LA KeyPlus – know your network and save

Knowing your healthcare cover well and being network-savvy can save you unexpected costs and admin time. So, take a little time to know your cover. You may be surprised to seehow convenient it is to use networks and the extra value you get.

Hospital stays

We pay for hospital stays in the KeyCare network, If you don’t use the network hospitals for your planned treatment, you may have to pay for unexpected co-payments. If your procedure is planned, it’s important contact us at least 48 hours before you are admitted into hospital. You can find your nearest KeyCare hospital here

GP visits

Some doctors charge more than the tariff specified by your medical scheme. This is something they have a right to do, but it means that if your health option only covers you for the specified tariff, you may have to make a co-payment.

Our GP Network consists of Preferred Providers who have contracted with us in order to provide you with quality care at an affordable rate. If you need to see your chosen GP more than 15 times in a year, you will have to ask for authorisation. We cover four visits to a GP that is not in the network each year. You have cover for specialist consultations only if you have been referred by your chosen GP.

Your LA KeyPlus doctor has a list of procedures and medicines that are covered on your option. If a specialist requests tests and procedures, the costs will be covered from, and be limited to, the specialist benefit limit. You will have to pay for procedures and medicines that are not on the LA KeyPlus list or are done at healthcare providers that are not in the network.

Make sure your doctor is on the Scheme’s network – look on the Find a healthcare professional tool on the member section of the website.

Pharmacies

When you use pharmacies that dispense medicine at the LA Health medicine rate, you get your medicine at the most affordable price and it offers you additional value. For medicine related to HIV or AIDS, you must get your medicine from one of the Scheme’s Designated Service Provider pharmacies.