Discovery Health is the biggest medical aid scheme in South Africa?

Published: 10th December 2009
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Discovery Health is the biggest medical aid scheme in South Africa and tends to dominate the South Afican Medical Aid industry. Discovery Health are an extremely innovative company and introduced a number of new concepts to the industry, including introducing the new generation savings plan schemes.



All benefits are pro-rated depending on when in the year one joins the scheme.



* A member has the option of downgrading their option at any time but may only upgrade without medical underwriting once per year effective from the 1st of January the following year.



Discovery Coastal Core and Classic Core



These are their Hospital plans. Both have unlimited Hospital benefits but cover claims at different rates;



* Coastal at NHRPL (National Health Reference Price List)

* Classic at 2X NHRPL.



The Hospital bill would be paid in full because of tariff agreements they have with the Hospital groups. To have the Surgeon and Anaesthetist bill fully covered, the member would have to use a practitioner who is contracted to charge the DHR (Discovery Health Rate) or buy a gap product that will pay the difference.



They both have the same Chronic Medication benefit as well as Emergency Evacuation



Discovery Coastal Saver and Classic Saver



Both of these plans have unlimited Hospital benefits but cover claims at different rates. The Hospital bill would be paid in full because of tariff agreements they have with the Hospital groups.



To have the Surgeon and Anaesthetist bill fully covered, the member would have to use a practitioner who is contracted to charge the DHR (Discovery Health Rate) or buy a gap product that will pay the difference. All day-to-day claims e.g. doctor's consultations, medicines, etc, are paid from a savings account.



The add-on benefit of the savings account is a 50% payment towards GP consultations paid by the medical aid if they are contracted in to Discovery, so only 50% would be paid from the savings. Any portion of the savings not used would be carried forward to the following year. They both have the same Chronic Medication benefit as well as Emergency Evacuation i.e. Ambulance and Helicopter, etc.



Discovery Classic Comprehensive



This plan has unlimited Hospital benefits paid at 2X NHRPL (National Health Reference Price List) rate.



The Hospital bill would be paid in full because of tariff agreements they have with the Hospital groups. To have the Surgeon and Anaesthetist bill fully covered, the member would have to use a practitioner who is contracted to charge the DHR (Discovery Health Rate) or buy a gap product that will pay the difference.



Claims submitted to the medical aid would first be paid out of savings until that is exhausted and then from the Threshold benefit. The add-on benefit of the savings account is a 50% payment towards GP consultations paid by the medical aid if they are contracted in to Discovery, so only 50% would be paid from the savings. Any portion of the savings not used would be carried forward to the following year.



There is a small gap between the savings limit and the Threshold benefit kicking in, called the self-payment gap, during which expenses must be paid by the member but the bills must still be submitted to the medical aid. Once all your accumulated day-to-day expenses (irrespective of who pays them) reach the Threshold Excess, it will pay all day-to-day expenses until the end of the year, subject to sub-limits. This plan also has an extended Chronic Medication benefit.



Discovery KeyCare Core



Discovery is the biggest medical aid in South Africa and dominates the medical aid environment. This is an inexpensive hospital plan, it has unlimited hospital cover paid at 100% NHRPL but is only available from a limited list of private hospitals. It has a Chronic Medication Benefit as well as Emergency Evacuation i.e. Ambulance and Helicopter, etc.



Discovery KeyCare Plus



Discovery is the biggest medical aid in South Africa and dominates the medical aid environment. This is an inexpensive hospital plan, it has unlimited hospital cover paid at 100% NHRPL but is only available from a limited list of private hospitals.



This is a network option, which means that you get unlimited primary care doctor's consultations, medicines and basic dentistry is unlimited from a network of practitioners. It has a Chronic Medication Benefit as well as Emergency Evacuation i.e. Ambulance and Helicopter, etc. Optional Additional Benefits



Vitality



This is Discovery's Wellness Program and one of their innovations. It's designed to encourage people to live a healthier, more active lifestyle because healthy people claim less, but it doesn't form part of the medical aid. Contrary to common belief, Vitality is a separate entity that the member may choose to join at a cost.



It offers discounts on a whole range of products and services based on your Vitality status, which ranges from blue to bronze to silver to gold. Your status would improve depending on how many points you accumulate through their various avenues e.g. lifestyle questionnaires, keeping member records current, having check-ups, being a non-smoker and reaching or maintaining your goal weight.



Health Plan Protector



This policy pays back your medical aid premiums (excluding savings) less claims annually into a HealthFund, a portion of which is paid back to the member each year or every 5 years (member's choice) with the full balance being paid out at the age of 65. Also, there is a 5 or 10 year medical aid premium waiver should the member die, become disabled or claim a Category A severe illness. For more information, read the Health Plan Protector document (.pdf format)



Discovery Life Members of Discovery Health and Vitality can get as much as 32.5% discount off any Discovery Life policy. For more information, read the Why Discovery Life document (.pdf format). Top-Up Cover



This is an independent product that can be used to increase your hospital cover limits to R2,000,000. Gap Cover This independent cover will pay the additional amount charged by the surgeon and anaesthetist above the NHRPL rate up to a maximum of 3 X NHRPL rate. Learn more about GAP cover.

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