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Discovery Health 2017 – Part 11

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In part ten of this series we gave you the big picture view of the Priority range. Today we look at the Classic Priority plan.

By the way, if you don’t have time to read each and every Discovery Health 2017 article, just read the ones with the *** in front and behind them.

The biggest issue by far is the number of co-payments on this range – more than any other plan.
Other concerns were the self-payment gap and the limited above threshold benefit.

There are only two plans to choose from on this range, and these are the last two plans offering the above threshold benefit.

So let’s take a look at the Classic Priority plan.

The Discovery Health rate

The Classic Priority plan offers 200% of the DHR for treatment by medical professionals while in hospital.
On the Priority range we only have a choice of 200% and 100%. While we don’t think 200% will cover you in full, it’s a much safer bet than 100%. (I don’t think 200% is enough either).

The hospital bill itself is paid at 100% of the DHR and hospital coverage is unlimited.

Unlimited means your in hospital costs for the year have no ceiling. A scheme with a limit of, say R500, 000, would stop paying your hospital bills once they reach that figure.

The amount going to your Medical Savings Account

25% of your contribution goes towards the medical savings account.  This has two advantages and one disadvantage:

  • A larger MSA
  • A smaller self-payment gap, and unfortunately
  • A higher cost

Let’s start off with the cost:

  • Main member – R2, 968 monthly
  • Adult dependants – R2, 337 each
  • Children – R1, 187 each (A maximum of three children are charged for. In other words, fourth child is free)

This gives us the following MSA for the year:

  • Main member – R8, 904
  • Adult dependants – R7, 008 
  • Children – R3, 552 (A maximum of three children are used in this calculation. No additional MSA for fourth child)

Word of warning:
Remember this is a line of credit. If you join halfway through the year, then you get half the amount. If you decide to leave Discovery Health halfway through the year – and in between you’ve used up all of your MSA – then you’ll have to pay back half of the MSA allocated to you.

This 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 you having run out of MSA.

  • Main member – R13, 150
  • Adult dependants – R9, 850
  • Children – R4, 300 (A maximum of three children are used in this calculation)

But here’s how the above threshold benefit on the Priority range works.

It’s a limited benefit unlike the Comprehensive range where it is unlimited. Once you reach this limit Discovery Health will no longer pay your day-to-day doctor bills (although you have access to their day-to-day extender benefit). So if you’re someone who digs deep into the above threshold benefit every year, this ain’t the plan for you.

Let’s take a look at the amounts available once you’re in the above threshold benefit:

  • Main member – R11, 150
  • Adult dependants – R7, 950
  • Children – R3, 850 (A maximum of three children are used in this calculation)

So let’s look at how the self-payment gap works for the main member:

  • Main member MSA for the year – R8, 904
  • Main member above threshold benefit – R13, 150
  • The difference between the two is your self-payment gap – R4, 246
  • The amount available once you’re above threshold – R11, 150

Here’s how it compares to Essential Delta Comprehensive:

Essential Delta ComprehensiveClassic PriorityDifference
Main member costR3, 410R2, 968R442
MSA R6, 132R8, 904(R2, 772)
Annual ThresholdR15, 500R13, 150R2, 350
Self-payment gapR9, 368R4, 300R5, 068
Above Threshold BenefitUnlimitedR11, 150 R11, 150

Clearly, if you’re not going to use much of the above threshold benefit then the Classic Priority plan makes more financial sense than the Essential Delta Comprehensive plan which is one level up.

But don’t just look at the cost:

  • Don’t forget about the oncological benefit which is only R200, 000 per annum on the Priority range
  • The range of co-payments applicable to the Priority range, or
  • The limited above threshold benefit

And your potential self-payment gap could be much bigger:

  • Schedule 0-2 medicines obtained via prescription or any means, are added to the self-payment gap even if paid from available MSA
  • Schedule 3 and above 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 and above medicines from the preferred medicine list are paid at 100% of the DHR but be careful since the pharmacy you use might charge more than the Discovery Health Rate thereby creating a self-payment gap. Use Dischem or Clicks or the Discovery MedXpress service to minimise this.
  • You might overspend on spectacles and dentistry. For instance, on the Priority range your annual limit for spectacles is R4, 200 per person. You purchase a pair for R5, 000 thereby adding R800 to your self-payment gap.

And I’m repeating this…
Remember to keep sending your medical bills to Discovery Health while in self-payment gap – how else will they know whether the gap is closing?

Next we’re going to take a look at the Essential Priority plan. After that we’re finished with self-payment gaps and above threshold benefits.

And if you’re looking for 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
  8. Part eight – The Essential Comprehensive plan
  9. Part nine – The Essential Delta Comprehensive plan
  10. Part ten***The Priority range***

Do you need assistance with your medical aid?

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Until next time.

The InsuranceFundi Team

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