(Procedures normally performed in hospital, performed in Doctor’s room/Day Ward e.g. Gastroscopy, etc.)
Comprehensive
(High Cover)
In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In-Hospital, Day Clinic and Doctors rooms: Endoscopic procedures Unlimited. No co-payments apply
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Comprehensive
(High Cover)
In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In & Out of Hospital: Unlimited, subject to pre-authorisation
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In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
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Comprehensive
(Medium to High Cover)
In & Out of Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Deductibles Apply
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
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In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Comprehensive
(Medium to High Cover)
–
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Deductibles Apply
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Comprehensive
(Medium to High Cover)
–
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Deductibles Apply
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Hospital & Savings
(Low to Medium Cover)
In & Out of Hospital: Endoscopic
Procedures covered 100% of scheme rate, subject to pre-auth
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
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Hospital & Savings
(Low to Medium Cover)
In & Out of Hospital: Endoscopic
Procedures covered 100% of scheme rate, subject to pre-auth
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Hospital & Savings
(Low to Medium Cover)
In & Out of Hospital: Endoscopic
Procedures covered 100% of scheme rate, subject to pre-auth
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Hospital & Savings
(Low to Medium Cover)
–
In & Out of Hospital: Unlimited, subject to pre-authorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Capitation
(Low Cover)
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In Hospital: Unlimited, subject to preauthorisation and use of Start Network Provider
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth and use of Smart Network only
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Defined list of procedures covered, subject to pre-authorisation
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Capitation
(Low Cover)
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In Hospital: Unlimited, subject to preauthorisation and use of Start Network Provider
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth and use of Smart Network only
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In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
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Hospital Plan
(Hospitalization Cover)
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In Hospital: Unlimited, subject to preauthorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 200% of Scheme Rate, subject to pre-auth
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Hospital Plan
(Hospitalization Cover)
In Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In Hospital: Unlimited, subject to preauthorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
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Hospital Plan
(Hospitalization Cover)
In Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
In Hospital: Unlimited, subject to preauthorisation
In Hospital: Endoscopic Procedures
Out of Hospital: Scopes covered up to 100% of Scheme Rate, subject to pre-auth
Unlimited, subject to pre-authorisation
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered, subject to pre-authorisation
In & Out of Hospital: Unlimited, subject to pre-authorisation and use of a DSP
Primary Care
(Network & Income Based)
In Hospital: Endoscopic Procedures covered 100% of scheme rate, subject to pre-auth
Day procedures: Limited to R52,500 per family for 9 non-PMB conditions. R2,625 co-payment for use of non-network hospital
In Hospital: Unlimited, subject to pre- authorisation and use of Network Provider
Cover for a defined list of procedures in the KeyCare day surgery network
Unlimited at cost at PMB level of care
In the day surgery network: All Scopes: Unlimited. *Co-payments apply (use of day surgery or further 35% co-payment)
In the doctors room: All scopes: Unlimited
Defined list of procedures covered (excludes Scopes), subject to pre-authorisation
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