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Should you downgrade to a cheaper plan next year…or upgrade to a more expensive one?

Today we’re only looking at the Rands and Cents equation when making that decision.
However, before we wax lyrical, none of this is going to make any sense unless you first download our excel spreadsheet. Click here to download your copy.

Let’s start off with…

The 7 Discovery Health Plan ranges

When you open our spreadsheet, things are going to look a little confusing. That’s because Discovery Health has 23 plans to choose from.

Forget about the 23 plans for the moment, we want you to focus on the left-hand side of the spreadsheet. The first thing you notice is the row marked ‘Executive’. Here’s a screenshot:

Discovery Health Plan Ranges

What you need to do is scroll down the spreadsheet to see the various plan types. The key to understanding Discovery Health is knowing the difference between the 7 different plan types. From top (most comprehensive) to bottom (Least comprehensive) they are:

  • Executive
  • Comprehensive
  • Priority
  • Saver
  • Smart
  • Core
  • KeyCare

A lot of people tell us they’re on the ‘Classic’ plan, but as you’ll see, there are a variety of ‘Classic’ plans on offer. Focus instead on the above mentioned plan types and we will get to ‘Classic’ later.

The most comprehensive of the lot is the Executive plan followed closely by the Comprehensive range. Just below Comprehensive we have the Priority plan range. These three plan types differ from all other plans in that they offer what’s known as ‘Above Threshold Benefits’.

In the middle, all on its own some is the Saver range. This plan, like those already mentioned, offers you a Medical Savings Account (MSA), but it does not have the Above Threshold Benefit. The Medical Savings Account is there to take care of your day-to-day expenses like GP and dentist visits. Once you run out of savings, besides limited visits to a network doctor, you get to pay your own way.

The new kid on the block is their Smart plan range. Basically, it’s a ‘souped up’ hospital plan allowing you to visit a Smart doctor (and who doesn’t want to see a smart doctor?) by making a small co-payment. Smart doctors and Smart hospitals are a must when choosing this option.

The hospital plans appear just below the Smart range and are known as the Core range. When people tell us that all they want is a ‘hospital plan’, this is what they refer to. However, as you will see, the Smart plan offers more at a lower cost.

Finally, right at the bottom is the KeyCare plans. These plans offer primary healthcare with no Medical Savings Account. In other words, the member may visit their KeyCare networked doctor as often as needed without the risk of ever depleting a savings account.  What you pay depends on what you earn.

Now it’s time to drill down into the plan types.

The 23 Discovery Health Plans

To view the individual plans, you will now need to look to the right of the spreadsheet. Take the Comprehensive range for instance, which offers 5 different plans. Here’s a screenshot:

Discovery Health Plan Types

Now we get to that ‘Classic’ thing. If you study the spreadsheet you will see what causes all the confusion:

  • Classic
  • Classic Delta
  • Essential
  • Essential Delta, and on the Saver and Core ranges
  • Coastal

Classic plans offer 200% of the Discovery Health Rate. This includes ‘Classic Delta’ plans which offer a discount if you use a network of hospitals.

The Essential plans all offer 100% of the Discovery Health Rate. Also included are ‘Essential Delta’ plans. Coastal plans fall into the same category by offering 100% of the Discovery Health Rate. However, they are cheaper than the Essential plans but to benefit, you must live at the coast.

The Discovery Health Rate is the rate which Discovery Health is willing to pay for a procedure or medicine. Plans offering 200% of the Discovery Health Rate pay double the Discovery Health Rate.

On the KeyCare range there are only 3 plans:

  • KeyCare Plus
  • KeyCare Start, and
  • KeyCare Core

KeyCare plus allows you to visit a KeyCare doctor and use a KeyCare networked hospital for procedures.
KeyCare Start is brand new and similar to KeyCare Plus, only more affordable. Certain benefits such as cancer treatment and chronic medication are only provided through state facilities.
KeyCare Core is a KeyCare hospital plan only.

KeyCare Plus and Core have two price points based on your income while KeyCare Start has three. Everyone on the same plan type enjoys the same benefits, but those who earn more, pay more.

Okay, so now we’ve run through the 7 plan ranges and the 23 plan types. Let’s explain what’s going on in the spreadsheet by using the Comprehensive Range as an example. Here’s a screenshot:

Discovery Health Plan Specifics

What to watch out for when choosing your plan

Two important things to mention before we proceed.

One, enter the number of adult dependants and children in the yellow block at the top left. Here’s a snapshot of that:

Discovery Health Plan Members

Two, make sure you’re aware of the Discovery Health Rate you require. Basically, the plans offer the following rates of cover:

  • Executive300%
  • Classic 200%
  • Essential, Coastal, and KeyCare100%
Now onto the block itself:
  • Main member – To the right of this you will notice the cost for the main member per plan type.
  • Spouse/Adult Dependant – This is the combined cost for all adults on your plan. Once a child turns 21 they’re charged adult rates.
  • Child – This is the combined cost for all children on your plan. You are only charged for a maximum of three children.
  • Total Spend – This reflects your total monthly cost.
  • In hospital expenses coverage – This is the Discovery Health Rate applicable to the plan you’re considering
  • Annual Medical Savings Account – This is the combined amount available to you and your dependants for a full year. If you join halfway through a year, then this amount is a pro rata benefit based on the number of months remaining for the year.
  • Annual Threshold Benefit – This is the point at which Discovery Health starts picking up your bills after you’ve depleted your Medical Savings Account
  • Self-Payment Gap – which needs to be paid by you after running out of Medical Savings and before entering the Above Threshold Benefit.
  • Above Threshold Benefit – This is the amount Discovery Health will pay once you’ve through the self-payment gap. On Comprehensive and Executive, it is unlimited while on Priority it is limited to the amount shown.
  • Annual Premium Payable – Your monthly payments x 12
  • Total Annual Cost including Self-Payment Gap – Annual cost including the self-payment gap showing you the potential amount you could end up paying.

Click here to download the calculator.

When choosing, first read through your plan brochure to determine which benefits are most suitable to your situation, and then only compare price. Always speak to your medical broker before making a final choice. That’s because you cannot upgrade once you’ve decided.

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