1. Healthcare

PLAN RANGE SUMMARY
2015 CONTRIBUTIONS
Series
EXECUTIVE
COMPREHENSIVE
PRIORITY
SAVER
CORE
KEYCARE **
Plan
Contributions to Medical
Savings Account
Contributions
Total contributions
Main
member
Adult
Child*
Main
member
Adult
Child*
Main
member
Adult
Child*
Executive
3 410
3 410
648
1 137
1 137
215
4 547
4 547
863
Classic Comprehensive
2 772
2 622
553
924
874
184
3 696
3 496
737
Classic Delta Comprehensive
2 497
2 362
497
832
787
165
3 329
3 149
662
Classic Comprehensive Zero MSA
2 772
2 622
553
No Medical Savings Account
2 772
2 622
553
Essential Comprehensive
2 640
2 496
532
465
440
93
3 105
2 936
625
Essential Delta Comprehensive
2 377
2 246
477
419
396
84
2 796
2 642
561
Classic Priority
1 859
1 463
744
619
487
248
2 478
1 950
992
Essential Priority
1 811
1 422
723
319
250
127
2 130
1 672
850
Classic Saver
1 629
1 283
652
543
427
217
2 172
1 710
869
Classic Delta Saver
1 301
1 026
523
433
342
174
1 734
1 368
697
Essential Saver
1 467
1 100
587
258
194
103
1 725
1 294
690
Essential Delta Saver
1 172
881
470
206
155
82
1 378
1 036
552
Coastal Saver
1 283
962
516
427
320
172
1 710
1 282
688
Classic Core
1 617
1 272
646
1 617
1 272
646
Classic Delta Core
1 294
1 018
517
1 294
1 018
517
Essential Core
1 389
1 040
557
1 389
1 040
557
Essential Delta Core
1 110
833
445
1 110
833
445
Coastal Core
1 195
896
477
1 195
896
477
KeyCare Plus (10 001+)
1 592
1 592
426
1 592
1 592
426
KeyCare Plus (7 051 – 10 000)
1 069
1 069
300
1 069
1069
300
KeyCare Plus (361 – 7 050)
764
764
276
764
764
276
KeyCare Plus (0 – 360)
330
330
330
330
330
330
KeyCare Access (10 001+)
1 556
1 556
420
1 556
1 556
420
KeyCare Access (7 051 – 10 000)
1 036
1 036
292
1 036
1 036
292
KeyCare Access (4 401 – 7 050)
718
718
258
718
718
258
KeyCare Access (0 – 4 400)
538
538
235
538
538
235
KeyCare Core (10 001+)
No Medical Savings Account
No Medical Savings Account
1 176
1 176
265
1 176
1 176
265
KeyCare Core (7 051 – 10 000)
762
762
187
762
762
187
KeyCare Core (0 – 7 050)
611
611
158
611
611
158
*W
e count a maximum of three children when we work out the monthly contribution, Annual Medical Savings Account, Annual Threshold and Above Threshold Benefit Limit
** Income verification will be conducted for the lower income bands. Income is defined as: earnings, commission and rewards from employment; interest from investments; income from leasing of assets/property; distributions received
from a trust, pension and/or provident fund; and financial assistance from any social assistance programme.
Annual Thresholds
Executive Plan and
Comprehensive Series
Vitality and KeyFIT contributions
Member
Adult
dependant
Child
dependant *
Executive Plan
13 640
13 640
2 550
Comprehensive Series
12 590
12 590
2 380
Member
Adult
dependant
Child
dependant *
Annual Threshold
10 980
8 250
3 590
Above Threshold
Benefit limit
9 340
6 650
3 210
Priority Series
Vitality
KeyFIT
Vitality and
KeyFIT
Member
185
40
199
Member +1
219
49
239
Member +2
249
60
275
Vitality is not a 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.
* We count a maximum of three children when we work out the Annual Threshold and Above Threshold
Benefit limit.
If members join the medical scheme after January, they won’t get the full amount because it is calculated
by counting the remaining months in the year.
GM_28813DHM_02/10/2014_V3
DISCOVERY HEALTH
MEDICAL SCHEME
PLAN RANGE SUMMARY
EXECUTIVE PLAN
COMPREHENSIVE SERIES
• U
nlimited 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
PRIORITY SERIES
CLASSIC | ESSENTIAL | DELTA
CLASSIC | ESSENTIAL
• 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
PRODUCT PLATFORM
THE GUARANTEE OF FULL COVER
THE DISCOVERY HEALTH MEDICAL SCHEME OFFERS A RANGE OF OPTIONS TO CATER FOR EVERY NEED –
FROM THE EXECUTIVE PLAN TO THE KEYCARE SERIES. EACH PLAN’S COVER RANGES FROM HOSPITALISATION
TO CHRONIC MEDICINE, WITH MANY PLANS OFFERING DAY-TO-DAY COVER AS WELL.
