Discovery Health 2017 – Part 6

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In part five we discussed the Discovery Health 2017 Classic Comprehensive Plan. Today we look at its little brother, the Classic Delta Comprehensive Plan.

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

  1. It’s cheaper which is a good thing, right?
  2. It has a smaller medical savings account which is bad since it creates a larger self-payment gap
  3. It makes use of a network of Delta hospitals. More about that later.

Let’s start off with the cost

  • Main member – R4, 059 monthly
  • Adult dependants – R3, 842
  • Children – R807 (A maximum of three children are charged for)

This gives us the following MSA for the year:

  • Main member – R12, 168
  • Adult dependants – R11, 520
  • Children – R2, 412 (A maximum of three children are used in this calculation)

Word of warning in case you didn’t read part five:
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 up all of your MSA – then you’ll have to pay 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 after having run out of MSA.

  • Main member – R15, 500 (Notice that it’s exactly the same gap as the Classic Comprehensive plan)
  • Adult dependants – R15, 500 (With the MSA being less for adult dependants than for the main member, it creates a larger self-payment gap)
  • Children – R2, 950 (A maximum of three children are used in this calculation)

And here’s how the self-payment gap works in real life:

  • Main member MSA for the year – R12, 168
  • Main member above threshold benefit – R15, 500
  • The difference between the two is your self-payment gap – R3, 332

Here’s how it compares to Classic Comprehensive:

Classic ComprehensiveClassic Delta ComprehensiveDifference
Main memberR4, 506R4, 059R447
MSA R13, 512R12, 168R1, 344
Annual ThresholdR15, 500R15, 500R0
Self-payment gapR1, 988R3, 332R1, 344

I guess what you could do is weigh up the cost savings of R447 a month on the Classic Delta Comprehensive plan against the difference in MSA and Self-Payment Gap, and then decide:

  • R447 x 12 months = R5, 364 for the year
  • Add R5, 364 onto the R12, 168 MSA and you get R17, 532

Bear in mind though that the full MSA is available on the 1st of January whereas the R5, 364 is only available after you have saved for the 12 months. A credit card would make a handy emergency parachute in this instance.

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

  • Over-the-counter medicines (Schedule 0-2) obtained via prescription or any means, are added to the self-payment gap even if paid from available MSA
  • Schedule 3 and above medicines on the non-preferred medicine list 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 on the preferred medicine list are paid at 100% of the DHR, but the pharmacy you choose might charge more than that. So use MedXpress, Clicks, or Dischem since they’re preferred providers (and I’m not paid by any of these companies to endorse them)
  • You overspend on spectacles and dentistry. For instance, your annual limit for spectacles is R4, 600 per person. You purchase a pair for R5, 000 thereby creating a R400 gap.

You might end up with a R5, 000 self-payment gap instead of the R3, 332 if you’re not careful. And remember to keep submitting your medical expenses to Discovery Health while in self-payment gap

Finally we get to the Delta networked hospitals:

I’m not going to publish the list here. The number of hospitals per province is as follows:

  • Gauteng – 23
  • Eastern Cape – 1
  • KwaZulu-Natal – 5
  • Western Cape – 5
  • Free State – 3

So clearly, if you live in North West, Limpopo, Mpumalanga, or Northern Cape this plan ain’t gonna work for you.

But does this mean you can’t use another private hospital?
Not at all!

Firstly, if it’s an emergency, you use the nearest private hospital – Delta rules don’t apply.
However, if it’s for a planned procedure where pre-authorisation is required, you can use a hospital of your choice BUT an upfront payment of R7, 100 is required in 2017.

The problem I’ve noticed is when the specialist you’re seeing doesn’t operate from any of the hospitals in the Delta network.

Here’s an example of how to decide:
You live in Kempton Park and choose the Delta option because Arwyp hospital – which is a Delta option – is just two blocks away. You’re:

  • happy using Arwyp
  • Your doctor has rooms in Arwyp, and
  • The R447 a month cost saving makes Rands and cents (I’d seriously consider using that to buy gap cover. By the way, Discovery has just launched gap cover)

Oh, and before I forget, just because you live in Kempton Park, doesn’t mean you have to use Arwyp. You can use any Delta hospital on the list.

In part seven we look at the Classic Comprehensive Zero MSA plan.

If you missed the previous articles:

If you’re specifically looking for articles about the Comprehensive range:

Do you need assistance with your medical aid?

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Until next time.

The InsuranceFundi Team

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