[banner id=”19730″]
In part ten we did a broad overview of the Priority range. Now it’s time to do the same thing for the Saver range.
Think of the Saver range as something like a comprehensive range but without the emergency parachute of the above threshold benefit.
By the way…
I’m not sure whether I’ve mentioned this before, but one advantage to all the plans offering you a medical savings account, is that you get to accumulate what’s left of the savings year after year. It’s not a case of ‘use it or lose it’ at the end of each year.
And if you’re wondering whether you can ever get your hands on your medical savings account…
No, unless you don’t intend to join another medical scheme. It either gets transferred to your new scheme or if you’re not joining another scheme, it gets paid back to you after four months.
But don’t wait out the four months if you intend to join another scheme later. After a 90 day gap of non-membership, a scheme is entitled to apply waiting periods before allowing you to claim.
So what kind of price increase can you look forward to in 2017 on the Saver range?
Four of the five plans have a 9, 9% increase while the Coastal Saver plan has a 7, 8% increase.
But don’t get too happy if you’re on Coastal Saver, there is some bad news which we’ll get to in the Coastal Saver article.
So where do Saver plans differ from the more comprehensive plans?
For those on chronic medication
Chronic medication is offered for all 27 diseases appearing on the prescribed minimum benefits list (PMB’s). Remember that the Comprehensive and Executive ranges cover additional chronic conditions.
Medicines from the approved list are paid in full. Medicines not on the approved list are paid at 100% of the DHR.
By the way, if you’re on any of the Delta options, you need to get your medicine from Discovery themselves via the MedXpress delivery service or a MedXpress network pharmacy. If you don’t, a 20% co-payment will apply.
There is no above threshold benefit.
Once you run out of available medical savings, you have to self-fund all further day-to-day medical expenses. Of course you’ll have access to the Day-to-Day Extender benefit which allows you to visit a networked GP once you’ve run out of medical savings.
On the Classic Saver range you also get antenatal consultations, kid’s casualty visits, and video call consultations with a paediatrician in the network.
The GP visits are limited though:
- Classic and Coastal – 3 visits for a single member and 6 visits for a family
- Essential – 2 visits for a single member and 4 visits for a family
The oncology benefit
I can’t stress this enough. If cancer treatment is vital in your family, then you need to be on either the Executive plan or any of the Comprehensive plans.
That’s because these plans offer up to R400, 000 of approved cancer treatment in every 12 month cycle. Anything costing more than R400, 000 in those 12 months will result in a 20% co-payment being levied.
On the Saver plan ranges the level of cover drops to R200, 000 in every 12 month cycle.
Scopes
As you drop lower and lower in the plans, the amount payable from your MSA increases. In the case of the Saver range, the amount is R3, 900 for 2017. Compare this to R3, 150 on the Comprehensive range and R3, 600 on the Priority range.
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, then R2, 900 is paid from your MSA with the balance coming from your hospital benefit.
What’s more or less the same as the more comprehensive plans?
Trauma Recovery Benefit
This pays for out of hospital claims related to trauma in the year the trauma occurred as well as the year thereafter.
Payment for medication
Medicines from the approved list are paid in full. Medicines not on the approved list are paid at 100% of the DHR.
What’s the big difference between Classic, Essential, Coastal, and Delta?
- The Classic plans offer 200% of the DHR for treatment in hospital by surgeons. The Essential and Coastal plans only offer 100% of the DHR for the same thing.
- Classic and Essential plans allow you to use a private hospital of your choice.
- Delta means you need to use a hospital in the Delta network except in the case of an emergency. Failure to use a Delta hospital means you’d need to pay the hospital R7, 100 upfront prior to admission.
- Coastal means you need to use any one of the selected private hospitals in the four coastal provinces. If you were to have a procedure done in Gauteng, for instance, then Discovery Health will only pay 70% of your bill. This doesn’t apply in an emergency.
- It’s also about the percentage going towards the Medical Savings Account (MSA). You see, to cover hospital expenses and chronic medication, Discovery Health charges a basic risk premium. But to pay for your day-to-day expenses, they offer you the MSA. On the Classic options the amount allocated to this is 25% of the risk premium. On the Essential plan this percentage reduces to 15% of the risk premium. On the Coastal range 20% is allocated for day-to-day expenses.
What about teeth?
Dentistry
All dentistry is paid from your MSA. What’s new, right?
Then there’s upfront payments for anything done while in hospital. It depends on whether you’re booked into a day clinic or hospital.
If it’s hospital:
- Children younger than 13 – R2, 050 upfront
- Anyone older than 13 – R5, 250 upfront
If it’s day clinic:
- Children younger than 13 – R930 upfront
- Anyone older than 13 – R3, 400 upfront
The balance is paid from your hospital benefit at 100% of the DHR. On Classic plans they will pay the anaesthetist at 200% of the DHR.
And spectacles, hearing aids, wheelchairs?
All paid from your available MSA, so you’re on your own here.
Part of the hospital benefit is 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.
I know 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:
- Part one – ***Discovery Health in a nutshell***
- Part two – ***Where does KeyCare fit in?***
- Part three – ***The Executive plan***
- Part four – ***The Comprehensive range***
- Part ten – ***The Priority range***
If you’d like to drill down into each plan we’ve covered so far, then click on the links below:
- Part five – The Classic Comprehensive plan
- Part six – The Classic Delta Comprehensive plan
- Part seven – The Classic Comprehensive Zero MSA plan
- Part eight – The Essential Comprehensive plan
- Part nine – The Essential Delta Comprehensive plan
- Part eleven – The Classic Priority plan
- Part Twelve – The Essential Priority plan
Do you need assistance with your medical aid? Leave your details below.
[banner id=”19730″]
Until next time.
The InsuranceFundi Team