OUR EXTENSIVE NETWORKS OF HEALTHCARE PROVIDERS, COMBINED WITH OUR UNIQUE SELF-SERVICE TOOLS
MEAN MEMBERS CAN ALWAYS AVOID CO-PAYMENTS. THESE TIPS WILL GUIDE MEMBERS TO FULL COVER.
There is no overall limit for hospital cover on any Discovery
Health Medical Scheme plan. Members can go to any private
hospital on most plans. The Delta, Coastal and KeyCare
Plans offer hospital cover in a defined network of hospitals.
If members use a specialist who we have a payment
arrangement with, we cover them in full for their approved
procedure in hospital.
CHRONIC ILLNESS COVER
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 members are 65 years or older or are registered for
certain chronic conditions, we also cover a seasonal flu vaccine.
We pay members’ day-to-day medical expenses from
the Medical Savings Account on Executive, Comprehensive,
Priority and Saver Plans. Any unused funds are carried over
to the next year – unlike traditional plans where unused
cover is lost.
THE INSURED NETWORK BENEFIT EXTENDS
MEMBERS’ DAY-TO-DAY COVER FOR
ESSENTIAL HEALTHCARE SERVICES
1
All Discovery Health Medical Scheme plans offer
a comprehensive list of medicine which we cover
in full. The Executive Plan offers additional cover
for an exclusive list of brand medicines. Under
the Insured Network Benefit, we cover preferred
medicine once members have spent the annual
funds in their Medical Savings Account. Members
can use Discovery MedXpress or express collections
or ask a pharmacist to find the best alternative
medicine to avoid a co-payment.
The Executive, Comprehensive and Priority Plans include an
Above Threshold Benefit that gives further day-to-day cover
once members’ claims add up to a set amount (their Annual
Threshold). On the Executive and Comprehensive Plans, the
Above Threshold Benefit is unlimited. On the Priority Plans, the
Above Threshold Benefit has an overall limit.
Discovery Vitality offers the world’s leading science-based programme with a personalised approach to wellness
USE OUR EXTENSIVE
HOSPITAL NETWORKS
Members are covered in full when they use
a network hospital on plans that offer a defined
network of hospitals. Members can use our online
MaPS tool to find a hospital in our network.
Hospital
We extend members’ day-to-day cover through the Insured
Network Benefit. When members have spent their annual
Medical Savings Account allocation and before claims add
up to the Annual Threshold, we cover services such as GP
consultation fees, blood tests, day-to-day cost-effective
medicine, maternity costs and durable external medical
items from a provider in our network. Cover depends on
the health plan members choose.
THE ABOVE THRESHOLD BENEFIT FURTHER
EXTENDS YOUR DAY-TO-DAY COVER
2
USE OUR PREFERRED MEDICINE
3
Day-to-day
All Discovery Health Medical Scheme
plans cover approved medicine for the
Prescribed Minimum Benefit conditions.
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
Executive and Comprehensive Plans offer cover
for additional conditions. On the Executive Plan
members also have exclusive access to a defined
list of brand medicines which we cover in full.
YOUR
HOSPITAL
MEDICAL
COVERSAVINGS ACCOUNT
onic cover
Chr
HOSPITAL COVER
4
Doctor
USE A GP OR SPECIALIST
WHO WE HAVE A PAYMENT
ARRANGEMENT WITH
USE A NETWORK PROVIDER
TO ACCESS THE INSURED
NETWORK BENEFIT
Our plans with a Medical Savings Account empowers
members to make informed decisions on how to
spend their day-to-day healthcare expenses. Once
members have spent their annual Medical Savings
Account allocation and before their claims add up
to the Annual Threshold, we extend their day-today cover through the Insured Network Benefit.
Members have cover for unlimited GP consultation
fees, blood tests, preferred day-to-day medicine,
maternity costs and certain durable external medical
items. Cover for these healthcare services depends
on the health plan you choose. Use our MaPS tool
to find a network provider.
We offer the broadest range of GP and specialist
payment arrangements, which provide full cover
both in and out of hospital. Over 90% of our
member interactions are with a GP or specialist in
our payment arrangements. Members can use our
MaPS tool to find a healthcare professional who
we have an arrangement with.
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.
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.
SAVER SERIES
CLASSIC | ESSENTIAL | DELTA | COASTAL
• 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
CORE SERIES
CLASSIC | ESSENTIAL | DELTA | COASTAL
• 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
KEYCARE SERIES
PLUS | ACCESS | CORE
• 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
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. It also summarises other Discovery products and value-added services. For compliance questions, email [email protected]. 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 Discovery Vitality (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider.