Not interested in the whole savings thing but wanting ‘extras’ such as the R400, 000 oncology benefit? Look no further.
In the previous article we discussed the 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:
- It’s much cheaper which is a good thing
- It has no medical savings account which also means no self-payment gap although it does offer an above threshold benefit. In other words, you have to cover the first R16, 790 worth of expenses before Discovery Health starts picking up the tab.
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, while being 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, 400 co-payment since you won’t have day-to-day savings available
- Scans not related to your admission require a co-payment of R2, 750. This won’t apply once you’ve 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.
Let’s start off with the cost
- Main member – R3, 662 monthly
- Adult dependants – R3, 464 per dependant
- Children – R731 per child (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 – R16, 790
- Adult dependants – R16, 790 per dependant
- Children – R3, 200 per child (A maximum of three children are used in this calculation)
Here’s how it compares to Classic Comprehensive:
|Classic Comprehensive||Classic Comprehensive Zero MSA||Difference|
|Main member||R4, 882||R3, 662||R1, 220|
|MSA||R14, 640||R0||R14, 640|
|Annual Threshold||R16, 790||R16, 790||R0|
|Self-payment gap||R2, 150||R16, 790||R14, 640|
I guess you’ve got to be willing to fork out the first R16, 790 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 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.
So instead of having a R16, 790 self-payment gap, you could end up with something closer to a R18, 000 gap.
And before I forget to mention this…
Send all your medical invoices to Discovery Health from day one. How else will they know when you’ve reached the above threshold benefit unless you tell them?
If you missed any 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 Classic Comprehensive plan
- The Classic Delta Comprehensive plan
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Until next time.
The InsuranceFundi Team