Plan Comparison 20 13 Executive Plan Executive Comprehensive Classic Comprehensive Classic Delta Comprehensive Classic Comprehensive Zero MSA Essential Comprehensive Essential Delta Comprehensive Priority Classic Priority Essential Priority Saver Classic Saver Classic Delta Saver Essential Saver Essential Delta Saver Coastal Saver Core Classic Core Classic Delta Core Essential Core Essential Delta Core Coastal Core Critical hospital care Planned hospital care Chronic Illness Day-to-day medical care Screening and prevention KeyFIT KeyCare KeyCare Plus KeyCare Access KeyCare Core This brochure is intended for intermediary use. It 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. Full details can be found in the Discovery Health Medical Scheme Rules on www.discovery.co.za/portal/rules. It also summarises other Discovery products and value-added services. For compliance questions, email compliance@discovery.co.za. Discovery Health Medical Scheme, registration number 1125, is administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Vitality is not part of the Discovery Health Medical Scheme. Vitality is a separate product sold and administered by Vitality Healthstyle (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider.
SUMMARY EXECUTIVE THE MOST EXTENSIVE COVER FOR IN-HOSPITAL AND DAY-TO-DAY BENEFITS and private ward cover Highest Medical Savings Account and an unlimited Above Threshold, which covers both in- and out-of-hospital claims Full cover for an exclusive list of chronic medicine COMPREHENSIVE CLASSIC ZERO MSA CLASSIC ESSENTIAL COMPREHENSIVE COVER FOR IN-HOSPITAL AND DAY-TO-DAY BENEFITS A choice of a high or no Medical Savings Account and an unlimited Above Threshold Comprehensive cover for chronic medicine Hospitals Unlimited cover at any private hospital and private ward cover of up to R1 300 each day HOSPITAL COVER Upfront payments No upfront payments to hospitals Specialists we have an Cover is subject to funds in Medical Savings Account or Above Threshold Specialists we do not have an Other healthcare 100% Radiology and pathology Unlimited cover at any private hospital Unlimited cover Full cover on Delta when using the Delta Hospital Network of private hospitals For planned admissions outside of the Delta Hospital Network, an upfront payment of R5 000 must be paid to the hospital Full Cover 300% 200% 100% 200% 100% 100% Conditions Medicine cover If done as part of an approved admission, we pay the hospital account from your Hospital and all related accounts from the Medical Savings account or Above Threshhold benefit Scans not related to your admission will be paid from your day-to-day benefits at 100% of the Discovery Health Rate If done as part of an approved admission, we will pay up to 100% of the Discovery Health Rate from the Hospital Covered once you reach your Annual Threshold If not related to your admission or if for conservative back or neck treatment, we pay the first R2 450 of the scan from your day-to-day benefits. We pay the balance of the scan from your Hospital, up to 100% of the Discovery Health Rate CHRONIC ILLNESS BENEFIT You have cover for conditions according to the Prescribed Minimum s list and on our Additional Disease List. Your condition needs to be approved in order to be covered Full cover for approved medicine on Discovery Health s most extensive medicine list. If you choose to use medicine that is not on our list, you have a set monthly amount available that is higher than that of our other plans. Full cover for an exclusive list of medicines only available on this plan. ONCOLOGY Full cover for approved medicine on Discovery Health s medicine list. If you choose to use medicine not on our list, we will pay it up to a set monthly amount. Covers first R400 000 of approved cancer treatment in full over a 12-month cycle Co-payments You will be required to pay 20% of the cost on all further treatment once costs for cancer treatment go over R400 000 Healthcare Medical Savings Account Self-payment gap DAY-TO-DAY BENEFITS Covers day-to-day medical expenses like GP visits, radiology and pathology at the rate the healthcare professional charges If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay for your medical expenses You pay all day-to-day medical expenses until you reach your Annual Threshold Pays for day-to-day medical expenses like GP visits, radiology and pathology as long as you