Discovery Health vs KeyHealth
Discovery Health Medical Scheme versus Keyhealth Medical Scheme compared and revealed.
We tested them side by side and verified their medical aid plans benefits, affordability, and much more.
This is a complete guide to Discovery Health and Keyhealth in South Africa.
In this in-depth guide you’ll learn:
- What is a Medical Scheme?
- Why do you need medical aid?
- Are medical schemes expensive in South Africa?
- How to compare medical aids against each other?
- Which should you choose: Discovery Health or Keyhealth?
So if you’re ready to go “all in” with Discovery Health versus Keyhealth in South Africa, this guide is for you.
Let’s dive right in…
Discovery Health vs KeyHealth Summary
Overall Comparison
| ℹ️ Feature | 🥇 Discovery Health | 🥈 KeyHealth |
| General comparison | 5/5 | 4/5 |
| Number of plans | 7 | 6 |
| Lowest premium | R1,102 (KeyCare Series) | R1,990 (Essence) |
| Highest premium | R10,303 (Executive Plan) | R11,308.00 (Platinum) |
| Student Plan | No | No |
| Gap Cover | Yes | No |
| Hospital plans | Yes | Yes |
| Maternity benefits | Yes | Yes |
| Number of members | 3.3 million | 69 000+ |
Plan benefits
| ℹ️ Feature | 🥇 Discovery Health | 🥈 KeyHealth |
| Name of Plan | • Executive Plan • Comprehensive Series • Priority Series • Saver Series • Core Series • Smart Series • KeyCare Series | • Essence • Origin • Equilibrium • Silver • Gold • Platinum |
| Price per plan | • Executive Plan: R8298 • Comprehensive Series: R4949 • Priority Series: R3749 • Saver Series: R2385 • Core Series: R1923 • Smart Series: R1450 • KeyCare Series: R930 | • Essence: R1990.00 • Origin: R2250.00 • Equilibrium: 2778.00 • Silver: R4799.00 • Gold: R7036.00 • Platinum: R11308.00 |
| GP Visits | Network only | Yes |
| GP in room visits | Network only | Yes |
| Specialist visits | Yes (in and out of hospital) | Yes |
| Acute medication | Yes | Yes |
| Chronic medication | Yes | Yes |
| Basic pathology | Yes, up to Discovery Health Rate | Yes |
| Basic and emergency dentistry | Basic only | Yes on basic dentistry |
| Basic optometry | Yes, 100% of Discovery Health Rate | Yes |
| HIV benefit | Yes | Yes |
| Maternity benefit | Yes | Yes |
| Road accident claims | Yes, full cover | No |
Discovery Health vs KeyHealth
Both Discovery Health and KeyHealth are known medical aid schemes that provide a comprehensive selection of tailored plans. Here, we compare in these two medical aid schemes to help you decide on the best option for your healthcare needs in 2024.
Which offers more affordable cover – Discovery Health or KeyHealth?
Although Discovery Health offers the lowest premium on its KeyCare plan, KeyHealth also offers good coverage in its plans. Overall, both Discovery Health and KeyHealth offers a good selection of affordable medical aid plans designed for singles, families, and pensioners.
Do both schemes offer gap cover?
Gap insurance is a short-term insurance policy that offers shortfall coverage when doctors and specialists charge fees that exceed the medical aid rates of cover. Gap insurance works in conjunction with your medical insurance.
The gap cover provider will compensate you for a portion of the difference between your medical bills and what your medical insurance would cover in exchange for a monthly premium. If you use a healthcare provider who is not part of your medical plan’s network, you may end up paying more for services at private hospitals than your plan would.
Discovery Health does offer gap cover. The gap cover products from Discovery Health cover for shortfalls on approved in-hospital specialist claims, specific out-of-hospital costs related to an approved hospital admission and shortfalls on approved emergency international claims while travelling outside of South Africa.
You also get cover for co-payments on approved endoscopies, MRI and CT scans, and cancer-related claims. Your cover depends on the Discovery Gap Cover option you choose. An overall annual limit of R185 000 applies to each person.
Although KeyHealth does not make specific provision for Gap Cover options, it has adopted two approaches to tackle this issue. The first is to keep its products as affordable as possible. Equilibrium includes a savings account which could be used to meet co-payments or day-to-day expenses if necessary.
Do both schemes offer hospital plans?
Yes, both Discovery Health and KeyHealth offer hospital plans. Discovery Health’s hospital plans include unlimited private hospital cover, guaranteed full cover in hospital for specialists, and full cover for chronic medication.
All six plans offered by KeyHealth include hospital plans to cover the treatment costs if you’re admitted to hospital such as ward costs, theatre fees, and accounts from other in-hospital providers such as anesthetists or radiologists. All its hospital plans are subject to Scheme rules, pre-authorization, case management, clinical protocols and the benefit option you have chosen.
