Not quite able to afford the Classic Comprehensive options but still wanting all the ‘extras’? Keep reading.
In the previous article we discussed the Classic Comprehensive Zero MSA Plan. It’s now time to get to the Essential Comprehensive plan, and then its baby brother – the Essential Delta Comprehensive plan.
This plan differs in two ways from the Classic Comprehensive plan:
- It’s much cheaper which is a good thing
- It has a smaller medical savings account which means a larger self-payment gap. Now that’s definitely not a good thing.
- It only offers 100% of the Discovery Health Rate (DHR) for treatment by medical professionals while in hospital compared to the 200% on the Classic options.
The good and the bad…
The 100% of DHR would concern me. If you’re going this route I’d suggest taking out medical gap cover for the potential shortfall.
The second concern is the large self-payment gap.
The annual above threshold benefit is set at exactly the same as the classic plans – R16, 790.
Here’s where the problem comes in…
Because the amount going to your medical savings account (MSA) is only 15% of your risk contribution, it means you’re not getting as much savings as with the classic options. You’ll see this below.
Let’s start off with the cost
- Main member – R4, 102 monthly
- Adult dependants – R3, 881 per dependant
- Children – R825 per child (A maximum of three children are charged for)
This gives us the following MSA for the year:
- Main member – R7, 380
- Adult dependants – R6, 984 per dependant
- Children – R1, 476 per child (A maximum of three children are used in this calculation)
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||Essential Comprehensive||Difference|
|Main member||R4, 882||R4, 102||R780|
|MSA||R14, 640||R7, 380||R7, 260|
|Annual Threshold||R16, 790||R16, 790||R0|
|Self-payment gap||R2, 150||R9, 410||R7, 260|
Spending R4, 102 a month for medical aid and then having a R9, 410 self-payment gap would leave a slightly bitter taste in my mouth.
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 could end up with a R12, 000 gap. This defeats the purpose of having an above threshold benefit.
And remember to send all your medical invoices to Discovery Health while in the self-payment gap.
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
- The Classic Comprehensive Zero MSA plan
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Until next time.
The InsuranceFundi Team