Post on 25-Oct-2021
KEYHEALTH 2022 PRODUCT LAUNCH PRESENTATION
ABOUT KEYHEALTH
We are proudly 100 years old,
and previously known as
Munimed / Global Health
We are amongst the 10 biggest open medical schemes in SA
• Big enough to make a difference in the lives and health of our members
We have 6 options from
entry level to comprehensive cover
We offer pure and authentic medical cover
• No frivolous add-ons that end up costing
you extra
What you see is what you get - keeping it simple!
100
6
10
BENEFIT OPTIONSWe have the following benefit options
Hospital plan with
comprehensive major
medical benefit cover
(including unlimited
hospitalisation).
Comprehensive major
medical benefit cover,
including unlimited
hospitalisation plus
comprehensive day-to-day
benefits funded from an
insured day-to-day risk
pool in addition to a
savings account benefit.
Comprehensive major
medical benefit cover which
includes unlimited
hospitalisation plus day-to-
day benefits funded from an
insured day-to-day risk
pool.
COMPREHENSIVE PLANS
Platinum
Origin Equilibrium Essence Silver
Gold
BENEFIT HIGHLIGHTS – 2021 / 2022
We have removed co-payments on
• MRI / CT scans (all options)
• In-hospital dentistry Platinum, Gold, Silver and Equilibrium
• Out-of-hospital pathology on Platinum, Gold and Silver
• Non-CDL chronic medicine on Platinum, Gold, Silver and Equilibrium
BENEFIT HIGHLIGHTS – 2022We are implementing the following benefit improvements for 2022
Specialised dentistry requires pre-authorisation.
We are helping our members to extend their benefits and make them
last longer by paying for PMB / Chronic Disease List conditions
from the major medical benefit. They were paid from day-to-day
benefits.
Medical Savings Account
contributions have been
increased in-line with
contribution increases.
We have enhanced our
designated service provider
hospitals to include Mediclinic in
the Western Cape and other
selected hospitals.
An inflationary increase of
approximately 4.6% has
been applied to all
benefit limits.
OPTIONS REVIEW
Local government contribution table (rounded up)
Option overview
Essence Origin Equilibrium Silver Gold Platinum
Hospitalisation
Unlimited, 100% MST at
any Netcare, Life
Healthcare and Mediclinic
in Western Cape
Unlimited, 100% MST
at any Netcare, Life
Healthcare and
Mediclinic in Western
Cape
Unlimited, 100% MST
at any Netcare, Life
Healthcare and
Mediclinic in Western
Cape
Unlimited, 100% MST
at any Netcare, Life
Healthcare and
Mediclinic in Western
Cape
Unlimited, 100% MST
at any Netcare, Life
Healthcare and
Mediclinic in Western
Cape
Unlimited, 100% MST
at any Netcare, Life
Healthcare and
Mediclinic in Western
Cape
Chronic26 PMB conditions 26 PMB conditions
26 PMB conditions
+ 3 additional for Child
Dependants
26 PMB conditions
+ 3 additional for Child
Dependants
26 PMB conditions
+ 18 additional chronic
26 PMB conditions
+ 29 additional chronic
Day-to-day /
Savings Account n/a Day-to-dayDay-to-day and
Savings AccountDay-to-day
Day-to-day and
Savings Account
Day-to-day
and
threshold
DentistryDental check-up from
Health BoosterSubject to day-to-day
Conservative and
orthodontics covered at
100% Scheme tariff
Conservative and
orthodontics covered at
100% Scheme tariff
Conservative and
specialised covered at
100% Scheme tariff
Conservative and
specialised covered at
100% Scheme tariff
Health BoosterIncluded in benefit Included in benefit Included in benefit Included in benefit Included in benefit Included in benefit
Smart BabyIncluded in benefit Included in benefit Included in benefit Included in benefit Included in benefit Included in benefit
Easy-ERIncluded in benefit Included in benefit Included in benefit Included in benefit Included in benefit Included in benefit
Value for money for young, healthy people
• Hospital plan
• Unlimited hospital cover paid at 100% MST, subject to pre-authorisation
• Varicose veins, reflux, facet joint injections, rhizotomy, back and neck (incl. spinal fusion) and joint replacement
surgeries only covered according to PMB entitlement. Hysterectomies covered at 100% of agreed tariff
• Oncology – R169 000 pfpa, PMB once exceeded, subject to designated service provider (DSP)
• MRIs and CT scans – R17 800 pfpa, in- or out-of-hospital
• Appliances – R7 900 pfpa, contraceptive device paid from the appliance benefit
• 26 PMB chronic conditions – GP nomination and registration
• Health Booster – preventative, early detection, maternity and weight loss
• Smart Baby Programme
