When someone tells us they’re on the “Classic” plan usually they’re talking about this one…
In part four of this series we looked at what exactly the Comprehensive range offers in terms of benefits.
What gets confusing is the five slices that make up the Comprehensive cake:
- Classic Comprehensive
- Classic Delta Comprehensive
- Classic Comprehensive Zero MSA
- Essential Comprehensive, and
- Essential Delta Comprehensive
Think of the Classic Comprehensive as the biggest slice and the Essential Delta Comprehensive as the smallest slice. Or how about slices one, two, and four as the fattest slices. Fortunately you get the chance to grab a different slice every year.
So let’s grab the first of the three Classic slices before everyone else jumps in.
The difference between the Classic Comprehensive Plans
I think we’ve mentioned this before that the Classic plans all pay 200% of the Discovery Health Rate (DHR) when it comes to ‘in hospital’ treatment by medical professionals. So the surgeon who operates on you; the anaesthetist who puts you to sleep; all get paid at 200% of the DHR. Which is good because they often charge way more than 100% of the DHR!
The hospital bill itself gets paid at 100% of the DHR and hospital coverage is unlimited. What does unlimited mean? Unlimited means you can book into hospital as often as you need to for any illness.
The Classic Comprehensive Plan
This plan is the most expensive of all the Comprehensive options.
It offers the largest Medical Savings Account (MSA) of the range.
Let’s start off with the cost:
- Main member – R4, 882 monthly
- Adult dependants – R4. 618 per adult on your plan
- Children – R974 per child on your plan (A maximum of three children are charged for)
This gives us the following MSA for the year:
- Main member – R14, 640
- Adult dependants – R13, 848 per dependant
- Children – R2, 916 per child (A maximum of three children are used in this calculation)
Word of warning:
Think of it as 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 it all up – then you’ll have the privilege of paying back half of the MSA allocated to you.
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 again. That’s of course, after having run out of MSA.
- Main member – R16, 790
- Adult dependants – R16, 790 per dependant (notice that with the MSA being less for adult dependants than for the main member, it creates a larger self-payment gap – R16, 790 minus R13, 848)
- Children – R3, 200 per child (A maximum of three children are used in this calculation)
And here’s how the self-payment gap works for the main member:
- Main member MSA for the year – R14, 640
- Main member above threshold benefit – R16, 790
- The difference between the two is your self-payment gap – R2, 150
Here’s how Classic Comprehensive compares to Executive:
|Main member||R5, 950||R4, 882||R1, 068|
|MSA||R17, 844||R14, 640||R3, 204|
|Annual Threshold||R20, 350||R16, 790||R3, 560|
|Self-payment gap||R2, 506||R2, 150||R356|
But your potential self-payment gap could be much bigger for these reasons:
- Over-the-counter medicines (Schedule 0 to 2 drugs) obtained via prescription or any means, are added to the self-payment gap even if paid from available MSA
- Brand name medicines are referred to as non-preferred medicines and are only included at 75% of the DHR. The remaining 25% of the DHR is added onto your self-payment gap.
- Preferred medicines, in other words generic medicines, are paid in full and don’t contribute to the self-payment gap.
- You overspend on spectacles and dentistry. For instance, your annual limit for spectacles is R5, 000 per person. You purchase a pair for R7, 000 thereby increasing your self-payment gap by R2, 000.
- The pharmacy filling your prescription might charge more than the DHR meaning that the difference is added to your self-payment gap.
Can you see how horribly wrong this can go?
You’re expecting to pay a self-payment gap of R2, 150 and instead wind up with a R3, 000 gap or larger.
And don’t forget to keep sending your medical bills to Discovery Health while in self-payment gap – how else will they know whether the gap is closing?