Good health can change the world SAVER AND CORE SERIES HEALTH PLAN GUIDE 2015 Classic Essential Delta Coastal
THE DISCOVERY HEALTH MEDICAL SCHEME: YOUR BEST CHOICE 5 REASONS WHY THE DISCOVERY HEALTH MEDICAL SCHEME IS THE BEST CHOICE FOR YOU The Discovery Health Medical Scheme is South Africa s largest and most stable medical scheme by far, with over 2.6 million members, the widest plan range, over R11 billion in reserves, and the highest possible credit rating (AA+) for our ability to pay your claims. Our rich benefits, competitive contributions and great service have resulted in us being voted SA s most loved medical aid by members, doctors, employers and financial advisers. 1 THE LOWEST CONTRIBUTIONS One of the benefits of the Discovery Health Medical Scheme is our ability to contain healthcare costs and pass these savings on to you. On a like-for-like basis, Discovery Health Medical Scheme plan contributions are as much as 14% lower than those of any other South African medical scheme. Contributions 14% LOWER Market The benefits explained in this brochure are provided by the Discovery Health Medical Scheme, registration number 1125, administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. This brochure is only a summary of the key benefits and features of the Discovery Health Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. When reference is made to we in the context of benefits, members, payments of cover, in this brochure this is a reference to the Discovery Health Medical Scheme. Vitality is not part of the Discovery Health Medical Scheme. Vitality is a seperate product sold and administered by Discovery Vitality (Pty) Ltd. Registration number 1999/007736/07, an authorised financial provider.
2 THE RICHEST BENEFITS AND FEATURES LIKE FULL COVER WITHIN OUR NETWORKS You will always enjoy full cover and avoid co-payments when visiting a specialist or GP who we have a payment arrangement with, when getting medicine on our day-to-day preferred medicine list from one of the 2000 pharmacies in our pharmacy network, or when using hospitals in our network. We even cover a range of preventive tests from cholesterol to HIV screening without you having to use the money in your Medical Savings Account. FULL COVER CHOICE FULL COVER CHOICE 3 ADDITIONAL BENEFITS THAT ENHANCE YOUR COVER You get access to unique benefits that enhance your cover such as access to second opinion services from Cleveland Clinic for life-threatening and life-changing conditions, cover for a defined list of the latest treatments through the Specialised Medicine and Technology Benefit, cover for treatment not available in South Africa, emergency medical cover when travelling abroad or emergency medical evacuations from certain sub-saharan African countries. 4 VITALITY: GET HEALTHY. GET REWARDED. By being a Discovery Health Medical Scheme member, you have the opportunity to join Vitality, the world s leading science-based wellness programme that encourages you to get healthier, and gives you fantastic rewards. 5 OUR TECHNOLOGY UNLOCKS THE BEST OF CARE Our Discovery app and our website have both been purpose-built to help you get the most out of your health plan. Discovery HealthID, our award-winning app for doctors, allows your doctor to digitally access your health record and write electronic prescriptions, all with the touch of a finger, after you have given permission. Our online booking facility and virtual consultations allow you to conveniently connect with your doctor. Vitality is not part of the Discovery Health Medical Scheme. Vitality is a separate product sold and administered by Discovery Vitality (Pty) Ltd. Registration number 1999/007736/07, an authorised financial services provider.