Who is Discovery Health?
Discovery Medical Health is a non-profit organisation controlled by the Medical Schemes Act 131 of 1998, as amended, and the Medical Schemes Council (CMS). According to the Scheme guidelines, it is a recognised open medical scheme that anybody can join.
Members own the Scheme, and its operations are controlled by an independent Board of Trustees (the Trustees or the Board). The Scheme outsources its administration and managed care functions to Discovery Health (Pty) Limited under a formal contractual relationship.
One of the Scheme’s strategic priorities is value-based healthcare. Their strategy, which places their members at the centre of care, compensates providers based on health outcomes rather than the volume of services they deliver.
It gives members access to programmes and providers committed to continuous quality improvement.
Discovery Health strives to ensure that our members have access to the safest, most efficient, and effective healthcare available in South Africa through a variety of quality of care programmes and innovations that are regularly examined by the Scheme on an ongoing basis.
The Scheme also provides its participants with information relevant to their needs.
Discovery Health Medical Aid offers 7 healthcare plans namely Executive Plan, Comprehensive Series, Priority Series, Saver Series, Keycare Series, Core Series, and Smart Series
Who will benefit from Discovery Health?
Discovery Health offers comprehensive medical cover that is well-suited towards established families and higher income earners. Discovery Health offers a comprehensive selection of plans, with greater coverage being afforded at higher premiums, with additional benefits for these members.
It is worth noting that Discovery Health operates on a network-based coverage basis, so that individuals should first check whether they reside in areas that fall within the pre-selected GP, hospital and specialist network, making it a better option for those residing in urban areas.
Who is KeyHealth?
KeyHealth is a well-known medical plan and health insurance company in South Africa. The Scheme, which is managed by PPS Healthcare, places a high value on transparency in the way it presents its health advantages, steering clear of “nice to haves” and emphasising the provision of “pure” medical aid benefits.
KeyHealth Medical Aid, strive to keep its members’ contributions as affordable as possible, throughout all its options, from the most basic to the most comprehensive plan. Members are given fair and reasonable value and cover in return for their monthly contributions.
All KeyHealth plans come with three additional complimentary benefits, namely Easy-ER, Health Booster, and Smart Baby, and all provide limitless coverage for Prescribed Medical Conditions (PMBs) in compliance with South African law. Some exclusions apply based on the chosen plan. The Chronic Disease List is covered by all options.
The most affordable option with Health is Essence. Some exclusions apply, such as day-to-day medical costs, dentistry, prostheses, and hospitalisation benefits for some surgical operations. Disaster and other significant medical expenses caused by accidents (in hospitals) are covered. Essence makes sure that users of this plan have access to basic, necessary medical coverage. The next option, equilibrium, is also reasonably priced, but although daily medical coverage is provided, some hospital benefits are excluded.
With the Silver plan two in-hospital treatment benefits and specialised dentistry are excluded. Gold is the recommended plan which offers comprehensive and complete cover. While member contributions are higher, the benefits are also higher. There are no in-hospital benefit exclusions, and coverage is limitless for both general and specialty dentistry operations.
The Platinum option is at the top of the list. A Threshold Zone that funds extra expenses after the predetermined Self-Payment Gap has been closed is one of the benefits. Other benefits include those for routine, daily expenses. The benefits of this complete choice go beyond the 26 ailments on the Chronic Disease List and cover 29 more chronic conditions.
Who will benefit from KeyHealth?
KeyHealth offers a fairly comprehensive medical cover that is well-suited towards individuals, families and pensioners. It offers comprehensive plans, with good coverage that is affordable.
FAQ
Which medical aid offers the cheapest medical plan, Discovery Health or KeyHealth?
Discovery Health has the cheapest medical plan between the two medical aids with its KeyCare Series plan at R1,102.00 per month. KeyHealth’s cheapest plan is the Essence plan at R1 696.00 per month.
Which medical aid, Discovery Health or KeyHealth are the most popular?
Discovery has the most members by far at 3.3 million compared to the 69 000+ of KeyHealth. It is definitely the most popular of the two.
Do Discovery and KeyHealth medical aids offer the option of gap cover?
Discovery Health does offer the option to apply for gap cover. KeyHealth, however, does not make specific provision for gap cover but opts to rather keep its products as affordable as possible. Member do have the option to apply for gap cover with an independent insurer.
Do Discovery Health and KeyHealth medical aids have a waiting period?
Yes, both Discovery Health and KeyHealth have a three-month waiting period during which you are unable to submit a claim.
Which is the best medical aid between Discovery Health and KeyHealth?
Discovery Health was founded in 1992 and provides fair pricing and a variety of packages to meet a variety of budgets and medical needs. KeyHealth has been operating since 1968 and has maintained the necessary high membership figures since then. The key to its success has been an unwavering determination to offer its members the best possible value for their hard-earned cash.
