KEYHEALTH 2022 PRODUCT LAUNCH PRESENTATION

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


Healthcare and


Cape

Unlimited, 100% MST


Healthcare and


Cape

Unlimited, 100% MST


Healthcare and


Cape

Unlimited, 100% MST


Healthcare and


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


• 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



• 26 PMB chronic conditions



• Easy-ER

ORIGIN

ORIGIN





• 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




EQUILIBRIUM Ideal for younger people who can manage their medical expenses

• New generation / hybrid – hospital plan with day-to-day and MSA benefits


• 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




and in the case of PMB conditions

EQUILIBRIUM



• Additional 3 chronic conditions for Child Dependants – ADHD / ADD / hyperkinesis, rhinitis and acne



• Easy-ER




• 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


• 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 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




and in the case of PMB conditions


SILVER

SILVER


• Additional 3 chronic conditions for Child Dependants – ADHD / ADD / hyperkinesis, rhinitis and acne



• Easy-ER





• Cover for day-to-day, including GP and specialist consultations, medication, pathology, radiology, optical, etc., from

combined family benefit


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



• Only pay for a maximum of 3 Child Dependants




Suitable for younger families who require substantial out-of-hospital benefits

• New generation / hybrid – hospital plan with day-to-day benefits


• Prosthesis benefit of R50 500 pfpa, no pre-determined co-payment, subject to DSP and reference price





• Hearing aids – R17 250 pfp5a, max R8 650 per ear

• Hearing aid maintenance – R1 085 pbpa

GOLD

GOLD


• Additional 18 chronic conditions, R9 200 pfpa, 100% MST



• Easy-ER





• Cover for day-to-day and MSA, including GP and specialist consultations, medication, pathology, radiology, optical

etc., from combined family benefit


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


• Metal frame dentures – 1 partial, upper or lower jaw, pbp5a




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 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




• Hearing aids – R37 700 pfp5a, max R18 700 per ear

• Hearing aid maintenance – R1 435 pbpa

PLATINUM


• Additional 29 chronic conditions, R20 500 pfpa, 100% MST



• Easy-ER





• Cover for day-to-day, including GP and specialist consultations, medication, pathology, radiology, optical etc., from

combined family benefit


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


• Metal frame dentures – 2 frames (upper and lower jaw), pbp5a




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

Documents

KEYHEALTH 2022 PRODUCT LAUNCH PRESENTATION