Options we offer

Options we offer

There are five benefit options to choose from. Each benefit option offers a different level of cover while still ensuring that you and your family will be covered in times of need

Choose the Option that is best suited for your needs by comparing the benefits in the table below.

Compare our Options

Benefit Option

Medical Savings Account

Day to day benefits from risk

Above Threshold Benefit

Hospital benefit

Chronic Illness Benefit

LA Comprehensive

--

Unlimited

PMB and Additional conditions

LA Core

--

Unlimited

PMB and Additional conditions

LA Active

--

Unlimited

PMB Conditions

LA Focus

--

--

Unlimited in the coastal network

PMB Conditions

LA KeyPlus

--

Unlimited cover from network GP

--

Unlimited in the KeyCare Network

PMB conditions

View the Plan comparison for 2021- This document provides a brief overview of the benefits available on
LA Health.

If you find a Benefit Option suited to your needs, contact your HR department or the nearest broker in your area. Read more.

LA Comprehensive

This benefit option has a Major Medical Benefit (MMB) for all in-hospital and large expenses. It provides cover for the Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions as well as for several Additional Disease List (ADL) conditions. For CDL conditions, all approved chronic medicine is subject to a medicine list (formulary) and if the formulary is not used, the medicine is paid up to a monthly Chronic Drug Amount (CDA).

The LA Comprehensive Option pays for day-to-day medical expenses from a Medical Savings Account (MSA). Once the MSA limits are depleted and the Annual Threshold for day-to-day claims is reached, further day-to-day expenses will be paid by the Scheme.

Only certain limits apply after the Threshold is reached.

LA Core

This benefit option has a Major Medical Benefit (MMB) for all in-hospital and large expenses.

It provides cover for the Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions as well as for several Additional Disease List (ADL) conditions. For CDL conditions, all approved chronic medicine is subject to a medicine list (formulary) and if the formulary is not used, the medicine is paid up to a monthly Chronic Drug Amount (CDA).

The LA Core Option pays for day-to-day expenses from a Medical Savings Account (MSA). Thereafter, cover for day-to-day claims for GPs, Specialists, acute medicine, radiology, pathology, dentistry and optical benefits is provided by the Scheme from the Extended day-to-day benefit (EDB).

The EDB benefit is limited in accordance with the number of beneficiaries registered on the membership.

LA Active

This Option has a Major Medical Benefit (MMB) for all in-hospital and large expenses and provides Prescribed Minimum Benefit (PMB)Chronic Disease List (CDL) cover according to a formulary. If the formulary is not used, the medicine is paid up to a monthly Chronic Drug Amount (CDA).

The LA Active Option pays for day-to-day expenses from a Medical Savings Account (MSA). Thereafter, cover for day-to-day claims for GPs, Specialists, acute medicine, radiology, pathology, dentistry and optical benefits is provided by the Scheme from the Extended day-to-day benefit (EDB).

The EDB benefit is limited in accordance with the number of beneficiaries registered on the membership.

LA Focus

This benefit option has Major Medical Benefit (MMB) cover for all in-hospital and large expenses and provides Prescribed Minimum Benefit (PMB), Chronic Disease List (CDL) cover according to a formulary. If the formulary is not used, the medicine is paid up to a monthly Chronic Drug Amount (CDA).

The LA Focus Option pays for day-to-day expenses from a Medical Savings Account (MSA).

This Option provides hospital cover specifically for members in any province with a coastline. A co-payment applies for non-PMB care in hospitals that are not in these provinces.

LA KeyPlus

This Option has Major Medical Benefit (MMB) cover for all in-hospital and large costs, cover for the Prescribed Minimum Benefit chronic conditions according to a formulary (list determined by the Scheme) and day-to-day medical expense benefits, mainly through network providers.

It has a Designated Service Provider (DSP) for in-hospital procedures, which is the KeyCare Hospital network. In an emergency, members may use any hospital, but in all other instances a KeyCare hospital must be used.

This applies specifically to all non-emergency Prescribed Minimum Benefits (PMB) and other planned procedures. If a Network Hospital is not used in these elective cases, no benefit will be payable.

If you already know an LA Health broker in your area, please complete an application form and submit it through that broker

Contributions

For 2021 contributions, please view the contributions table

For 2020 contributions, please view the contributions table

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