If you’re going to be on the Priority plans – this is the one you need
Previously we gave you the 1, 000 foot view of the Priority range.
There were three major issues:
- The biggest issue by far was the number of co-payments on this range.
- 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 final two plans offering the above threshold benefit.
So let’s take a look at the Classic Priority plan in more detail.
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 safer bet than 100%. (200% is not enough either).
The hospital bill itself gets paid at 100% of the DHR and hospital coverage is unlimited.
Unlimited means your in hospital costs for the year have no ceiling.
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
- Higher cost
Let’s start off with the cost:
- Main member – R3, 214 monthly
- Adult dependants – R2, 534 per adult
- Children – R1, 286 per child (A maximum of three children are charged for)
This gives us the following MSA for the year:
- Main member – R9, 636
- Adult dependants – R7, 596 per adult
- Children – R3, 852 per child (A maximum of three children are used in this calculation)
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 they’ll want half of it back.
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 having run out of MSA.
- Main member – R14, 240
- Adult dependants – R10, 670 per adult
- Children – R4, 660 per child (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 limited. Once you reach this limit you will once again have to pay your own bills. 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 – R12, 080
- Adult dependants – R8, 610 per adult
- Children – R4, 170 per child (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 – R9, 636
- Main member above threshold benefit – R14, 240
- The difference between the two is your self-payment gap – R4, 604
- The amount available once you’re above threshold – R12, 080
Here’s how it compares to Essential Delta Comprehensive:
|Essential Delta Comprehensive||Classic Priority||Difference|
|Main member cost||R3, 694||R3, 214||R480|
|MSA||R6, 648||R9, 636||R2, 988|
|Annual Threshold||R16, 790||R14, 240||R2, 550|
|Self-payment gap||R10, 142||R4, 604||R5, 538|
|Above Threshold Benefit||Unlimited||R12, 080|
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
- And the range of co-payments applicable to the Priority range, or
- The limited above threshold benefit
Your potential self-payment gap could be much bigger:
- Schedule 0-2 medicines (over-the-counter medications) 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 (Brand name medicines) 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 (generic medicines) 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 overspend on spectacles and dentistry. For instance, on the Priority range your annual limit for spectacles is R4, 550 per person. You purchase a pair for R5, 000 thereby adding R450 to your self-payment gap.
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.
If you missed some of our previous Discovery Health 2018 articles click on the links below:
- Choosing you plan
- Is KeyCare the right match for you
- The Executive plan
- The Comprehensive series
- The Priority series