THE DISCOVERY HEALTH MEDICAL SCHEME PLAN RANGE EXECUTIVE PLAN COMPREHENSIVE SERIES CLASSIC ESSENTIAL DELTA PRIORITY SERIES CLASSIC ESSENTIAL Unlimited cover in any private hospital, including private ward cover Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 300% of the Discovery Health Rate for other specialists Full cover for chronic medicine for all Chronic Disease List conditions plus some additional chronic conditions; plus access to an exclusive list of brand medicines The highest savings account and unlimited Above Threshold Benefit for your day-to-day healthcare needs Additional cover when your Medical Savings Account runs out for GP consultation fees, preferred medicine, blood tests, maternity costs and some durable external medical items Access to specialised, advanced medical care in SA and abroad Cover for medical emergencies when travelling Unlimited private hospital cover Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 200% of the Discovery Health Rate on Classic Plans and 100% on Essential Plans for other healthcare professionals Full cover for chronic medicine for all Chronic Disease List conditions plus some additional chronic conditions A high savings account as well as unlimited Above Threshold Benefit for your day-to-day healthcare needs Additional cover when your Medical Savings Account runs out for GP consultation fees, preferred medicine, blood tests, maternity costs and some durable external medical items Access to specialised, advanced medical care in SA and abroad Cover for medical emergencies when travelling 2 Unlimited cover in any private hospital Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 200% of the Discovery Health Rate on the Classic Plan and 100% on the Essential Plan for other healthcare professionals Full cover for chronic medicine for all Chronic Disease List conditions A savings account and limited Above Threshold Benefit for your day-to-day healthcare needs Additional cover when your Medical Savings Account runs out for GP consultation fees, blood tests, maternity costs and some durable external medical items Cover for medical emergencies when travelling
SAVER SERIES CLASSIC ESSENTIAL COASTAL CORE SERIES CLASSIC ESSENTIAL COASTAL KEYCARE SERIES PLUS ACCESS CORE Unlimited private hospital cover Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 200% of the Discovery Health Rate on Classic Plans and 100% on Essential and Coastal Plans for other healthcare professionals Full cover for chronic medicine for Chronic Disease List conditions A savings account for your day-to-day healthcare needs Additional cover when your Medical Savings Account runs out for GP consultation fees and maternity costs Cover for medical emergencies when travelling Unlimited private hospital cover Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 200% of the Discovery Health Rate on Classic Plans and 100% on Essential and Coastal Plans for other healthcare professionals Full cover for chronic medicine for Chronic Disease List conditions when you use MedXpress Cover for medical emergencies when travelling Unlimited hospital cover in the KeyCare network of hospitals Guaranteed full cover in hospital for specialists in the KeyCare network, and up to 100% of the Discovery Health Rate for other healthcare professionals Essential cover for chronic medicine on our medicine list for Chronic Disease List conditions Unlimited cover for medically appropriate GP consultations, blood tests, x-rays or medicine in our KeyCare network on the KeyCare Plus and KeyCare Access Plans Vitality is not part of the Discovery Health Medical Scheme. Vitality is a separate product sold and administered by Discovery Vitality (Pty) Ltd. Registration number 1999/007736/07, an authorised financial services provider. 3
SAVER & CORE SERIES PRODUCT PLATFORM THE DISCOVERY HEALTH MEDICAL SCHEME OFFERS A RANGE OF OPTIONS TO CATER FOR EVERY NEED THE SAVER AND CORE SERIES OFFER AFFORDABLE COVER FOR HOSPITAL AND CHRONIC CONDITIONS. THE SAVER SERIES OFFERS COVER FOR DAY-TO-DAY MEDICAL EXPENSES AS WELL HOSPITAL COVER There is no overall limit for hospital cover on the Saver and Core Series. On Classic and Essential, you can go to any private hospital and on Delta options and Coastal you must go to our network of hospitals. If you use a specialist who we have a payment arrangement with, we cover you in full for your approved procedure in hospital. YOUR MEDICAL SAVINGS ACCOUNT The Saver Series pays your day-to-day medical expenses from your Medical Savings Account. Any unused funds are carried over to the next year unlike traditional plans where unused cover is lost. The Core Series does not offer a Medical Savings Account. CHRONIC ILLNESS COVER We pay approved chronic medicines that are on the Scheme s medicine list in full, or up to a set monthly rand amount for medicines not on the medicine list. The Designated Services Provider for chronic medicine for Delta Saver and Core Plans is MedXpress. SCREENING AND PREVENTION The Screening and Prevention Benefit