• Easy-ER
ESSENCE
ESSENCE
• DBC – document based care offers a solution for the treatment of back and neck conditions
• DRM Programme – a unique programme to assist members in managing their chronic conditions effectively and to
improve the well-being of affected members
• Unlimited Netcare 911 emergency transport
• No co-payments for in-hospital dentistry, MRI and CT scans, and endoscopic procedures if performed at DSP hospital
MONTHLY CONTRIBUTION
Principal Member Adult Dependant Child Dependant
Monthly contribution R1 697 R1 360 R612
Entry-level option that provides excellent value for money
• Traditional hospital plan with day-to-day benefits
• Unlimited hospital cover paid at 100% MST, subject to pre-authorisation
• Varicose veins, reflux, facet joint injections, rhizotomy, back and neck (incl. spinal fusion) and joint replacement surgeries
only covered according to PMB entitlement. Hysterectomies covered at 100% of agreed tariff
• Oncology – R169 000 pfpa, PMB once exceeded, subject to DSP
• MRIs and CT scans – R17 800 pfpa, in- and out-of-hospital
• No co-payments for in-hospital dentistry, MRI and CT scans, and endoscopic procedures if performed at DSP hospital
• Appliances – R7 900 pfpa, contraceptive device paid from the appliance benefit
• 26 PMB chronic conditions
• Health Booster – preventative, early detection, maternity and weight loss
• Smart Baby Programme
• Easy-ER
ORIGIN
ORIGIN
• DBC – document based care offers a solution for the treatment of back and neck conditions
• DRM Programme – a unique programme to assist members in managing their chronic conditions effectively and to
improve the well-being of affected members
• Unlimited Netcare 911 emergency transport
• Cover for day-to-day medical expenses, including GP and specialist consultations, medication, pathology, radiology,
optical, dentistry, etc., from combined family benefit
• PM = R2 815 AD = R1 640 CD = R865 Total for PM + AD + 2 CD = R6 185
• No sublimit applicable to over-the-counter medicine or optical
MONTHLY CONTRIBUTION
Principal Member Adult Dependant Child Dependant
Monthly contribution R1 939 R1 381 R631
EQUILIBRIUM Ideal for younger people who can manage their medical expenses
• New generation / hybrid – hospital plan with day-to-day and MSA benefits
• Unlimited hospital cover paid at 100% MST, subject to pre-authorisation
• Prosthesis benefit of R3 500 pfpa, no pre-determined co-payment, subject to use of preferred providers and
reference price
• Varicose veins and reflux surgery covered according to PMB entitlement
• Oncology – R169 000 pfpa, PMB once exceeded, subject to DSP
• MRIs and CT scans – R17 800 pfpa, in- or out-of-hospital
• No co-payments for in-hospital dentistry, MRI and CT scans, and endoscopic procedures if performed at DSP hospital
and in the case of PMB conditions
EQUILIBRIUM
• Appliances – R7 900 pfpa, contraceptive device paid from the appliance benefit
• 26 PMB chronic conditions
• Additional 3 chronic conditions for Child Dependants – ADHD / ADD / hyperkinesis, rhinitis and acne
• Health Booster – preventative, early detection, maternity and weight loss
• Smart Baby Programme
• Easy-ER
• DBC – document based care offers a solution for the treatment of back and neck conditions
• DRM Programme – a unique programme to assist members in managing their chronic conditions effectively and to
improve the well-being of affected members
• Cover for day-to-day and MSA, including GP and specialist consultations, medication, pathology, radiology, optical,
etc., from combined family benefit
• PM = R5 154 AD = R3 397 CD = R1 581 Total for PM + AD + 2 CD = R11 713
• No sublimit applicable to over-the-counter medicine or optical
EQUILIBRIUM
• Unlimited Netcare 911 emergency transport
• Separate dental benefit – 100% MST, subject to DENIS protocols and sublimits
• 1 check-up and cleaning pbpa, X-rays, fillings, root canals and extractions
• Plastic dentures – 1 set, upper and lower jaw, pbp4a
• Orthodontics – covered at 100% MST for Child Dependants aged 9-18 years
• Only pay for a maximum of 3 children
MONTHLY CONTRIBUTION
Principal Member Adult Dependant Child Dependant
Monthly contribution R2 196 R1 357 R674
Monthly savings R172 R106 R53
Total monthly contribution R2 368 R1 463 R727
Suitable for younger families who require substantial out-of-hospital benefits
• Traditional – hospital plan with day-to-day benefits
• Unlimited hospital cover paid at 100% MST, subject to pre-authorisation.