have money available If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay for your day-to-day medical expenses Pays for certain day-to-day benefits after you have run out of money in your Medical Savings Account and before you reach the Annual Threshold Insured Network GP consultations, day-to-day generic medicines (above schedule 3) and blood tests will be covered if you use a provider in our network GP consultations, day-to-day generic medicines (above schedule 3)* and blood tests* will be covered if you use a provider in our network *On Classic and Classic Delta only Above Threshold Screening and Prevention Trauma Recovery Extender Specialised Medicine and Technology Overseas Treatment Allied, Therapeutic and Psychology Extender Paid from your available Medical Savings Account or Above Threshold The Above Threshold is unlimited ADDITIONAL BENEFITS Covered once you reach your Annual Threshold We pay the first R2 450 of your MRI or CT scan from your day-to-day benefits. We cover the balance of the scan from your Hospital, up to the Discovery Health Rate (except for conservative back and neck, where specific rules apply). Covers certain tests at a Discovery Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. 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. Out-of-hospital claims for recovery after certain traumatic events are covered on for the rest of the year in which the trauma took place, and a year after the trauma Cover up to R200 000 for each person for a defined list of the latest and most advanced treatments Up to R500 000 for each person if they travel to seek evidence-based healthcare treatment not available in South Africa. A co-payment of 20% and specific rules apply to. Out-of-hospital claims for recovery after certain traumatic events are covered on for the rest of the year in which the trauma took place, and a year after the trauma Provides unlimited cover for a list of allied healthcare services, like physiotherapy. This unlimited cover is for a defined list of conditions, for example quadriplegia and cerebral palsy. Cover depends on your condition and the criteria for it.
SUMMARY Hospitals Upfront payments to hospitals Specialists we have an Specialists we do not have an Other healthcare Radiology and pathology PRIORITY SAVER CLASSIC ESSENTIAL CLASSIC ESSENTIAL COASTAL COST-EFFECTIVE IN-HOSPITAL AND DAY-TO-DAY BENEFITS Essential cover for chronic medicine A Medical Savings Account and a limited Above Threshold Unlimited cover at any private hospital HOSPITAL COVER An upfront payment of between R1 950 and R9 500 must be paid to the hospital when you are admitted for a defined list of procedures ECONOMICAL IN-HOSPITAL AND DAY-TO-DAY BENEFITS Essential cover for chronic medicine A Medical Savings Account Full cover Unlimited cover at any private hospital Full cover on Delta when using Delta Hospital Network of private hospitals For planned admissions at hospitals outside of the Delta Hospital Network, an upfront payment of R5 000 must be paid to the hospital 200% 100% 200% 100% 200% 100% 200% 100% 100% Unlimited cover at any coastal private hospitals If a coastal hospital is not used, a payment of up to 70% of the hospital account is paid and you must pay the difference If done as part of an approved admission, we will pay up to 100% of the Discovery Health Rate from the Hospital Conditions Medicine cover If not related to your admission, we pay the first R2 450 of the scan from your day-to-day benefits. We pay the balance of the scan from the Hospital up to 100% of the Discovery Health Rate. If for conservative back and neck treatment, you have to pay the first R1 950 of the hospital account and we pay the first R2 450 of the scan from your day-to-day benefits. We pay the balance of the scan from the Hospital up to 100% of the Discovery Health Rate If not related to your approved admission or if for conservative back or neck treatment, we pay the first R2 450 of the scan from your day-to-day benefits. We pay the balance of the scan from your Hospital, up to 100% of the Discovery Health Rate. CHRONIC ILLNESS BENEFIT You have cover for conditions according to the Prescribed Minimum s list. Your condition needs to be approved in order to be covered Full cover for approved medicine on Discovery Health s medicine list. If you choose to use medicine not on our list, we will pay it up to a set monthly amount. ONCOLOGY