The KeyCare Series

Whether you need to be hospitalised for a planned hospital procedure or need emergency cover, the KeyCare Series offers cover in a network of private hospitals with no overall limit.

We cover you in a private hospital for emergency and planned hospital admissions that you have authorised with us.

Emergency cover when you need it most

In an emergency, go straight to hospital but call us or get someone to call us within 12 hours.

If you need medically-equipped transport in a medical emergency, call 0860 999 911. This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport.

Cover for planned hospital admissions

For planned hospital admissions, you have cover in any private hospital in the KeyCare hospital network. Please call us 48 hours before you go to hospital to confirm your admission. You will not have cover if you do not call us.

Click here to view a list of the KeyCare hospitals

No overall limit

There is no overall hospital limit on your hospital cover. Limits, clinical policies and guidelines apply to some healthcare services and procedures.

We have negotiated with specialists to guarantee that when you use a specialist in the KeyCare direct payment arrangement we pay them directly at our agreed rate. This means that when consulting a specialist in our direct payment arrangement you will be covered in full.

Full cover for specialists participating in our payment arrangement

You can benefit by using healthcare professionals participating in the KeyCare direct payment arrangement because we will cover their approved accounts in full.

You may have a co-payment if you use other specialists

If you are treated in-hospital by any other specialist, we cover the accounts up to the Discovery Health Rate. If the specialist charges more than the Discovery Health Rate, you must pay the difference.

Other healthcare professionals

We cover GPs, radiology, pathology and other healthcare services up to 100% of the Discovery Health Rate.

Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies)

We will cover your scope but please phone us before going for it to confirm where the scope can be done.

MRI and CT scans

If your scan is related to an approved hospital admission we pay it from your Hospital Benefit. If it is not related to an approved hospital admission we pay it from your Specialist Benefit up to R2 000 for each person. We do not pay for MRI or CT scans that are related to conservative back or neck treatment.

Dentistry

We do not cover in-hospital dentistry on the KeyCare Plans.

Mental health benefit	21 days for each person
Alcohol and drug rehabilitation	21 days for each person
Terminal care benefit	R16 950 for each person
Chronic dialysis	We cover these expenses in full as long as we have approved your treatment plan and you use a provider in our network

The Chronic Illness Benefit offers full cover for a list of medicines.

Your cover for chronic conditions

You have cover for a list of chronic conditions as long as your medicine is on the KeyCare medicine list and you get your approved medicine from our courier pharmacy. If you get your medicine anywhere else, you will need to pay 40% of the Discovery Health Medication Rate.

On the KeyCare Plus Plan your chosen GP must prescribe the medicine. We need to approve your chronic condition before we will pay for it from the Chronic Illness Benefit.

Your cover for cancer treatment

We cover your cancer treatment if it is a Prescribed Minimum Benefit and if you go to a cancer specialist in the ICON network. Please call us to register on the Oncology Programme.

All KeyCare members have cover for the following benefits out of hospital:

Specialist Benefit

If you visit a specialist and you have a valid reference number from us, you will be covered up to R2 000 for each person. You must call us before your consultation and your GP must refer you.

Antenatal Benefit

You have access to expert care for antenatal treatment and specialist visits when your GP feels you need to see one.

The Antenatal Benefit covers you for the following healthcare services while you are pregnant, at the Discovery Health Rate:

• four visits to a gynaecologist in a KeyCare network hospital
• one routine scan (between 10 and 20 weeks)
• selected antenatal blood tests requested by your gynaecologist.

Screening and Prevention Benefit

Early detection and prevention of diseases is vital to your wellbeing. The Screening and Prevention Benefit pays for a range of healthcare services that help to prevent and screen for diseases that would otherwise go unnoticed.

If you go for certain preventive screening tests, we will cover the claim. The screening tests include: blood glucose, blood pressure, cholesterol and body mass index at a Discovery Wellness Network provider. The benefit also covers a mammogram, Pap smear, PSA and HIV screening tests. Members from the age of 65 and members registered for certain chronic conditions are also covered for a seasonal flu vaccine from this benefit.

We have networks of GPs, dentists and optometrists all over South Africa to make sure that KeyCare Plus members have access to quality day-to-day healthcare services.