covers blood glucose, blood pressure, cholesterol and body mass index measurements at a Discovery Wellness Network provider. The benefit also pays for a mammogram, Pap smear, PSA (prostate screening test) and HIV screening tests. If you are 65 years or older or are registered for certain chronic conditions, we also cover a seasonal flu vaccine. THE INSURED NETWORK BENEFIT EXTENDS YOUR DAY-TO-DAY COVER FOR ESSENTIAL HEALTHCARE SERVICES The Saver Series extends your day-to-day cover through the Insured Network Benefit. When you have spent your annual Medical Savings Account allocation, we cover services such as GP consultation fees and maternity costs from a providers in our network. Cover depends on the health plan you choose. The Core Series does not offer the Insured Network Benefit. Discovery Vitality offers the world s leading science-based programme with a personalised approach to wellness Vitality helps you get healthier by giving you the knowledge, tools and motivation to improve your health it s been clinically proven that Vitality members are healthier, live longer and have lower healthcare costs. 4
THE GUARANTEE OF FULL COVER OUR EXTENSIVE NETWORKS OF HEALTHCARE PROVIDERS, COMBINED WITH OUR UNIQUE SELF-SERVICE TOOLS MEAN YOU CAN AVOID CO-PAYMENTS. THESE TIPS WILL GUIDE YOU TO FULL COVER 1 USE OUR EXTENSIVE HOSPITAL NETWORKS On the Delta options you are covered in full when you use a network hospital. On the Coastal Plans, you must go to a hospital in one of our four coastal provinces for planned admissions. Use our online MaPS tool to find a hospital in these networks. 2 USE OUR PREFERRED MEDICINE We offer a comprehensive list of medicine which we cover in full. Use Discovery MedXpress to order medicine for home delivery or express collections at selected pharmacies. Alternatively ask your pharmacist about your options to avoid a co-payment. 4 Doctor Hospital Day-to-day Chronic cover 3 USE A GP OR SPECIALIST WHO WE HAVE A PAYMENT ARRANGEMENT WITH We offer the broadest range of GP and specialist payment arrangements, which provides full cover both in and out of hospital. Over 90% of our member interactions are with a GP or specialist in our payment arrangements. Use our MaPS tool to find a healthcare professional who we have an arrangement with. USE A NETWORK PROVIDER TO ACCESS THE INSURED NETWORK BENEFIT The Saver Series has a Medical Savings Account which empowers you to make informed decisions on how to spend on your day-to-day healthcare expenses. Once you have spent your annual Medical Savings Account allocation, we extend your day-to-day cover through the Insured Network Benefit. You have additional cover for GP consultation fees and maternity costs. Cover for these healthcare services depends on the health plan you choose. Use our online MaPS tool to find a network provider. This benefit does not apply to the Core Series. Vitality is not part of the Discovery Health Medical Scheme. Vitality is a separate product sold and administered by Discovery Vitality (Pty) Ltd. Registration number 1999/007736/07, an authorised financial services provider. 5
FULL COVER CHOICE FULL COVER CHOICE SAVER & CORE SERIES KEY FEATURES BENEFITS AVAILABLE ON THE SAVER AND CORE SERIES Saver Series Core Series Unlimited private hospital cover Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 200% of the Discovery Health Rate on Classic Plans and up to 100% of the Discovery Health Rate on Essential and Coastal Plans for other healthcare professionals Full cover for chronic medicine for all Chronic Disease List chronic conditions A savings account for your day-to-day healthcare needs (Saver only) Additional cover when your Medical Savings Accounts runs out for GP consultation fees and maternity costs (Saver only) Cover for medical emergencies when travelling Vitality is not part of the Discovery Health Medical Scheme. Vitality is a separate product sold and administered by Discovery Vitality (Pty) Ltd. Registration number 1999/007736/07, an authorised financial services provider. 6
THE SAVER AND CORE SERIES EACH HAVE FIVE HEALTH PLAN OPTIONS THE HEALTH PLANS ARE: Classic Classic Delta Essential Essential Delta Coastal There are slight differences in benefits as indicated below. The benefits not mentioned in the table are the same across all five options. Classic Classic Delta Essential Essential Delta Coastal Hospital cover Hospital Network Any private hospital Private hospitals in the Delta network Any private hospital Private hospitals in the Delta network Private hospitals in the four coastal provinces Cover for healthcare professionals in hospital 200% of the Discovery Health Rate for specialists, GPs and other healthcare professional services 100% of the Discovery Health Rate for specialists, GPs and other healthcare professional services Day-to-day benefits (Saver only) Insured Network Benefit GP consultations Extended day-to-day cover when your Medical Savings Account allocation has run out for: Antenatal consultations and two 2D pregnancy scans