Covers first R200 000 of the approved cancer treatment in full over a 12-month cycle Co-payments You will be required to pay 20% of the cost on all further treatment once costs for cancer treatment go over R200 000 Healthcare Medical Savings Account Self-payment gap Insured Network Above Threshold Screening and Prevention Trauma Recovery Extender Specialised Medicine and Technology Overseas Treatment Allied, Therapeutic and Psychology Extender DAY-TO-DAY BENEFITS Pays for day-to-day medical expenses like GP visits, radiology and pathology as long as you have money available If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay for your day-to-day medical expenses Pays for certain day-to-day benefits after you have run out of money in your Medical Savings Account and before you reach the Annual Threshold GP consultations, on Classic and Essential. Blood tests on Classic only. You must use a provider in our network The Above Threshold * is limited Main member R7 800 Adult R5 550 Child dependant R2 680 We pay the first R2 450 of the scan from your day-to-day benefits. We pay the balance of the scan from the Hospital up to 100% of the Discovery Health Rate ADDITIONAL BENEFITS Pays for day-to-day medical expenses like GP visits, radiology and pathology as long as you have money available You need to pay claims when your Medical Savings Account runs out Covers GP consultations in our network up to a limit depending on your plan type and family size These plans do not offer We pay the first R2 450 of MRI or CT scan from your available Medical Savings Account. We cover the balance of the scan from your Hospital, up to the Discovery Health Rate. For conservative back and neck, specific rules and limits may apply. Covers certain tests at a Discovery Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. 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. Out-of-hospital claims for recovery after certain traumatic events are covered on for the rest of the year in which the trauma took place, and a year after the trauma These plans do not offer these benefits * If you join the medical scheme after January, you wont get the full amount because it is calculated by counting the remaining months in the year.
SUMMARY Hospitals Upfront payments Specialists we have an Specialists we do not have an Other healthcare Radiology and pathology Conditions Medicine cover CORE CLASSIC ESSENTIAL COASTAL CORE PLUS ACCESS VALUE-FOR-MONEY HOSPITAL PLAN Essential cover for chronic medicine Unlimited cover at any private hospital Full cover on Delta when using Delta Hospital Network of private hospitals For planned admissions at hospitals outside of the Delta Hospital Network, an upfront payment of R5 000 must be paid to the hospital HOSPITAL COVER Unlimited cover at any coastal private hospitals If a coastal hospital is not used, a payment of up to 70% of the hospital account is paid and you must pay the difference KEYCARE AFFORDABLE MEDICAL AID COVER Unlimited emergency and trauma cover in our KeyCare network of hospitals and planned hospital cover on KeyCare Core and KeyCare Plus Essential antenatal care Cover in our network when you need to see a specialist Cover for medical emergencies in South Africa Full cover Unlimited cover in the KeyCare Hospital Network. A list of procedures are covered in the day surgery network. If you do not use hospitals in your plan s networks, you will have to pay all costs 200% 100% 100% 200% 100% 100% 100% If your MRI or CT scan is done as part of an approved hospital admission, we cover your scan up to 100% of the Discovery Health Rate from your Hospital If not related to your admission or if for conservative back or neck treatment, we do not pay for it Unlimited cover for in the KeyCare Access Hospital and KeyCare Hospital networks for emergencies and trauma and in the KeyCare Access Hospital Network for childbirth and care for newborns. Other conditions are covered in contracted network of state facilities. If not related to your admission, we pay it from the Specialist up to a limit of R2 550 each person each year. CHRONIC ILLNESS BENEFIT You have cover for conditions according to the Prescribed Minimum s list. Your condition needs to be approved in order to be covered. Full cover provided for approved medicine on Discovery Health s medicine list. If you choose to use medicine not on our list, we will pay it up to a set