If you’re comfortable with the large self-payment gap and using the Delta hospitals then this one’s for you.
In the previous article we discussed the Essential Comprehensive plan. Now it’s time for its baby brother – the Essential Delta Comprehensive plan. And right off the bat, Delta networked hospital options are an excellent option.
This plan differs in four ways from the Essential Comprehensive plan:
- It’s much cheaper
- It has an even smaller medical savings account which means an even bigger self-payment gap
- It also 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, and lastly,
- You have to use one of the Delta networked hospitals
The good and the bad…
Once again, 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 threshold benefit is exactly the same as the classic plans at R16, 790. However, 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. And because the risk premium on the Delta plans is even lower than the standard Essential plan, it means even less in your MSA than on the Essential plan.
Let’s start off with the cost
- Main member – R3, 694 monthly
- Adult dependants – R3, 490 per dependant
- Children – R742 per child (A maximum of three children are charged for)
This gives us the following MSA for the year:
- Main member – R6, 648
- Adult dependants – R6, 276 per dependant
- Children – R1, 332 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 Essential Comprehensive:
|Essential Comprehensive||Essential Delta Comprehensive||Difference|
|Main member||R4, 102||R3, 694||R408|
|MSA||R7, 380||R6, 648||R732|
|Annual Threshold||R16, 790||R16, 790||R0|
|Self-payment gap||R9, 410||R10, 142||R732|
A R10, 142 self-payment gap would make anyone choke on their whisky…errr, coffee.
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.
And remember to send all your medical invoices to Discovery Health while in the self-payment gap. How else will they know when you’ve reached the above threshold benefit unless you tell them?
Finally we get to the Delta networked hospitals:
I’m not going to publish the 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 R408 a month cost saving between the two Essential plans makes Rands and cents (I’d seriously consider using that to buy gap cover. Discovery also markets gap cover)
Just because you live in Kempton Park, doesn’t mean you have to use ARWYP. You can use a Delta hospital of your choice.
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
- The Essential Comprehensive plan
InsuranceFundi has partnered with some of SA’s most reputable insurance and investment companies. We believe that everyone should have access to a wide range of comprehensive and affordable solutions. Pick the product you are interested in below, and expect a call-back from our partners.
Until next time.
The InsuranceFundi Team