at network providers Extended day-to-day cover for limited GP consultations at a network provider when your Medical Savings Account allocation has run out Medical Savings Account Your MSA allocation is 25% of your monthly contributions Chronic benefits (Saver) Your MSA allocation is 15% of your monthly contributions Your MSA allocation is 25% of your monthly contributions Designated network for chronic medicines You have cover for approved chronic medicine in our network of 2 000 pharmacies. If you use a pharmacy outside of this network, you may have a co-payment on the dispensing fee charged by the pharmacist You have cover for approved chronic medicine, if you use MedXpress. If you don t use MedXpress a 20% co-payment applies You have cover for approved chronic medicine in our network of 2 000 pharmacies. If you use a pharmacy outside of this network, you may have a co-payment on the dispensing fee charged by the pharmacist You have cover for approved chronic medicine, if you use MedXpress. If you don t use MedXpress a 20% co-payment applies You have cover for approved chronic medicine in our network of 2 000 pharmacies. If you use a pharmacy outside of this network, you may have a co-payment on the dispensing fee charged by the pharmacist 7
SAVER & CORE SERIES HOSPITAL COVER WE COVER YOU IN HOSPITAL FOR EMERGENCY AND PLANNED HOSPITAL ADMISSIONS. THERE IS NO OVERALL LIMIT FOR HOSPITAL COVER Your Hospital Cover is made up of: Cover for the account from the hospital Cover for the accounts from your admitting doctor, anaesthetist or any other approved healthcare professional. Cover for your hospital account We cover you in any private hospitals for emergency and preauthorised hospital admissions. We cover your hospital account (the ward and theatre fees) at the rate agreed with the hospital. You have unlimited cover for general wards. Network hospitals on Delta and Coastal On Classic Delta and Essential Delta, you are covered in full at private hospitals and day clinics in the Delta Hospital Network. For planned admissions at hospitals outside the network, you must pay an amount of R5 950 upfront to the hospital. This does not apply in an emergency. On the Coastal Plan, you must go to a hospital in one of the four coastal provinces for a planned hospital admission. If you don t use a coastal hospital, we pay up to a maximum of 70% of the hospital account and you pay the difference. Investigations are covered differently Cover for scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) The first R3 400 of the hospital account The balance of the hospital account Saver Paid from available Medical Savings Account You pay Paid from Hospital Benefit Core Cover for related accounts We guarantee full cover when you use healthcare professionals who we have a payment arrangement with. If you are on a Classic Plan you benefit from access to the broadest range of specialists, which represents over 90% of our members specialist interactions. On the Classic Plans we cover specialists who we don t have a payment arrangement with and other healthcare professionals up to 200% of the Discovery Health Rate. On the Essential and Coastal Plans we cover specialists who we don t have a payment arrangement with and other healthcare professionals up to 100% of the Discovery Health Rate. Radiology and pathology are covered up to 100% of the Discovery Health Rate on all plans. 8
HOSPITAL COVER Cover for MRI and CT scans If your MRI or CT scan is done as part of an approved hospital admission, we pay for it from your Hospital Benefit at 100% of the Discovery Health Rate. On the Saver, if you are admitted for conservative back or neck treatment, or if the scan is not related to your hospital admission, we pay the first R2 600 of the amount for the scan from your available day-to-day benefits. We pay the balance of the scan from your Hospital Benefit, up to 100% of the Discovery Health Rate. Specific rules and limits apply to conservative back and neck scans. On the Core Series, if you are admitted for conservative back and neck treatment, or if the scan is not related to your hospital admission, we do not pay for it. Severe dental and oral surgery The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. This benefit is subject to authorisation and the Scheme s clinical rules. Other dental treatment in hospital You need to pay a portion of your hospital or day clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment: Hospital YOUNGER THAN 13 R1 700 We pay the balance of the hospital account from your 13 and older R4 400 Hospital Benefit, up to 100% of the Discovery Health Rate. COVER We pay the related accounts, which include the dental surgeon s account, from your Hospital Benefit, up to 100% FOR DENTAL Day clinic of the Discovery Health Rate. On Classic Plans, we pay anaesthetists up to 200% of the Discovery Health Rate. YOUNGER THAN 13 R800 TREATMENT 13 and older R2 850 For beneficiaries 13 and older, we cover routine, conservative dentistry, such as preventive treatments, simple fillings and root canal treatments from your available day-to-day benefits. No overall dental limit Saver Series There is no overall limit for dental treatment. However, all dental appliances, their placement, and orthodontic treatment (including related accounts for orthognathic surgery) are paid at 100% of the Discovery Health Rate from your Medical Savings Account, as long as you have money available. Core Series You are responsible for paying the cost of all dental appliances, their placements and orthodontic treatment (including the related accounts for orthognathic surgery). 9