monthly amount. ONCOLOGY Covers first R200 000 of the approved cancer treatment in full over a 12-month cycle You will have to pay 20% of the cost on all further treatment once costs for cancer treatment go over R200 000 Approved medicine must be purchased from one of our network pharmacies or from your chosen GP. If medicine is purchased elsewhere, you will have to pay a 20% co-payment. Chosen GP must prescribe the chronic medicine. Cancer treatment is covered according to the Prescribed Minimum s and if you go to a cancer specialist in our network Co-payments Healthcare DAY-TO-DAY BENEFITS Medical Savings Account Self-payment gap Insured Network These plans do not offer these benefits These plans do not offer these benefits Above Threshold Scans paid from the Specialist up to a limit of R2 550. ADDITIONAL BENEFITS Screening and Prevention Trauma Recovery Extender Specialised Medicine and Technology Overseas Treatment Allied, Therapeutic and Psychology Extender Cancer treatment is covered according to the Prescribed Minimum s in a network of contracted state Facilities These plans do offer but they cover primary care through your chosen GP and day-to-day medicine from our medicine list. We pay for basic radiology and pathology at a network provider. Covers certain tests at a Discovery Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. 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. These plans does not offer These plans do not offer. Out-of-hospital claims for recovery after certain traumatic events are covered on for the rest of the year in which the trauma took place, and a year after the trauma
Contributions 2013 Plan Contributions Contributions to Medical Savings Account Total contributions Main member Adult Child* Main member Adult Child* Main member Adult Child* Executive Executive 2 823 2 823 536 941 941 178 3 764 3 764 714 Main member Annual thresholds Adult Child* 11 280 11 280 2 125 Comprehensive Priority Saver Core KeyCare Classic Comprehensive 2 315 2 189 462 771 729 154 3 086 2 918 616 Classic Delta Comprehensive 2 085 1 972 415 695 657 138 2 780 2 629 553 Classic Comprehensive Zero MSA 2 315 2 189 462 No Medical Savings Account 2 315 2 189 462 Essential Comprehensive 2 205 2 084 442 389 367 78 2 594 2 451 520 Essential Delta Comprehensive 1 985 1 876 397 350 331 70 2 335 2 207 467 Classic Priority 1 552 1 222 621 517 407 207 2 069 1 629 828 Essential Priority 1 512 1 188 604 266 209 106 1 778 1 397 710 Classic Saver 1 361 1 071 544 453 357 181 1 814 1 428 725 Classic Delta Saver 1 087 856 436 362 285 145 1 449 1 141 581 Essential Saver 1 226 917 490 216 161 86 1 442 1 078 576 Essential Delta Saver 980 735 391 172 129 69 1 152 864 460 Coastal Saver 1 071 803 431 357 267 143 1 428 1 070 574 Classic Core 1 350 1 062 539 1 350 1 062 539 Classic Delta Core 1 081 849 432 1 081 849 432 Essential Core 1 160 869 464 No Medical Savings Account 1 160 869 464 Essential Delta Core 927 695 372 927 695 372 Coastal Core 998 748 398 998 748 398 KeyCare Plus (8 301+) 1 330 1 330 356 1 330 1 330 356 KeyCare Plus (6 251 8 300) 893 893 250 893 893 250 KeyCare Plus (0 6 250) 638 638 230 638 638 230 KeyCare Access (8 301+) 1 300 1 300 350 1 300 1 300 350 KeyCare Access (6 251 8 300) 865 865 245 865 865 245 No Medical Savings Account KeyCare Access (3 901 6 250) 600 600 215 600 600 215 KeyCare Access (0 3 900) 450 450 195 450 450 195 KeyCare Core (8 301+) 982 982 222 982 982 222 KeyCare Core (6 251 8 300) 636 636 158 636 636 158 KeyCare Core (0 6 250) 511 511 129 511 511 129 9 170 6 890 3 000 9 170 6 890 3 000 No Annual Threshold No Annual Threshold No Annual Threshold * We count a maximum of three children when we calculate family contributions, Annual Thresholds and Above Threshold limits. We pro-rate the Annual Thresholds according to when you join the medical scheme. All amounts are in rands. Vitality and KeyFIT contributions Single member Member with one dependant Member with two or more dependants Vitality 155 179 199 KeyFIT 33 39 49 Vitality and KeyFIT 165 195 229 Discovery Health offers a range of options to meet the individual needs of our members For detailed information visit www.discovery.co.za
Discovery Health Medical Scheme 16 Fredman Drive Sandton 0860 99 88 77 www.discovery.co.za Discovery Health Medical Scheme, registration number 1125, is administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. GM_17407DHM_29/10/2012