject to the day-to-day benefit and threshold zone. |
| 🤓 Optical Services | Limited to R6,600 per beneficiary every two years. Subject to the day-to-day limit and threshold zone. Optical management protocols will apply. The benefit must be confirmed with the scheme. Covered up to 100% of the medical scheme tariff. |
| 👓 Frames | Limited to R1,975 and one frame per beneficiary every 2 years. Subject to the overall optical benefit. |
| 1️⃣ Lenses | Limited to 1 pair of single-vision lenses per beneficiary every 2 years. Subject to the overall optical benefit. |
| 2️⃣ Eye Tests | Limited to one test per beneficiary every 2 years. Subject to the overall optical benefit. |
| 3️⃣ Contact Lenses | Limited to R3,060 per beneficiary per year. Subject to the overall optical benefit. |
| 4️⃣ Refractive Surgery | Covered up to R25,100 per beneficiary every two years. Pre-approval is required. |
| 🦷 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. Two check-ups per beneficiary per year. Three specific (emergency) consultations per beneficiary per year. |
| ❎ Extra-oral X-Rays | One extra-oral x-ray per beneficiary every 3 years 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 2 partial metal frames 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 80% of the medical scheme tariff. |
| ➡️ Implants | Limited to R5,490 per beneficiary per year. DENIS pre-approval is required. Covered up to 80% of the medical scheme tariff. |
| ⚠️ Orthodontics (non-cosmetic and only treatment) | Covered up to 80% 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. |
| 💙 Periodontics | DENIS pre-approval is required. Limited to conservative, non-surgical therapy only. Applied to beneficiaries registered on the Perio Program. |
| 🙂 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. Temporomandibular joint (TMJ) therapy is limited to non-surgical intervention/treatment. Claims for oral pathology procedures (cysts, biopsies, and tumor removals) are only covered if supported by a laboratory report confirming the diagnosis. |
| 🤍 Surgery in-hospital with general anesthesia | Covered up to 100% of the medical scheme tariff. DENIS pre-authorization is required. |
| 💙 Hospitalization and Anaesthesia | DENIS protocols and Scheme rules apply. |
| 🧡 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. |
| 💤 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. Reserved extensive dental treatment. |
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. Limited to R24,000 per beneficiary per year and subject to the maximum chronic benefit of R49,000 per family per year. |
Platinum Plan falls within Category A of the CDL of KeyHealth and covers a selection of conditions including:
The Platinum Plan covers the following additional non-PMB/CDL conditions:
| 🧠 Psychiatric Treatment | Limited to R70,400 per family per year. Covered up to 100% of the medical scheme tariff. Pre-approval is required. Subject to case management. Out-of-hospital treatment is covered up to R29,300. |
| 🩸 Blood Transfusions | Unlimited cover. Covered up to 100% of the medical scheme tariff. Pre-approval required. |
| 🦾 Prostheses Internal External Fixation Devices Implanted Devices | Unlimited cover. 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. |
| 👩🏻🦼 Wheelchairs Orthopaedic Appliances Incontinence Equipment | Limited to R14,550 per family per year. Covered up to 100% of the medical scheme tariff. Combined benefit 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 R44,100 per family per year. Limited to R21,900 per ear. |
| 👂 Hearing aids and maintenance | Limited to R1,680 per beneficiary per year. |
| 🩺 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. |
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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 R480 per year. |
| 🚩 HPV vaccination | Two doses per lifetime for female beneficiaries between 9 and 14. |
| 🚼 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> |
| ➡️ 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 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 1,510 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 R2,550 per pregnancy. |
| 🧡 Antenatal Classes | Limited to R2,550 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.
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. |
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The KeyHealth Platinum Plan has specific exclusions, including:
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:
💙 Discover What Is the Difference Between Medical Aid and Medical Insurance
| 🔎 Medical Aid Plan | 🥇 KeyHealth Platinum (2025) | 🥈 Medihelp MedPlus (2024) | 🥉 Fedhealth Maxima EXEC (2025) |
| 👤 Main Member Contribution | R12,779 | R10,980 | R10,719 |
| 👥 Adult Dependent Contribution | R8,960 | R10,980 | R9,304 |
| 💙 Child Dependent Contribution | R2,699 | R2,742 | R3,312 |
| ⚕️ Hospital Cover | Unlimited | ☑️ Yes | Unlimited |
| 💶 Prescribed Minimum Benefits | ☑️ Yes | ✅ Yes | ☑️ Yes |
| 📉 Screening and Prevention | ✅ Yes | ☑️ Yes | ✅ Yes |
| 💳 Medical Savings Account /Day-to-Day benefits | ✅ Yes | ☑️ Yes | ✅ Yes |
| 🤓 Optometry Benefit | ☑️ Yes | ✅ Yes | ☑️ Yes |
| 🦷 Dentistry Benefit | ✅ Yes | ☑️ Yes | ✅ Yes |
💙 KeyHealth Platinum is a comprehensive medical insurance plan offered by KeyHealth Medical Scheme in South Africa. The plan offers a range of benefits and features, including unlimited hospital coverage, coverage for chronic conditions, and extensive outpatient benefits.