• Elective back surgery (incl. spinal fusion), facet joint injections, rhizotomy, hysterectomy and joint replacement covered
• Prosthesis benefit of R 6 900 pfpa, no pre-determined co-payment, subject to DSP and reference price
• Varicose veins and reflux surgery covered according to PMB entitlement
• Oncology – R189 500 pfpa, PMB once exceeded, subject to DSP
• MRIs and CT scans – R17 800 pfpa, in- or out-of-hospital
• No co-payments for in-hospital dentistry, MRI and CT scans, and endoscopic procedures if performed at DSP hospital
and in the case of PMB conditions
• Appliances – R8 200 pfpa, contraceptive device paid from the appliance benefit
SILVER
SILVER
• 26 PMB chronic conditions
• Additional 3 chronic conditions for Child Dependants – ADHD / ADD / hyperkinesis, rhinitis and acne
• Health Booster – preventative, early detection, maternity and weight loss
• Smart Baby Programme
• Easy-ER
• DBC – document based care offers a solution for the treatment of back and neck conditions
• DRM Programme – a unique programme to assist members in managing their chronic conditions effectively and to
improve the well-being of affected members
• Unlimited Netcare 911 emergency transport
• Cover for day-to-day, including GP and specialist consultations, medication, pathology, radiology, optical, etc., from
combined family benefit
• PM = R8 315 AD = R6 045 CD = R1 680 Total for PM + AD + 2 CD = R17 720
SILVER
• Separate dental benefit – 100% MST, subject to DENIS protocols and sublimits.
• 2 check-ups and cleaning pbpa, X-rays, fillings, root canals and extractions
• Plastic dentures – 1 set, upper and lower jaw, pbp4a
• Orthodontics – covered at 100% MST for Child Dependants aged 9-18 years
• Only pay for a maximum of 3 Child Dependants
MONTHLY CONTRIBUTION
Principal Member Adult Dependant Child Dependant
Monthly contribution R4 084 R2 197 R852
Suitable for younger families who require substantial out-of-hospital benefits
• New generation / hybrid – hospital plan with day-to-day benefits
• Unlimited hospital cover paid at 100% MST, subject to pre-authorisation
• Prosthesis benefit of R50 500 pfpa, no pre-determined co-payment, subject to DSP and reference price
• Oncology – R433 500 pfpa, PMB once exceeded, subject to DSP
• MRIs and CT scans – R17 800 pfpa, in- or out-of-hospital
• No co-payments for in-hospital dentistry, MRI and CT scans, and endoscopic procedures if performed at DSP hospital
• Appliances – R9 700 pfpa, contraceptive device paid from the appliance benefit
• Hearing aids – R17 250 pfp5a, max R8 650 per ear
• Hearing aid maintenance – R1 085 pbpa
GOLD
GOLD
• 26 PMB chronic conditions
• Additional 18 chronic conditions, R9 200 pfpa, 100% MST
• Health Booster – preventative, early detection, maternity and weight loss
• Smart Baby Programme
• Easy-ER
• DBC – document based care offers a solution for the treatment of back and neck conditions
• DRM Programme – a unique programme to assist members in managing their chronic conditions effectively and to
improve the well-being of affected members
• Unlimited Netcare 911 emergency transport
• Cover for day-to-day and MSA, including GP and specialist consultations, medication, pathology, radiology, optical
etc., from combined family benefit
• PM = R12 544 AD = R8 858 CD = R2 694 Total for PM + AD + 2 CD = R26 790
GOLD• Separate dental benefit – 100% MST for conservative and 100% MST for specialised, subject to DENIS protocols
