Classic Saver Plan Option_2011

7/31/2019 Classic Saver Plan Option_2011

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Your Guideto Discovery Health

Medical Schemes

Classic SaverPlan 2011

You have selected aClassic Saver PlanThere are ve plans in the Saver Series

Classic Saver, Classic Delta Saver network option, Essential Saver,

Essential Delta Saver network option and Coastal Saver

Please keep this inormation in a sae place or uture reerence.


2/14

Message rom Discovery Health

Dr Jonathan BroombergCEO: Discovery Health

Milton StreakPrincipal Ofcer:Discovery HealthMedical Scheme

Thank you or giving us the opportunity to look ater your healthcare cover needs. You can have peace o mind that DiscoveryHealth places our members rst with comprehensive and stable benets, highly competitive premiums and additional benets and

services to improve the quality o care available to our members. Our strong nancial perormance, very high levels o reserves and

being at the statutory 25% solvency level should give you complete condence that your medical scheme will be able to pay your

claims over the long term.

In 2010, the South Arican healthcare industry underwent many signicant changes and developments. Among these are a new

proposal on the National Health Insurance and other regulatory changes. Within this changing environment Discovery Health, as

the clear market leader, is well equipped to continue to deliver stability o contributions, increased benets and extra products and

services that provide you with signicant value.

This value is clear in all our members having access to the broadest and deepest level o healthcare cover available in the market. In

addition to excellent benets, Discovery Health continues to invest heavily in our people and technology to ensure that we deliver

world-class service to our members, through our call centres and walk-in centres around the country.In an eort to urther increase value and improve the quality o care and service convenience or our members, Discovery Health will

be reaching into the healthcare system in 2011 to introduce a series o new services. The Discovery Integrated Care Unit oers a

specialised treatment approach to members with complex healthcare needs. You will also have access to Discovery Trauma Support

Services, available 24/7 or qualied counselling and support ater any traumatic event. Our new Discovery Med-Xpress service, rolling

out over next year, will allow you to order all medicines telephonically and have them delivered to your home or workplace. This

service will also make it easier or you to avoid co-payments on medicine, and will extend your health plans available benets, with

dispensing ees that are at or below the Schemes rate.

With DiscoveryCares personal approach to managing chronic and other medical conditions you can also rely on compassionate care

and our continued support, when you need us most.

Discovery Health provides you with all the tools you need to know your health plan and how to make the most o your cover.

We are here to help and guide you in making the best choices when it comes to your healthcare. We look orward to giving you

certainty o cover, added value and access to unique benets and services in 2011.

Regards


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Contents

Summary o benefts .................................................................................................................................................. 1

Discovery Health Plan StarRater................................................................................................................................ 2

Cover or medical emergencies ................................................................................................................................. 4

Hospital benefts ........................................................................................................................................................ 5

Cover or chronic conditions and oncology ..............................................................................................................8

Out-o-hospital cover ................................................................................................................................................. 9

General exclusions .................................................................................................................................................... 10

Important tips when claiming ................................................................................................................................. 11


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1

Summary o benefts

The Hospital Beneft covers you i you are admitted to hospital and Discovery Health has conrmed your admission and treatment.

You have fexible cover or a list o chronic conditions and cover or cancer, HIV and AIDS.

Your health benets also include cover or medical expenses while travelling in other countries and cover or evacuation or medical emergencies

when travelling or working in Arica through the Arica Evacuation Beneft.

We pay your day-to-day expenses rom the available money in your Medical Savings Account. We extend your day-to-day cover by paying or GP

consultations through the Insured Network Beneft.

Your plan includes a basic level o cover or a list o medical conditions and treatments defned by the Prescribed Minimum Benefts.

These benets include cover or a list o 271 conditions, most emergency conditions and 27 chronic conditions that includes HIV and AIDS.

Medical schemes must provide cover or the diagnosis, treatment and ongoing care o these conditions as long as the tests, investigations and results

match all the rules and requirements or cover as a Prescribed Minimum Benet.

These rules and requirements do not apply in lie-threatening emergencies. However, once stable you must get treatment rom a healthcare

provider in the Discovery Health network as soon as possible otherwise you may have to pay a part o the treatment costs yoursel.Read more about

Prescribed Minimum Benets on www.discovery.co.za

All our legal rules are available on request

This brochure is only a summary o the benets and eatures o the Discovery Health Medical Scheme Plans, pending ormal approval rom

the Council or Medical Schemes. The rules o the Discovery Health Medical Scheme apply to your benets. I you want to reer to the ull

set o legal rules on which this brochure is based, please email [email protected]

Detailed information is available on www.discovery.co.za

You can get detailed inormation on the benets oered by your plan on www.discovery.co.za

If you want to change your plan

You can change to any other plan at the end o each year with eect rom 1 January the ollowing year, not during the year. Please speak

to your nancial adviser beore you decide to change your plan.

