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Executve

Plan
Comprehensive
Series
Priority
Series
Saver
Series
Core
Series
KeyCare
Series
Executve
Classic Comprehensive
Classic Delta Comprehensive
Classic Comprehensive Zero MSA
Essental Comprehensive
Essental Delta Comprehensive
Classic Priority
Essental Priority
Classic Saver
Classic Delta Saver
Essental Saver
Essental Delta Saver
Coastal Saver
Classic Core
Classic Delta Core
Essental Core
Essental Delta Core
Coastal Core
KeyCare Plus
KeyCare Access
KeyCare Core
This brochure is intended for intermediary use. It is only a summary of the key benefts and features of the Discovery Health Medical Scheme plans, awaitng formal approval
from the Council for Medical Schemes. Full details can be found in the Discovery Health Medical Scheme Rules on www.discovery.co.za/portal/rules. It also summarises other
Discovery products and value-added services. For compliance questons, email compliance@discovery.co.za. Discovery Health Medical Scheme, registraton number 1125, is
administered by Discovery Health (Pty) Ltd, registraton number 1997/013480/07, an authorised fnancial services provider. Vitality is not part of the Discovery Health Medical
Scheme. Vitality is a separate product sold and administered by Vitality Healthstyle (Pty) Ltd, registraton number 1999/007736/07, an authorised fnancial services provider.
Screening and preventon
KeyFIT
Day-to-day medical care
Chronic Illness Beneft
Planned
hospital care
Critcal
hospital care
20
13
Plan Comparison
SUMMARY
EXECUTIVE
COMPREHENSIVE
CLASSIC ZERO MSA CLASSIC ESSENTIAL
THE MOST EXTENSIVE COVER FOR IN-HOSPITAL AND DAY-TO-DAY BENEFITS COMPREHENSIVE COVER FOR IN-HOSPITAL AND DAY-TO-DAY BENEFITS
Unlimited private hospital cover and private ward cover
Highest Medical Savings Account and an unlimited Above Threshold Beneft, which covers both in- and
out-of-hospital claims
Full cover for an exclusive list of chronic medicine
Cover for medical emergencies when travelling in and outside South Africa
Unlimited private hospital cover
A choice of a high or no Medical Savings Account and an unlimited Above Threshold Beneft
Comprehensive cover for chronic medicine
Cover for medical emergencies when travelling in and outside South Africa
HOSPITAL COVER
Hospitals
Unlimited cover at any private hospital and
private ward cover of up to R1 300 each day
Unlimited cover at any
private hospital
Unlimited cover
Full cover on Delta when using the Delta Hospital Network
of private hospitals
Upfront
payments
to hospitals
No upfront payments
For planned admissions outside of the Delta Hospital Network,
an upfront payment of R5 000 must be paid to the hospital
Specialists
we have an
agreement with
Cover is subject to funds in Medical Savings Account or Above Threshold Beneft Full Cover
Specialists we
do not have an
agreement with
300% 200% 100%
Other
healthcare
professionals 100%
200% 100%
Radiology and
pathology
100%
MRI and CT
scans
If done as part of an approved admission, we pay the hospital account from your Hospital
Beneft and all related accounts from the Medical Savings account or Above Threshhold beneft
If done as part of an approved admission, we will pay up to 100% of the Discovery Health Rate
from the Hospital Beneft
Scans not related to your admission will be paid from your day-to-day benefts at 100% of the
Discovery Health Rate
Covered once you reach
your Annual Threshold
If not related to your admission or if for conservatve back or neck
treatment, we pay the frst R2 450 of the scan from your
day-to-day benefts. We pay the balance of the scan from your
Hospital Beneft, up to 100% of the Discovery Health Rate
CHRONIC ILLNESS BENEFIT
Conditons You have cover for conditons according to the Prescribed Minimum Benefts list and on our Additonal Disease List. Your conditon needs to be approved in order to be covered
Medicine cover
Full cover for approved medicine on Discovery Healths most extensive medicine list. If you choose
to use medicine that is not on our list, you have a set monthly amount available that is higher than
that of our other plans.
