Comprehensive
(High Cover)
Wound care benefit: Savings first. Limit of R10,500 per family, subject to overall day-to-day limit
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
Subject to available Savings and Threshold
Unlimited at 100% of Fedhealth Rate
Limited to R4,300 per person (pooled per family)
Subject to available Savings & Threshold (Unlimited once Threshold is reached)
Subject to day-to-day benefits
Comprehensive
(High Cover)
Wound care benefit: Savings first. Limit of R7,535 per family, subject to overall day-to-day limit
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
–
–
- M: R3,550
- M+1: R4,600
- M+2: R5,750
- M+3+: R6,900
Subject to available Savings & Threshold (Unlimited once Threshold is reached)
–
Comprehensive
(Medium to High Cover)
Wound care benefit: Savings first. Limit of R4,188 per family, subject to overall day-to-day limit
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
Subject to available Savings and Threshold
–
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Comprehensive
(Medium to High Cover)
–
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk. Additional 2 for beneficiaries under the age of 6 years, payable from Overall annual limit
Subject to available Savings and Threshold
Unlimited at 100% of Fedhealth Rate. Co- payment of R800 per visit for non-PMBs
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Comprehensive
(Medium to High Cover)
–
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk. Additional 2 for beneficiaries under the age of 6 years, payable from Overall annual limit
Subject to available Savings and Threshold
Unlimited at 100% of Fedhealth Rate. Co- payment of R800 per visit for non-PMBs
Subject to Savings and Day-to-Day Benefits, once savings is depleted
Subject to Savings, if available
Subject to day-to-day benefits
Hospital & Savings
(Low to Medium Cover)
Wound care benefit: Limit of R4,079 per family
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk. Additional 2 for beneficiaries under the age of 6 years, payable from Overall annual limit
Subject to available Savings
Unlimited at 100% of Fedhealth Rate. Co- payment of R800 per visit for non-PMBs
Subject to Savings
Subject to Savings, if available
–
Hospital & Savings
(Low to Medium Cover)
Wound care benefit: Limit of R4,079 per family
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk. Additional 2 for beneficiaries under the age of 6 years, payable from Overall annual limit
Subject to available Savings
Unlimited at 100% of Fedhealth Rate. Co- payment of R800 per visit for non-PMBs
Outpatient emergency unit services, medicine and services by a non-network GP paid at 80% of MT up to R1,350 pbpa and R2,700 pfpa
Subject to Savings, if available
Subject to day-to-day benefits
Hospital & Savings
(Low to Medium Cover)
Wound care benefit: Limit of R4,079 per family
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk. Additional 2 for beneficiaries under the age of 6 years, payable from Overall annual limit
Subject to available Savings
Unlimited at 100% of Fedhealth Rate. Co- payment of R750 per visit for non-PMBs
Subject to Savings
Subject to Savings, if available
Subject to day-to-day benefits
Hospital & Savings
(Low to Medium Cover)
–
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk. Additional 2 for beneficiaries under the age of 6 years, payable from Overall annual limit
Subject to available Savings
Unlimited at 100% of Fedhealth Rate. Co- payment of R750 per visit for non-PMBs
Subject to Savings
Subject to Savings, if available
Subject to day-to-day benefits
Capitation
(Low Cover)
–
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
No Benefit
–
–
Subject to Health Saver, if available
–
Capitation
(Low Cover)
–
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
No Benefit
–
Subject to Prescribed Minimum Benefits. Listed essential cases – clinical guidelines and pre-authorisation apply
Subject to Health Saver, if available
–
Hospital Plan
(Hospitalization Cover)
–
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
No Benefit
–
–
–
–
Hospital Plan
(Hospitalization Cover)
Wound care benefit: Limit of R4,079 per family
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
No Benefit
Unlimited at 100% of Fedhealth Rate. Co-payment of R800 per visit for non-PMBs
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
–
Hospital Plan
(Hospitalization Cover)
Wound care benefit: Limit of R4,079 per family
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
No Benefit
Unlimited at 100% of Fedhealth Rate. Co- payment of R800 per visit for non-PMBs
Subject to Day-to-Day Benefits
Subject to Health Saver, if available
Subject to PMB
Primary Care
(Network & Income Based)
PMBs only
2 Emergency consultations per family at a casualty ward or emergency room facility of a hospital paid from risk
Cover for one casualty visit at any casualty unit within Keycare Hospital Network.
Member pays first R475 of consultation
Unlimited at 100% of Fedhealth Rate. Co- payment of R800 per visit for non-PMBs
Outpatient emergency unit services, medicine and services by a non-network GP paid at 80% of MT up to R1,350 pbpa and R2,700 pfpa
Subject to out-of-network GP, casualty OR after-hours visits: 1 visit pbpa, max of 2 visits pfpa. Subject to authorisation within 72 hours else 30% co-payment applies
–