SAVER & CORE SERIES HOSPITAL COVER SOME IN-HOSPITAL HEALTHCARE SERVICES HAVE AN ANNUAL LIMIT Cochlear implants, auditory brain implants and processors R187 000 for each person for each benefit Internal nerve stimulators R129 000 for each person Hip, knee and shoulder joint prostheses There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R36 400 applies to each prosthesis Prosthetic devices used in spinal surgery R25 500 for the first level, R51 000 for two or more levels, limited to one procedure for each person Mental health 21 days for each person Alcohol and drug rehabilitation 21 days for each person Compassionate care R44 000 for each person in their lifetime Chronic dialysis We cover these expenses in full if we have approved your treatment plan and you use a provider in our network. If you go elsewhere you have to make a co-payment 10
DISCOVERY HOMECARE UNIQUE HOME-BASED SERVICES DISCOVERY HOMECARE DISCOVERY HOMECARE DISCOVERY HOMECARE Discovery HomeCare is a unique home-based service that offers you quality care in the comfort of your own home. HomeCare allows you, as a Discovery Health Medical Scheme member, to continue to recover in a familiar environment, and with minimum disruption to your normal routine and family life whilst maximising your time at home with your loved ones. Healthcare services offered We offer quality nursing and care worker support for these therapeutic areas: Post-natal care End of life, palliative care delivered in partnership with the Hospice Palliative Care Association of South Africa Home IV infusions of antimicrobials, biologics, IV iron and immunoglobulins for stable patients Wound care of venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for stable patients Respite care short-term care services that offer temporary relief for caregivers looking after the healthcare needs of beneficiaries How to use Discovery HomeCare This service is subject to existing benefits, and will be offered in 2015 to members living in Gauteng. Respite care will be for your own pocket, as these services are not covered by the Scheme. You can speak to your doctor to discuss your options. 11
SAVER & CORE SERIES CHRONIC ILLNESS, CANCER AND HIV COVER Cover for chronic conditions You have extensive cover for an essential list of chronic conditions. We need to approve your application before we cover your condition from the Chronic Illness Benefit. If you are registered on the Chronic Illness Benefit for diabetes and a defined list of heart-related conditions you can access our Personal Health Programmes to help better manage your condition. Medicine cover on the Chronic Disease List You have full cover for approved medicine on our medicine list. If you use medicine that is not on the medicine list, you can use up to a set monthly amount for each class of medicine. How we pay for medicine We pay for medicine up to a maximum of the Discovery Health Rate for medicines. The Discovery Health Rate for medicines is the price of medicine as well as a fee for dispensing it. The Discovery Health Health Medical Scheme has negotiated contracts with over 2 000 pharmacies, who have agreed to charge no more than this rate. If you use a pharmacy out of this network, you may have a co-payment on the dispensing fee charged by the pharmacist. Designated Service Provider for Delta and Core Plans On Classic Delta, Essential Delta and Core Plans your Designated Service Provider is MedXpress. If you don t use MedXpress a 20% co-payment applies. Cover for diabetes We cover approved bluetooth enabled glucose monitoring devices and test strips that help you and your doctor with real time management of your condition. Cover for cancer If you re diagnosed with cancer, we cover you from the DiscoveryCare Oncology Programme once we have approved your cancer treatment. We do not limit your cancer treatment costs. We cover the first R200 000 of your approved cancer treatment over a 12-month cycle in full. If your treatment costs more than R200 000, you will need to pay 20% of the additional costs. Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. All cancer-related healthcare services are covered up to 100% of the Discovery Health Rate. You might have a co-payment if your healthcare professional charges above this rate. Cover for HIV and AIDS When you register for our HIVCare Programme you are covered for the all-inclusive care that you need. You get access to clinically sound and cost-effective treatment and you can be assured of confidentiality at all times. Approved medicines on our medicine list are covered in full. Medicines not on our list are covered up to a set monthly amount. You will need to get your medicine from a Designated Service Provider to avoid a 20% co-payment. 12