Full cover for an exclusive list of medicines only available on this plan.
Full cover for approved medicine on Discovery Healths medicine list. If you choose to use
medicine not on our list,
we will pay it up to a set monthly amount.
ONCOLOGY
Beneft Covers frst R400 000 of approved cancer treatment in full over a 12-month cycle
Co-payments You will be required to pay 20% of the cost on all further treatment once costs for cancer treatment go over R400 000
Healthcare
professionals
Paid up to 100% of the Discovery Health Rate
DAY-TO-DAY BENEFITS
Medical Savings
Account
Covers day-to-day medical expenses like GP visits, radiology and pathology at the rate the
healthcare professional charges
This plan does not ofer
this beneft
Pays for day-to-day medical expenses like GP visits, radiology and
pathology as long as you have money available
Self-payment
gap
If you run out of money in your Medical Savings Account before your claims add up to the
Annual Threshold, you will have to pay for your medical expenses
You pay all day-to-day
medical expenses untl
you reach your Annual
Threshold
If you run out of money in your Medical Savings Account before
your claims add up to the Annual Threshold, you will have to pay
for your day-to-day medical expenses
Insured Network
Beneft
Pays for certain day-to-day benefts afer you have run out of money in your Medical Savings Account and before you reach the Annual Threshold
GP consultatons, day-to-day generic medicines (above schedule 3) and blood tests will be
covered if you use a provider in our network
This plan does not ofer
this beneft
GP consultatons, day-to-day generic medicines
(above schedule 3)* and blood tests* will be covered if you use a
provider in our network
*On Classic and Classic Delta only
Above Threshold
Beneft
The Above Threshold Beneft is unlimited
MRI and CT
scans
Paid from your available Medical Savings Account or Above Threshold Beneft
Covered once you reach
your Annual Threshold
We pay the frst R2 450 of your MRI or CT scan from your day-to-day
benefts. We cover the balance of the scan from your Hospital Beneft,
up to the Discovery Health Rate (except for conservatve back and neck
scans, where specifc rules apply).
ADDITIONAL BENEFITS
Screening and
Preventon
Beneft
Covers certain tests at a Discovery Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate
screening test) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditons are also covered for a seasonal fu vaccine.
Trauma
Recovery
Extender Beneft
Out-of-hospital claims for recovery afer certain traumatc events are covered on this beneft for the rest of
the year in which the trauma took place, and a year afer the trauma
This plan does not ofer
this beneft
Out-of-hospital claims for recovery afer certain traumatc events
are covered on this beneft for the rest of the year in which the
trauma took place, and a year afer the trauma
Specialised
Medicine and
Technology
Beneft
Cover up to R200 000 for each person for a defned list of the latest and most advanced treatments
Overseas
Treatment
Beneft
Up to R500 000 for each person if they travel to seek evidence-based healthcare treatment not available in South Africa.
A co-payment of 20% and specifc rules apply to this beneft.
Allied,
Therapeutc
and Psychology
Extender Beneft
Provides unlimited cover for a list of allied healthcare services, like physiotherapy. This unlimited cover is for a defned list of conditons,
for example quadriplegia and cerebral palsy. Cover depends on your conditon and the criteria for it.
