2026 Rules Active
2026 Strategy Validated
Income-Banded KeyCare Network Plan
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Actuarial Strategy Reference
This strategy is generated based on the 2026 Council for Medical Schemes (CMS) registered rules and actuarial pricing matrices.
VERIFIED: 2025-12-20 | SOURCE: SCHEME_BENEFIT_GUIDE_2026
Similar Situations
Key Terms Explained
Key Terms for this Strategy
- Elective Procedure Co-payment
- A mandatory upfront fee you must pay to the hospital for specific scheduled surgeries that are not emergencies. [Source: Council for Medical Schemes Official Benefit Rules]
Common Questions
If I go to a hospital that is not in the KeyCare hospital network for a planned procedure, will the scheme pay anything? [KeyCare Plus Income‑Banded Network Plan]
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. Strategy reference: ork-2026.
Do I need to nominate a specific GP, or can I see any GP and still get full cover? [KeyCare Plus Income‑Banded Network Plan]
Full cover for GP consultations depends on visiting your nominated KeyCare Network GP, and using other GPs can trigger member payments under the rules. Strategy reference: ork-2026.
Do I need a referral and a reference number before I see a specialist? [KeyCare Plus Income‑Banded Network Plan]
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. Strategy reference: ork-2026.
Is there any cover for a non-emergency casualty visit, and what do I pay? [KeyCare Plus Income‑Banded Network Plan]
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). Strategy reference: ork-2026.
If I’m diagnosed with cancer, do I have cover beyond Prescribed Minimum Benefits? [KeyCare Plus Income‑Banded Network Plan]
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. Strategy reference: ork-2026.
Could I pay extra for oncology medicine even if my cancer treatment is approved? [KeyCare Plus Income‑Banded Network Plan]
A co-payment applies if approved oncology medicine is not obtained through the designated service provider arrangements described for oncology medicine. Strategy reference: ork-2026.
When does preauthorisation become important for my GP visits? [KeyCare Plus Income‑Banded Network Plan]
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. Strategy reference: ork-2026.
Are joint replacements covered on KeyCare Plus? [KeyCare Plus Income‑Banded Network Plan]
Joint replacements are listed under KeyCare plan exclusions, except where a defined benefit or Prescribed Minimum Benefit rules require cover in specific circumstances. Strategy reference: ork-2026.
What maternity care is included on this plan? [KeyCare Plus Income‑Banded Network Plan]
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. Strategy reference: ork-2026.
How many chronic conditions are covered under the Chronic Illness Benefit? [KeyCare Plus Income‑Banded Network Plan]
The plan guide states the Chronic Illness Benefit covers the defined Chronic Disease List of 27 conditions, subject to application and scheme rules. Strategy reference: ork-2026.
KeyCare Plus Income‑Banded Network Plan strategy verified
Covering 2 family members
2026 rates applied