MEDXPRESS MEDICINE DELIVERED TO YOUR DOOR DELIVERING MEDICINE WHEREVER YOU ARE MedXpress lets you order medicine online or over the phone and have it delivered directly to your door. In 2015, you will have the option to collect your prescription medicine from selected pharmacies. What Discovery MedXpress offers you Convenience Delivery to your door there s no need to wait in queues or leave home to get your medicine. A simple process there are no complicated forms to complete. All we need is a valid script and a phone call. Regular updates we ll keep you up to date on any changes that may affect your cover for chronic medicine when you call us to order your medicine. Advice to help you save When using MedXpress, Discovery Health s qualified service agents can also advise you on the most cost-effective alternatives. And you will always be charged at the Discovery Health Rate for medicines or less in effect getting rid of all those small co-payments that add up over time. Important points to remember Delivery of your medicine Chronic or repeatable prescription medicine will be delivered to your preferred address anywhere in South Africa. Once-off prescription medicine delivery orders are currently only available in the Johannesburg, Pretoria and Cape Town metropolitan areas. Collect your medicine Send a photo of your prescription through MedXpress and collect your medicine from one of our partner pharmacies. Your medicine will be ready for collection at a designated counter. Please remember to bring your original prescription when you collect your medicine. How you can order medicine Clearly mark your prescription with the word MedXpress and your membership number, and email your prescription to medxpress@discovery.co.za or fax it to 011 539 1020, or you can call us 0860 99 88 77. There is no additional administration or delivery cost, so you can take back the time spent in the pharmacy by placing your order now. 13
SAVER & CORE SERIES MANAGING YOUR CHRONIC CONDITION THROUGH OUR PERSONAL HEALTH PROGRAMMES Our Personal Health Programmes are a set of unique lifestyle programmes to assist you with the help of your Premier Practice GP to actively manage your chronic condition to make you healthier. Any Discovery Health Medical Scheme member registered on the Chronic Illness Benefit for diabetes, hypertension, hyperlipidaemia or ischemic heart disease can join a Personal Health Programme. You have the option to enrol on one of these programmes via our website or through your GP if they belong to the Discovery Health Premier Practice Network. Your Premier Practice GP will prescribe a chronic disease management lifestyle programme for you. Our Personal Health Programmes are based on clinical and lifestyle guidelines, and give you and your GP the tools to better monitor and manage your condition. In addition, the programme unlocks valuable healthcare services such as dieticians and biokineticists that you may require as part of the programme. Personal Health Programmes features to make you healthier: The programme guides you on what to do to improve your health Your Premier Practice GP is your dedicated partner on this journey and will monitor you throughout the programme Premier Practice GPs are able to track and monitor your progress in real time by viewing your health metrics such as fitness and blood glucose levels, weight management, nutrition and medication intake You can also monitor your own progress at any time, through relevant alerts and reminders If you are a Vitality member, you will also earn points and unlock additional rewards to help you live well How to join a Personal Health Programme Speak to your GP or log onto www.discovery.co.za Personal Health Programmes are brought to you by Discovery Vitality (Pty) Ltd, registration number 1999/007736/07 and Discovery Health (Pty) Ltd, registration number 1997/013480/07. Authorised financial services providers. 14
HEALTHID YOUR MEDICAL INFORMATION IN YOUR DOCTORS HANDS HealthID is the first electronic health record application of its kind in South Africa. It puts all your health records in your doctor s hands so you won t have to try and remember everything. It also assists your doctor in interacting with us. With Discovery s HealthID app doctors can: Access your medical history and electronic health records Your doctor can go into your electronic health record and access your health information to see your medical history. So, if you are having trouble remembering particular medicines you ve taken, this information is available to your doctor immediately. Also, you can save time and money by not having to repeat tests and investigations, because the results of your