SUMMARY
PRIORITY SAVER
CLASSIC ESSENTIAL CLASSIC ESSENTIAL COASTAL
COST-EFFECTIVE IN-HOSPITAL AND DAY-TO-DAY BENEFITS ECONOMICAL IN-HOSPITAL AND DAY-TO-DAY BENEFITS
Unlimited private hospital cover
Essental cover for chronic medicine
A Medical Savings Account and a limited Above Threshold Beneft
Cover for medical emergencies when travelling in and outside South Africa
Unlimited private hospital cover
Essental cover for chronic medicine
A Medical Savings Account
Cover for medical emergencies when travelling in and outside South Africa
HOSPITAL COVER
Hospitals Unlimited cover at any private hospital
Unlimited cover at any private hospital
Unlimited cover at any coastal
private hospitals
Full cover on Delta when using
Delta Hospital Network of private hospitals
Upfront
payments
to hospitals
An upfront payment of between R1 950 and R9 500 must be paid to the hospital when you are
admited for a defned list of procedures
For planned admissions at hospitals outside of the Delta Hospital
Network, an upfront payment of R5 000 must be paid to the hospital
If a coastal hospital is not used,
a payment of up to 70% of the
hospital account is paid and you
must pay the diference
Specialists
we have an
agreement with
Full cover
Specialists we
do not have an
agreement with
200% 100% 200% 100%
Other
healthcare
professionals
200% 100% 200% 100%
Radiology and
pathology
100%
MRI and CT
scans
If done as part of an approved admission, we will pay up to 100% of the Discovery Health Rate from the Hospital Beneft
If not related to your admission, we pay the frst R2 450 of the scan from your day-to-day benefts. We
pay the balance of the scan from the Hospital Beneft up to 100% of the Discovery Health Rate. If for
conservatve back and neck treatment, you have to pay the frst R1 950 of the hospital account and we
pay the frst R2 450 of the scan from your day-to-day benefts. We pay the balance of the scan from the
Hospital Beneft up to 100% of the Discovery Health Rate
If not related to your approved admission or if for conservatve back or neck treatment, we pay
the frst R2 450 of the scan from your day-to-day benefts. We pay the balance of the scan from
your Hospital Beneft, up to 100% of the Discovery Health Rate.
CHRONIC ILLNESS BENEFIT
Conditons You have cover for conditons according to the Prescribed Minimum Benefts list. Your conditon needs to be approved in order to be covered
Medicine cover Full cover for approved medicine on Discovery Healths medicine list. If you choose to use medicine not on our list, we will pay it up to a set monthly amount.
ONCOLOGY
Beneft Covers frst R200 000 of the approved cancer treatment in full over a 12-month cycle
Co-payments You will be required to pay 20% of the cost on all further treatment once costs for cancer treatment go over R200 000
Healthcare
professionals
Paid up to 100% of the Discovery Health Rate
DAY-TO-DAY BENEFITS
Medical Savings
Account
Pays for day-to-day medical expenses like GP visits, radiology and pathology as long as you have
money available
Pays for day-to-day medical expenses like GP visits, radiology and pathology as long as you have
money available
Self-payment
gap
If you run out of money in your Medical Savings Account before your claims add up to the
Annual Threshold, you will have to pay for your day-to-day medical expenses
You need to pay claims when your Medical Savings Account runs out
Insured Network
Beneft
Pays for certain day-to-day benefts afer you have run out of money in your Medical Savings
Account and before you reach the Annual Threshold
Covers GP consultatons in our network up to a limit depending on your plan type and family size
GP consultatons, on Classic and Essental.
Blood tests on Classic only. You must use a provider in our network
Above Threshold
Beneft
The Above Threshold Beneft* is limited
Main member R7 800
Adult R5 550
Child dependant R2 680
These plans do not ofer this beneft
MRI and CT
scans
We pay the frst R2 450 of the scan from your day-to-day benefts. We pay the balance of the scan
from the Hospital Beneft up to 100% of the Discovery Health Rate
We pay the frst R2 450 of MRI or CT scan from your available Medical Savings Account.
We cover the balance of the scan from your Hospital Beneft, up to the Discovery Health Rate. For conservatve
back and neck scans, specifc rules and limits may apply.
ADDITIONAL BENEFITS
Screening and
Preventon
Beneft
Covers certain tests at a Discovery Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate
screening test) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditons are also covered for a seasonal fu vaccine.
Trauma
Recovery
Extender Beneft
Out-of-hospital claims for recovery afer certain traumatc events are covered on this beneft for the rest of the year in which the trauma took place, and a year afer the trauma
Specialised
Medicine and
Technology
Beneft
These plans do not ofer
these benefts
Overseas
Treatment
Beneft
Allied,
Therapeutc
and Psychology
Extender Beneft
* If you join the medical scheme afer January, you wont get the full amount because it is calculated by countng the remaining months in the year.
