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Discovery Health 2017 – Part 19

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In part thirteen we did a broad overview of the Saver range. This year Discovery Health gave birth to their Classic Smart plan.

Obviously they’re onto something big here, and have decided to extend the range. From 2017 you will have two Smart plan options – Classic Smart and Essential Smart.

A bit of background first

In 2016 Discovery Health launched a brand new option known as the Classic Smart plan. Think of it as a hospital plan with benefits.
Imagine all those healthy young people needing hospital cover for “just in case”, but also wanting to see a doctor (GP) “just in case”.
Even better is that this comes at the same cost as a straight hospital plan

In 2017 they’re taking this further by introducing the Essential Smart plan. Those of you already on the Classic Smart plan might also want to consider this option.

So what kind of price increase can you look forward to in 2017 on Smart plans?

A 9, 9% increase folks.

So where do Smart plans differ from the other plans?

For those on chronic medication

Chronic medication is offered for all 27 diseases appearing on the prescribed minimum benefits list (PMB’s). These medicines must be on the Discovery Health list, and you must obtain them at:

  • MedXpress (A Discovery Health courier service for which you need to register)
  • Clicks
  • Dischem

There is no above threshold benefit and no savings at all

Someone asked me whether they could visit a specialist on this plan.
Let’s be clear on this…the Smart plan is basically a hospital plan. It’s not there to pay for spectacles, specialist visits, and dental work (unless the dental surgery is done in hospital). If you need all the bells and whistles, then this ain’t for you.

The oncology benefit

You would need to register for the Discovery Health Chronic Disease Benefit. This cover would not be as extensive as their more comprehensive plans.

Scopes

As you drop lower and lower in the plans, the amount payable from your MSA increases. In the case of the Smart plan range, the amount is R3, 900 for 2017, and since you have no MSA, it goes without saying that it comes out of your pocket.

MRI and CT scans

The good news is that these are paid from the hospital benefit in full IF related to an approved admission.
If not related to your admission, or because of conservative back and neck treatment, it works as follows:

  • On the Classic Smart plan R2, 900 is paid from your MSA with the balance coming from your hospital benefit.
  • On the Essential Smart plan it’s not covered at all. You pay for the full scan.

What’s the big difference between Classic and Essential?

  • The Classic Smart plan offers 200% of the DHR for treatment in hospital by surgeons. The Essential Smart plan only offers 100% of the DHR for the same thing.
  • On both plans you must use a Smart plan networked hospital. Using any other hospital will mean an upfront payment of R8, 200 to the hospital in question. Doctors who have a payment arrangement with Discovery Health are paid in full

So why would anyone want to select the Smart plan?

It’s all to do with the fact that you can see a GP whenever you need to after paying a small co-payment.
How does paying R50 to see a Smart plan doctor sound? Compare that to someone else wanting to see a doctor.
How much would you expect to pay in 2017? R400 for a consultation?

Of course there’s a catch.
You need to consult one of the doctors in the Smart plan network. So if loyalty to the family GP is important; this plan ain’t for you.
What you do is download the Discovery app onto your smartphone. Whenever you need to see a doctor, you do a search for one on the app. Once you find one close to you, you book an appointment on the app. Bob’s your uncle! And you don’t need to see him or her for a follow up appointment since you can do a video call.

But you also get more than just seeing a GP whenever you need to. Depending on the Smart plan you choose, you get:

  • One eye test
  • One dental check-up
  • Prescription medicines from the Smart plan medicine list (The categories are defined, so be careful with your expectations around brand name medicines)
  • Cover for sports related injuries which include things like x-rays, specialist visits, and physiotherapy.

The hospital benefit includes the following:

  • Cochlear implants – R207, 000 per person
  • Internal nerve stimulators – R142, 200 per person
  • Shoulder joint prosthesis – no limit if you use their supplier. If you use your own supplier then this is limited to R40, 000 per prosthesis.
  • Major joints surgery – Paid in full if you use their supplier or at 80% if you use your own supplier
  • Alcohol and drug rehab – 21 days per person
  • Prosthetic devices used in spinal surgery – no limit if you use their provider. If not, then Discovery will cover R25, 500 for the first level and R51. 000 for two or more levels. This is limited to one procedure per person
  • Mental health – 21 days admission or 15 out of hospital consultations per person for things like bulimia and anorexia. Anything stress related is limited to 12 out of hospital consultations.
  • Chronic dialysis – Paid in full if approved and where their provider is used. If you go anywhere else then Discovery will only pay 80% of the DHR.

If this all seems confusing, so if you only want to read the pillar articles relating to Discovery Health 2017, then click on the links below:

If you’d like to drill down in more detail, here are the links to each and every plan:

Do you need assistance with your medical aid? Leave your details below.

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Until next time.

The InsuranceFundi Team

If you would like further information, submit your details below & we will contact you.