and sublimits
• 2 check-ups and 2 cleanings pbpa
• X-rays, fillings, root canals and extractions
• Crowns and bridges, 1 per tooth pbp5a
• Implants subject to MSA
• Plastic dentures – 1 set, upper and lower jaw, pbp4a
• Metal frame dentures – 1 partial, upper or lower jaw, pbp5a
• Orthodontics – covered at 100% MST for Child Dependants aged 9-18 years
MONTHLY CONTRIBUTION
Principal Member Adult Dependant Child Dependant
Monthly contribution R5 380 R3 638 R1 056
Monthly savings R597 R404 R117
Total monthly contribution R5 977 R4 042 R1 173
PLATINUM Suitable for more mature families
• Threshold option – hospital plan with extensive day-to-day and threshold benefits
• Unlimited hospital cover paid at 100% MST, subject to pre-authorisation
• Unlimited prosthesis benefit, subject to use of DSP and reference price
• Unlimited cover for certain major medical occurrences (for example, oncology / dialysis) covered at 100% MST
• MRIs and CT scans – R26 700 pfpa, in- or out-of-hospital
• No co-payments for in-hospital dentistry, MRI and CT scans, and endoscopic procedures if performed at DSP hospital
• Appliances – R12 450 pfpa, contraceptive device paid from the appliance benefit
• Hearing aids – R37 700 pfp5a, max R18 700 per ear
• Hearing aid maintenance – R1 435 pbpa
PLATINUM
• 26 PMB chronic conditions
• Additional 29 chronic conditions, R20 500 pfpa, 100% MST
• Health Booster – preventative, early detection, maternity and weight loss
• Smart Baby Programme
• Easy-ER
• DBC – document based care offers a solution for the treatment of back and neck conditions
• DRM Programme – a unique programme to assist members in managing their chronic conditions effectively and to
improve the well-being of affected members
• Unlimited Netcare 911 emergency transport
• Cover for day-to-day, including GP and specialist consultations, medication, pathology, radiology, optical etc., from
combined family benefit
• PM = R11 685 AD = R11 335 CD = R2 770 Total for PM + AD + 2 CD = R28 560
PLATINUM
• Threshold zone applies
• Separate dental benefit – 100% MST for conservative and 100% MST for specialised, subject to DENIS protocols and
sublimits
• 2 check-ups and 2 cleanings pbpa
• X-rays, fillings, root canals and extractions
• Crowns and bridges, 1 per tooth pbp5a
• Implants – R4 700 pbpa, DENIS pre-authorisation compulsory
• Plastic dentures – 1 set, upper and lower jaw, pbp4a
• Metal frame dentures – 2 frames (upper and lower jaw), pbp5a
• Orthodontics – covered at 100% MST for Child Dependants aged 9-18 years
MONTHLY CONTRIBUTION
Principal Member Adult Dependant Child Dependant
Monthly contribution R9 624 R6 747 R2 031
Chronic conditions covered
OPERATIONSThe journey of restoring governance at KeyHealth Medical Scheme is continuing. The following have already been realised:
Review of the Scheme rules
to ensure an effective governance model
Review of the Scheme
contracts to derive more value for the Scheme
Development of a new
strategic direction with a
vision of reaching 60 000 members in 2030
Increasing access to
hospital and specialist DSP networks
Development of road
map for election of
trustees and upliftment of the curatorship
Capacitation of the Scheme
Key stakeholder
engagements to ensure
partnership with local
authorities, unions,
management and
bargaining council officials
QUESTIONS