SUMMARY
CORE KEYCARE
CLASSIC ESSENTIAL COASTAL CORE PLUS ACCESS
VALUE-FOR-MONEY HOSPITAL PLAN AFFORDABLE MEDICAL AID COVER
Unlimited private hospital cover
Essental cover for chronic medicine
Cover for medical emergencies when travelling in and outside South Africa
Unlimited emergency and trauma cover in our KeyCare network of hospitals and planned hospital
cover on KeyCare Core and KeyCare Plus
Essental antenatal care
Cover in our network when you need to see a specialist
Cover for medical emergencies in South Africa
HOSPITAL COVER
Hospitals
Unlimited cover at any private hospital
Unlimited cover at any coastal private
hospitals
Unlimited cover in the KeyCare Hospital Network. A list of procedures
are covered in the day surgery network.
Unlimited cover for in the
KeyCare Access Hospital and
KeyCare Hospital networks for
emergencies and trauma and
in the KeyCare Access Hospital
Network for childbirth and care
for newborns. Other conditons
are covered in contracted
network of state facilites.
Full cover on Delta when using
Delta Hospital Network of private hospitals
Upfront
payments
For planned admissions at hospitals outside of the
Delta Hospital Network, an upfront payment of
R5 000 must be paid to the hospital
If a coastal hospital is not used, a payment of
up to 70% of the hospital account is paid and
you must pay the diference
If you do not use hospitals in your plans networks,
you will have to pay all costs
Specialists
we have an
agreement with
Full cover
Specialists we
do not have an
agreement with
200% 100% 100%
Other healthcare
professionals
200% 100% 100%
Radiology and
pathology
100%
MRI and CT scans
If your MRI or CT scan is done as part of an approved hospital admission, we cover your scan up to 100% of the Discovery Health Rate from your Hospital Beneft
If not related to your admission or if for conservatve back or neck treatment,
we do not pay for it
If not related to your admission, we pay it from the Specialist Beneft up to a limit of R2 550 each
person each year.
CHRONIC ILLNESS BENEFIT
Conditons You have cover for conditons according to the Prescribed Minimum Benefts list. Your conditon needs to be approved in order to be covered.
Medicine cover
Full cover provided for approved medicine on Discovery Healths medicine list. If you choose to use
medicine not on our list, we will pay it up to a set monthly amount.
Approved medicine must be purchased from one of our network pharmacies or from your chosen GP.
If medicine is purchased elsewhere, you will have to pay a 20% co-payment. Chosen GP must prescribe
the chronic medicine.
ONCOLOGY
Beneft Covers frst R200 000 of the approved cancer treatment in full over a 12-month cycle
Cancer treatment is covered according to the Prescribed Minimum
Benefts and if you go to a cancer specialist in our network
Cancer treatment is covered
according to the Prescribed
Minimum Benefts in a network
of contracted state Facilites
Co-payments
You will have to pay 20% of the cost on all further treatment once costs for cancer treatment go over
R200 000
Paid up to 100% of the Discovery Health Rate
Healthcare
professionals
Paid up to 100% of the Discovery Health Rate
DAY-TO-DAY BENEFITS
Medical Savings
Account
These plans do not ofer these benefts
This plan does not ofer
this beneft
These plans do ofer this beneft but they cover primary care through your
chosen GP and day-to-day medicine from our medicine list. We pay for
basic radiology and pathology at a network provider.
Self-payment gap
These plans do not ofer these benefts
Insured Network
Beneft
Above Threshold
Beneft
MRI and CT scans Scans paid from the Specialist Beneft up to a limit of R2 550.
ADDITIONAL BENEFITS
Screening and
Preventon
Beneft
Covers certain tests at a Discovery Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate screening test)
and HIV screening tests. Members 65 years or older and members registered for certain chronic conditons are also covered for a seasonal fu vaccine.
