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SA's No 1 Insurance Blog

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In part six we discussed the Discovery Health 2017  Classic Delta Comprehensive Plan. Today we look at the brother no-one talks about, the Classic Comprehensive Zero MSA Plan.

This plan differs in two ways from the Classic Comprehensive plan:

  1. It’s much cheaper which is a good thing
  2. It has no medical savings account which means your self-payment gap is R15, 500. Fortunately it does offer an unlimited above threshold benefit

The good and the bad…
I think it’s great for those wanting the R400, 000 oncology benefit not offered on the lower plan ranges, but at the same time, unable to afford the Classic Comprehensive Plan.

Just be aware of the co-payments which normally come out of the medical savings account on the other two plans:

  • Scopes require a R3, 150 co-payment
  • Scans not related to your admission or if connected to conservative back or neck treatment, require a co-payment of R2, 900. This won’t apply if you’ve already reached the above threshold benefit.

There are also no unlimited GP consultation fees, and things like kid’s casualty visits which form part of the day-to-day Extender benefit available on all the other Comprehensive plans. This benefit kicks in once you run out of savings and are in the self-payment gap.

There is also no Trauma Recovery Extender benefit on this plan. Check the Comprehensive range article for an explanation of this benefit.

Let’s start off with the cost

  • Main member – R3, 380 monthly
  • Adult dependants – R3, 199
  • Children – R674 (A maximum of three children are charged for)

This gives us the following MSA for the year:

It’s not called Zero MSA for nothing.

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 after having run out of MSA.

  • Main member – R15, 500
  • Adult dependants – R15, 500
  • Children – R2, 950 (A maximum of three children are used in this calculation)

Here’s how it compares to Classic Comprehensive:

Classic ComprehensiveClassic Comprehensive Zero MSADifference
Main memberR4, 506R3, 380R1, 126
MSA R13, 512R0R13, 512
Annual ThresholdR15, 500R15, 500R0
Self-payment gapR1, 988R15, 500R13, 512

I guess you’ve got to be willing to fork out the first R15, 500 of day-to-day expenses from your pocket. If you have sufficient savings for this – or the handy old credit card – then it would make sense.

What happens if you downgrade/upgrade and there’s still money in your MSA from the previous year?
After four months have elapsed, the balance owed to you would be refunded. Why four months? Just in case a few unexpected bills come through.

But also remember your potential self-payment gap could be much bigger than R3, 332:

  • Schedule 0-2 medicines 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 are only acknowledged 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 are paid at 100% of the DHR.
  • You also might overspend on spectacles and dentistry. For instance, your annual limit for spectacles is R6, 700 per person. You purchase a pair for R7, 000 thereby creating a further R300 gap for yourself.
  • Finally, the pharmacy filling your prescription might charge more than the DHR meaning that the difference gets added to your self-payment gap.

So instead of having a R15, 500 self-payment gap, you could end up with a R20, 000 gap.

And before I forget to mention this…
Send all your medical invoices to Discovery Health. How else will they know when you’ve reached the above threshold benefit unless you tell them?

Do you need assistance with your medical aid?

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Until next time.

The InsuranceFundi Team

 

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