Wish you could join the Classic Comprehensive plan next year but short of cash? We have a solution.
In the previous article we discussed the 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:
- It’s cheaper which is a good thing
- It has a smaller medical savings account which is a bad thing since this creates a larger self-payment gap
- It makes use of a network of Delta hospitals which might – or might not – work for you
Let’s start off with the cost
- Main member – R4, 398 monthly (Compare that to the R4, 882 on the Classic Comprehensive plan)
- Adult dependants – R4, 162 per dependant
- Children – R874 per child (A maximum of three children are charged for)
This gives us the following MSA for the year:
- Main member – R13, 188
- Adult dependants – R12, 480 per dependant
- Children – R2, 616 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 up all of your MSA – then they’ll want half of it back.
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 (notice that with the MSA being less for adult dependants than for the main member, it creates a larger self-payment gap)
- 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 – R13, 188
- Main member above threshold benefit – R16, 790
- The difference between the two is your self-payment gap – R3, 602
Here’s how it compares to Classic Comprehensive:
|Classic Comprehensive||Classic Delta Comprehensive||Difference|
|Main member||R4, 882||R4, 398||R484|
|MSA||R14, 640||R13, 188||R1, 452|
|Annual Threshold||R16, 790||R16, 790||R0|
|Self-payment gap||R2, 150||R3, 602||R1, 452|
I guess what you could do is weigh up the cost savings of R484 a month on the Classic Delta Comprehensive plan against the difference in MSA and Self-Payment Gap, and then decide:
- R484 x 12 months = R5, 808 for the year
- Add R5, 808 onto the R13, 188 MSA and you get R18, 996
Bear in mind though that the full MSA is available on the 1st of January whereas the R5, 808 is only available after you have saved for the 12 months. A credit card would make a handy emergency parachute in this instance.
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.
You might end up with a R5, 000 self-payment gap instead of the R3, 602 you bargained on. Remember to keep submitting your medical expenses while in self-payment gap
Finally we get to the Delta networked hospitals:
I’m not going to publish the full list here. The number of hospitals is as follows:
- Gauteng – 23 (with an additional 6 exception hospitals for certain conditions)
- Eastern Cape – 1
- KwaZulu-Natal – 5 (with 2 exception hospitals for certain conditions)
- Western Cape – 7 (with 4 exception hospitals for certain conditions)
- Free State – 3
So quite clearly, if you live in North West, Limpopo, Mpumalanga, or Northern Cape this ain’t gonna work for you.
The exception hospitals are additional hospitals on the list for certain conditions. For instance in Gauteng, Sunninghill hospital is an exception when it comes to arrhythmia conditions. A Delta plan member would not be allowed to use Sunninghill for any other reason.
There are also a ton of day clinics on the Delta network:
- Gauteng – 54 day clinics
- Free State – 4 day clinics
- Mpumalanga – 1 day clinic
- Kwazulu – Natal – 13 day clinics
- Western Cape – 29 day clinics
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 non-Delta hospital of your choice BUT an upfront payment of R7, 650 must be made in 2018. The good news is that gap cover can take care of this for you.
The problem comes in 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 R484 a month cost saving makes Rands and cents (I’d seriously consider using that to buy gap cover. Even Discovery is marketing gap cover nowadays)
Of course it doesn’t mean that just because you live in Kempton Park, you have to use the ARWYP hospital. You can use any Delta hospital you wish to.
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
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Until next time.
The InsuranceFundi Team