Trauma Recovery
Extender Beneft
These plans does not ofer
this beneft
Out-of-hospital claims for recovery afer certain traumatc events are
covered on this beneft for the rest of the year in which the trauma took
place, and a year afer the trauma
Specialised
Medicine and
Technology
Beneft
Overseas
Treatment
Beneft
These plans do not ofer this beneft.
Allied,
Therapeutc
and Psychology
Extender Beneft
Series Plan Contributons
Contributons to Medical
Savings Account
Total contributons
Main member Adult Child* Main member Adult Child* Main member Adult Child*
Executve Executve 2 823 2 823 536 941 941 178 3 764 3 764 714
Comprehensive
Classic Comprehensive 2 315 2 189 462 771 729 154 3 086 2 918 616
Classic Delta Comprehensive 2 085 1 972 415 695 657 138 2 780 2 629 553
Classic Comprehensive Zero MSA 2 315 2 189 462 No Medical Savings Account 2 315 2 189 462
Essental Comprehensive 2 205 2 084 442 389 367 78 2 594 2 451 520
Essental Delta Comprehensive 1 985 1 876 397 350 331 70 2 335 2 207 467
Priority
Classic Priority 1 552 1 222 621 517 407 207 2 069 1 629 828
Essental Priority 1 512 1 188 604 266 209 106 1 778 1 397 710
Saver
Classic Saver 1 361 1 071 544 453 357 181 1 814 1 428 725
Classic Delta Saver 1 087 856 436 362 285 145 1 449 1 141 581
Essental Saver 1 226 917 490 216 161 86 1 442 1 078 576
Essental Delta Saver 980 735 391 172 129 69 1 152 864 460
Coastal Saver 1 071 803 431 357 267 143 1 428 1 070 574
Core
Classic Core 1 350 1 062 539
No Medical Savings Account
1 350 1 062 539
Classic Delta Core 1 081 849 432 1 081 849 432
Essental Core 1 160 869 464 1 160 869 464
Essental Delta Core 927 695 372 927 695 372
Coastal Core 998 748 398 998 748 398
KeyCare
KeyCare Plus (8 301+) 1 330 1 330 356
No Medical Savings Account
1 330 1 330 356
KeyCare Plus (6 251 8 300) 893 893 250 893 893 250
KeyCare Plus (0 6 250) 638 638 230 638 638 230
KeyCare Access (8 301+) 1 300 1 300 350 1 300 1 300 350
KeyCare Access (6 251 8 300) 865 865 245 865 865 245
KeyCare Access (3 901 6 250) 600 600 215 600 600 215
KeyCare Access (0 3 900) 450 450 195 450 450 195
KeyCare Core (8 301+) 982 982 222 982 982 222
KeyCare Core (6 251 8 300) 636 636 158 636 636 158
KeyCare Core (0 6 250) 511 511 129 511 511 129
Annual thresholds
Main
member
Adult Child*
11 280 11 280 2 125
10 375 10 375 1 950
10 375 10 375 1 950
10 375 10 375 1 950
10 375 10 375 1 950
10 375 10 375 1 950
9 170 6 890 3 000
9 170 6 890 3 000
No Annual Threshold
No Annual Threshold
No Annual Threshold
* We count a maximumof three children when we calculate family contributons, Annual Thresholds and Above Threshold Beneft limits. We pro-rate the Annual Thresholds according to when you join the medical scheme. All amounts are in rands.
Single member Member with one dependant Member with two or more dependants
Vitality 155 179 199
KeyFIT 33 39 49
Vitality and KeyFIT 165 195 229
Vitality and KeyFIT contributons
2013
Contributons
Discovery Health offers a range of options
to meet the individual needs of our members
For detailed information visit
www.discovery.co.za
GM_17407DHM_29/10/2012
Discovery Health Medical Scheme | 16 Fredman Drive | Sandton | 0860 99 88 77 | www.discovery.co.za
Discovery Health Medical Scheme, registraton number 1125, is administered by Discovery Health (Pty) Ltd,
registraton number 1997/013480/07, an authorised fnancial services provider.