Cover for GP visits

When joining KeyCare Plus, you choose a GP from the KeyCare GP network. When you go to your chosen GP, we will cover your consultations and some minor procedures.

We will cover you for one out-of-network visit for each person; this includes a GP visit, with selected blood tests and x-rays and acute medicines (they must be on the KeyCare acute medicine list).

X-rays and blood tests

We pay for selected basic x-rays and blood tests, only if requested by your chosen KeyCare network GP.

Acute medicines

We pay for medicines on the KeyCare acute medicine list when they are prescribed by your chosen KeyCare network GP.

Cover for dentistry

We cover selected basic dentistry (consultations, fillings and extractions) only at a dentist within the KeyCare dentist network.

Cover for eye care

We cover one eye test and one pair of clear single-vision, bifocal or multi-focal lenses with a basic frame or a basic set of contact lenses for each person 24 months from your last claim, only at an optometrist within the KeyCare optometry network.

Casualty visits

If you go to one of our preferred casualty units in the KeyCare network of hospitals, you only pay the first R95 of the consultation.

You can also visit other casualty units in the KeyCare network of hospitals but you pay the first R210 of the consultation.

Please remember to call us to confirm your benefits.

Trauma Recovery Extender Benefit

We will cover specific out-of-hospital claims for your recovery after certain traumatic events. Your cover applies for the rest of the year in which the trauma takes place, as well as the year after your trauma.

Mobility Devices Benefit

We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the KeyCare mobility list, from a network provider. There is an overall limit of R3 300 for each family.

Discovery Health does not cover certain healthcare services. You can find a full list of these exclusions here. In addition to the general Discovery Health Medical Scheme exclusions that apply on all plans, KeyCare Plans have the following exclusions, except as set out in the Prescribed Minimum Benefits:

1. Hospital admissions related to:
   • dentistry
   • obesity
   • skin disorders
   • investigations and diagnostic work-up
   • functional nasal surgery
   • elective caesarean section, except if medically necessary
   • surgery for oesophageal reflux and hiatus hernia
   • back and neck treatment or surgery
   • joint replacements, including but not limited to hips, knees shoulders and elbows
   • cochlear implants, auditory brain implants and internal nerve stimulators. This includes procedures, devices and processors
   • healthcare services that should be done out of hospital and for which an admission to hospital is not necessary.
2. Brachytherapy for prostate cancer
3. Refractive eye surgery
4. Non-cancerous breast conditions
5. Healthcare services outside South Africa

We also do not cover the cost of treatment for any complications, or the direct or indirect expenses related to these excluded conditions and treatments.

If we apply waiting periods because you have never belonged to a medical scheme or have had a break in membership of more than 90 days before joining Discovery Health, you will not have access to the Prescribed Minimum Benefits during your waiting periods. This includes emergency admissions.

List of KeyCare hospitals for 2010

Eastern Cape

Free State

Gauteng

KwaZulu Natal

Limpopo

Mpumalanga

North West

Northern Cape

Western Cape

KeyCare Core
Family size	R0 - R6 000	R6 001 - R8 000	R8 001 +
Principal	R396	R492	R761
Spouse / adult dependant	R396	R492	R761
Child	R99	R123	R171

KeyCare Plus
Family size	R0 - R3 750	R3 751 - R6 000	R6 001 - R8 000	R8 001 +
Principal	R412	R494	R692	R1 030
Spouse / adult dependant	R412	R494	R692	R1 030
Child	R110	R143	R193	R275

We market our Discovery Health Plans through independent and accredited financial advisers. If you want a financial adviser to help you choose a Health Plan to suit the needs of your family, please send us your contact details and we will contact you.

Applicable to the KeyCare Core and KeyCare Plus Plans. You must go to one of these hospitals for planned hospital admissions. If you do not use one of these hospitals for a planned admission, you will need to pay your claims.

Eastern Cape

Free State

Gauteng

KwaZulu Natal

Limpopo

Mpumalanga

North West

Northern Cape

Western Cape

* These hospitals have a casualty unit, but it is not a preferred casualty unit.

** These hospitals have a preferred casualty unit.

Please note that this list of hospitals is subject to change. Go to www.discovery.co.za for the latest list of hospitals and casualty units or phone us.