For planned admissions outside the KeyCare hospital network, the hospital and related accounts are not paid; only PMB admissions have partial payment rules, so using the network is essential.

Full cover for GP consultations depends on visiting your nominated KeyCare Network GP, and using other GPs can trigger member payments under the rules.

Specialist visits require referral by your nominated network GP and a reference number from the scheme before the consultation to be covered under the Specialist Benefit rules.

There is cover for one casualty visit per person per year at a network hospital casualty unit, and you pay the first R520 of the consultation (the scheme pays thereafter under the plan rules).

Cancer treatment described in the plan guide is tied to Prescribed Minimum Benefit rules and requires using the designated providers/network arrangements to avoid shortfalls.

A co-payment applies if approved oncology medicine is not obtained through the designated service provider arrangements described for oncology medicine.

Preauthorisation is required after a stated number of GP visits, so heavy GP use can trigger extra admin steps even though visits are described as unlimited when medically appropriate.

Joint replacements are listed under KeyCare plan exclusions, except where a defined benefit or Prescribed Minimum Benefit rules require cover in specific circumstances.

The maternity basket includes up to eight antenatal consultations, up to two 2D ultrasound scans (or an alternative combination described), and defined post-birth support including limited baby visits to a GP/paediatrician/ENT specialist.

The plan guide states the Chronic Illness Benefit covers the defined Chronic Disease List of 27 conditions, subject to application and scheme rules.