💙 One of the unique features of KeyHealth Platinum is that it offers a personal medical savings account (MSA) that can be used to pay for day-to-day medical expenses, such as consultations with healthcare professionals, medication, and diagnostic tests. The MSA is replenished annually, and unused funds can be rolled over to the following year.
💙 Another advantage of KeyHealth Platinum is that it covers a range of chronic conditions, including cancer, HIV/AIDS, and diabetes. The plan also covers certain medical procedures, such as organ transplants. In addition, it offers access to a network of healthcare professionals and hospitals.
💙 However, there are some drawbacks to the plan. For example, the premium for KeyHealth Platinum is relatively high compared to other comprehensive medical aid plans in South Africa. Additionally, certain exclusions and waiting periods may apply to some benefits, such as maternity benefits.
💙 In conclusion, KeyHealth Platinum is a comprehensive medical insurance plan offering a range of benefits and features, including unlimited hospital cover, chronic conditions, and a personal medical savings account. While the premium is relatively high and exclusions and waiting periods exist, the plan provides extensive coverage and access to a network of healthcare professionals and hospitals.
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KeyHealth Platinum is a comprehensive medical aid plan offered by KeyHealth Medical Scheme in South Africa that provides a range of benefits and features, including unlimited hospital coverage, cover for chronic conditions, and extensive outpatient benefits.
A personal medical savings account (MSA) is a feature of KeyHealth Platinum that allows you to set aside funds to pay for day-to-day medical expenses, such as consultations with healthcare professionals, medication, and diagnostic tests. The MSA is replenished annually, and unused funds can be rolled over to the following year.
KeyHealth Platinum covers a range of chronic conditions, including cancer, HIV/AIDS, and diabetes, among others.
Outpatient benefits include medical services outside a hospital, such as consultations with healthcare professionals, diagnostic tests, and medication.
KeyHealth Platinum provides access to a network of healthcare professionals and hospitals that have agreed to provide medical services to plan members at negotiated rates.
The premium for KeyHealth Platinum is relatively high compared to other medical aid plans in South Africa. However, the cost will vary depending on factors such as age, health status, and the level of coverage selected. Principal member start at R12 779 for 2025.
Maternity benefits are included from KeyHealth Platinum.
To access KeyHealth’s provider login, go to the KeyHealth website and click the “Provider Login” button in the top right corner of the screen. You will need to enter your username and password to log in.
Yes, KeyHealth Platinum provides coverage for certain medical procedures, including organ transplants.
To cancel your KeyHealth membership, you must contact the scheme directly by phone or email. They will provide the necessary forms and instructions for canceling your membership.
KeyHealth’s gap cover is an additional insurance product that covers medical expenses not covered by your medical aid plan. This includes things like co-payments, deductibles, and other out-of-pocket expenses.
Yes, KeyHealth offers international travel coverage as an optional add-on to their medical insurance plans. This provides cover for medical expenses that may be incurred while traveling abroad.
To access your KeyHealth membership information, log in to the KeyHealth website using your username and password. You can view your membership details, claims history, and other relevant information from there.
To submit a claim to KeyHealth, you must complete a claims form and submit it to the scheme along with any relevant supporting documentation, such as invoices and receipts. You can do this online through the KeyHealth website, email, or post.
Yes, KeyHealth Platinum covers a range of chronic conditions, including HIV/AIDS and cancer.
KeyHealth’s waiting period for new members varies depending on the level of coverage selected and the individual’s health status and history. Therefore, reviewing the plan’s terms and conditions carefully before enrolling is important.
You can contact KeyHealth by phone, email, or through their website. Their customer service team will be able to assist you with any questions or concerns you may have about your membership or coverage.
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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