previous tests are available for your doctor to see. Apply for chronic cover If you are diagnosed with a chronic condition, your doctor can complete an electronic Chronic Illness Benefit application using HealthID. This application is easy and convenient, because your doctor gets the information they need for your specific condition when completing the application and you can get immediate approval for certain conditions. Write electronic scripts During your consultation, your doctor can prescribe medicine for you using electronic scripting. You can find ways to reduce or even avoid co-payments on your medicines before you even reach the pharmacy because your doctor can also see medicines on our approved medicine list, as well as the cost of those medicines, before finalising your prescription. View your benefit information Your doctor also has instant access to your health benefit information to help you get the most out of your benefits. All these functions are designed to make your visit to your doctor easier and more productive. Give your doctor consent To benefit from HealthID, your doctor will need your permission to access your health records. You will need to give consent to each doctor you visit before that doctor can access your health records on HealthID. You can log onto www.discovery.co.za to give your consent. No unauthorised person will have access to your personal medical information. HealthID is brought to you by Discovery Health (Pty) Ltd. Registration number 1997/013480/07, an authorised financial services provider. 15
SAVER & CORE SERIES DAY-TO-DAY COVER (SAVER SERIES) HOW WE COVER YOUR DAY-TO-DAY HEALTHCARE EXPENSES Your cover is made up of two elements: Your Medical Savings Account The Insured Network Benefit We pay for day-to-day medical expenses like visits to healthcare professionals, radiology and pathology from your Medical Savings Account, as long as you have money available. When you have spent your annual Medical Savings Account allocation, we extend your cover for essential healthcare services through the Insured Network Benefit, and you will need to pay for your other day-to-day expenses. 16
INSURED NETWORK BENEFIT (SAVER SERIES) WHEN YOUR ANNUAL MSA ALLOCATION IS USED UP, YOU HAVE ACCESS TO A UNIQUE SET A HEALTHCARE SERVICES THAT ARE PAID IN FULL WHEN YOU USE A NETWORK PROVIDER. WE COVER: GP CONSULTATIONS FULL COVER CHOICE ANTENATAL CONSULTATIONS We cover your face-to-face and virtual GP consultations if you use a GP in the Discovery network, up to: Plan Classic and Coastal Single member Family 3 consultations 6 consultations FULL COVER CHOICE On the Classic and Classic Delta you have access to eight antenatal consultations and two 2D pregnancy scans, provided you use a gynaecologist who we have a payment arrangement with. Essential 2 consultations 4 consultations 17
SAVER & CORE SERIES ADDITIONAL BENEFITS THAT ENHANCE YOUR COVER WE MAKE YOUR COVER LAST LONGER Preventive screening The Screening and Prevention Benefit covers certain tests like blood glucose, blood pressure, cholesterol and body mass index when done at any one of the Discovery Wellness Network providers. We also cover a mammogram, Pap smear, PSA (a prostate screening test) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine. Scopes We pay for scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) from your Hospital Benefit, if it s done in your doctor s rooms. We pay up to 200% of the Discovery Health Rate if you are on a Classic Plan and up to 100% of the Discovery Health Rate if you are on an Essential or Coastal Plan. Claims related to traumatic events The Trauma Recovery Extender Benefit covers out-of-hospital claims related to certain traumatic events. Claims are paid from the Trauma Recovery Extender Benefit for the rest of the year in which the trauma occurred, as well as the year after the event occurred. You may need to apply for this benefit. Not available on Core Series. ACCESS TO THE MOST ADVANCED MEDICAL COVER International second opinion services Through your specialist you have access to online second opinion from Cleveland Clinic on life-threatening and lifechanging conditions. We cover 50% of the cost of the consultation. TRAVEL AND EVACUATION COVER International travel You have cover of up to R5 million for each person on each journey for emergency medical costs while you travel outside South Africa. This cover is for a period of 90 days from your departure from South Africa. Pre-existing conditions are excluded. Africa evacuation cover You have cover for emergency medical evacuations from certain sub-saharan African countries back to South Africa. Pre-existing conditions are excluded. ACCESS TO DIGITAL CONVENIENCE Online bookings and virtual consultations You can conveniently use our Discovery app to make real time bookings and connect with your doctor virtually. These virtual consultations are paid from your available day-to-day benefits on the Saver Series. On Core Series you will have to pay for these services yourself. 18