Network Plus 2026

Total annual limit
Subject to an Overall Annual Limit (OAL) of R223,000 per insured person.

Tariff shortfalls
We pay up to an additional 500% for shortfalls on doctors’ procedures performed in-hospital. We also pay up to an additional 500% on doctors’ procedures performed out of hospital, but deemed to be in-hospital by the medical scheme and paid from risk.

Listed Procedures:
We pay a benefit equal to the cost of in-hospitalisation and associated medical expenses relating to one of the below-mentioned listed procedure, less the cover provided in terms of the insured’s medical scheme option.

Annual limit of R80,000.

• Breast lumpectomy, limited to the excision of the lump only and excluding any pathology and testing thereof.
• Surgery for oesophageal reflux and hiatus hernia.
• Bunionectomy.
• Removal of varicose veins.
• Skin diseases, including benign growths and lipomas.
• In-hospital management of dentistry, limited to impacted teeth for minors under 18 years or reconstructive plastic surgery due to an accident during the period of cover.
• Back and neck treatment or surgery, joint replacements, including but not limited to hips, knees, shoulders, and elbows.
• Knee and shoulder surgery.
• Arthroscopy.
• Non-cancerous breast conditions.
• Functional nasal surgery.
• Cochlear implants, auditory brain implants, and internal nerve stimulators. This includes procedures, devices, and processors.

Please take note: Keycare Network Specialists and Hospitals must be used if hospitalised for any of the listed procedures.

Co-payments / deductibles
We pay the defined co-payment/deductible amount that medical aid schemes have specified for co-payments or deductibles. Annual limit of R10,000, limited to R5,000 per event.

Casualty Benefit
We pay when you have accidental trauma-related or crime-related injuries which require treatment in a hospital out-patients or casualty unit. The limit is R13,000 per event.

Illness-related emergencies for infants and children under the age of 8 will be covered at any time of the day or night.

Illness-related emergencies for members 8 years and older will be covered between 6pm and 8am.

All illness-related emergencies are limited to R3,000 per event and R8,000 per family per annum.