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In part seven we discussed the Classic Comprehensive Zero MSA Plan. It’s now time to get to the Essential Comprehensive plan, and then its baby brother – the Essential Delta Comprehensive plan.

This plan differs in two big ways from the Classic Comprehensive plan:

1. It’s much cheaper which is a good thing
2. It has a smaller medical savings account which also means a larger self-payment gap. Now that’s definitely not a good thing.
3. It only offers 100% of the Discovery Health Rate (DHR) for treatment by medical professionals while in hospital compared to the 200% offered on the Classic options.

So here’s the good and the bad…

The 100% of DHR would concern me. If you’re going this route I’d suggest taking out medical gap cover for the potential shortfall.

The second concern is the large self-payment gap.
The annual above threshold benefit is set at exactly the same as the classic plans – R15, 500.

Here’s where the problem with this comes in…
Because the amount going to your medical savings account (MSA) is only 15% of your risk contribution, it means you’re not getting as much savings as with the classic options. And because you don’t have that much savings, you end up with a massive self-payment gap. You’ll see this below.

Let’s start off with the cost

• Main member – R3, 787 monthly
• Adult dependants – R3, 580
• Children – R762 (A maximum of three children are charged for)

This gives us the following MSA for the year:

• Main member – R6, 816
• Adult dependants – R6, 444
• Children – R1, 368 (A maximum of three children are used in this calculation)

Which brings us to the above threshold benefit

The above threshold benefit is the hurdle you need to reach before Discovery Health starts picking up the bills after having run out of MSA.

• Main member – R15, 500
• Adult dependants – R15, 500
• Children – R2, 950 (A maximum of three children are used in this calculation)

Here’s how it compares to the Classic Comprehensive plan:

Spending R3, 787 a month for medical aid and then having a R8, 684 self-payment gap would leave a slightly bitter taste in my mouth.

But your potential self-payment gap could be much bigger than this:

• Schedule 0-2 medicines are added to the self-payment gap even if paid in full from your available MSA
• Schedule 3 medicines from the non-preferred medicine list are only included at 75% of the DHR. The remaining 25% of the DHR is added onto your self-payment gap.
• Schedule 3 medicines from the preferred medicine list are paid in full at 100% of the DHR. However, if the pharmacy you decide to us charges more than 100% of the DHR, then this also gets added to the self-payment gap.
• Another thing is overspending on spectacles and dentistry. For instance, your annual limit for spectacles is R6, 700 per person. You purchase a pair for R7, 000 thereby creating a R300 gap.

You could end up with a R10, 000 gap or larger which defeats the purpose of having an above threshold benefit in the first place.

And remember to keep sending all your medical invoices to Discovery Health. How else will they know when you’ve reached the above threshold benefit unless you tell them?

Check out our other Discovery Health 2017 articles:

1. Part one – Discovery Health in a nutshell
2. Part two – Where does KeyCare fit in?
3. Part three – The Executive plan
4. Part four –  The Comprehensive range
5. Part five – The Classic Comprehensive plan
6. Part six – The Classic Delta Comprehensive plan
7. Part seven – The Classic Comprehensive Zero MSA plan

Do you need assistance with your medical aid?

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Until next time.

The InsuranceFundi Team