Discovery Health (Pty) Ltd Registration number 1997/013480/07 administers the Discovery Health Medical Scheme Registration number 1125. Discovery Health (Pty) Ltd is anauthorised nancial services provider.


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3

Discovery Health Plan StarRaterkey

In-hospital cover

The blue star indicates that you have cover in any hospital. The number o stars reers to the level o cover you have in hospital.

A circled star indicates that to get ve-star cover in hospital, you need to use a provider in one o Discoverys networks or payment

arrangements either a network hospital or a doctor participating in our direct payments arrangements, or both.

Out-o-hospitalcover

All plans except KeyCare

To show the level o cover each plan oers or out-o-hospital and day-to-day benets, weve added together the star-ratings or each o the ollowing:

A Medical Savings Account equal to 15% o your total medical scheme contribution.

A Medical Savings Account equal to 25% o your total medical scheme contribution.

An additional star i the plan oers the Insured Network Benet to extend your day-to-day cover.

An additional star i the plan oers a limited Above Threshold Benet.

Two additional stars i the plan oers an unlimited Above Threshold Benet.

KeyCare Plus

Your plan oers cover in a network or certain day-to-day healthcare costs.

Chronic Illness

Beneft and

oncology

You have cover or the conditions listed in the Prescribed Minimum Benets, but you must use our designated service provider to get

your approved chronic medicines, or you will have a co-payment. You have ull cover or medicines on our list i you choose a dierent

medicine, you have cover up to a monthly rand amount, except on KeyCare. You must use our designated service provider or

cancer treatment.

You have cover or the conditions listed in the Prescribed Minimum Benets you can get your approved chronic medicine rom any

provider. You have ull cover or medicines on our list i you choose a dierent medicine, you have cover up to a monthly rand amount. I

one o the three stars is circled, you must get your approved medicine rom our designated service provider or you will have a co-payment.

You have cover or the conditions listed in the Prescribed Minimum Benets, as well as or conditions on an additional disease list. You have ull

cover or medicines on our list i you choose a dierent medicine, you have cover up to a higher monthly rand amount than on other plans.

You also have higher cover or cancer treatment.

make sure you

understand thebenefts you have

on the plan youchoose

We want you to be sure the benefts you have available on your health plan meet your

individual needs. We understand that its not possible to know exactly what your healthcare

needs will be in the next year. You can, however, make sure you understand the benefts you

have on the plan you choose and how this will cover you i you need the benet.

Detailed explanations o our benets are available on www.discovery.co.za


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4

Cover or medical emergencies

Cover or medical emergencies

in South AricaIn a medical emergency, call Discovery 911

on 0860 999 911 this number is on your

membership card and car sticker or easy

reerence. I you need medically-equipped

transport, or example an ambulance or

helicopter, we will cover these costs rom your

Hospital Benet, whether you are admitted to

hospital or not.

In an emergency, go straight to hospital but

get someone to call us within 12 hours o

your admission. Your emergency treatment

in hospital will be covered according to your

health plans benets.

There are times when you may not have access

to cover on your health plan, or example

when you have run out o benets, reached

a benet limit or you are in a waiting period.

Even in these instances, you will still be covered

or a lie-threatening emergency, which is a

Prescribed Minimum Benet. This means that

you have ull cover in any hospital until your

condition is stable.

When your condition is stable and any urther

treatment you need qualies as a Prescribed

Minimum Benet, you have the choice totranser to one o the Schemes designated

service providers (a provider or hospital the

Scheme chooses) to have ull cover. I you

choose to get treated in a hospital that is not

a designated service provider, we will pay all

urther claims at up to 80% o the Discovery

Health Rate. You will have to pay the balance

o all these claims.

This co-payment on Prescribed Minimum

Benet treatment in a hospital that is not a

designated service provider, will apply to all

accounts. This includes the hospital account

and related accounts. A related account is anyaccount other than the hospital account, or

example accounts rom the admitting doctor,

anaesthetists and accounts or other approved

healthcare expenses you incur, like all radiology

and pathology accounts.

Cover or HIVprophylactics

I you need HIV prophylactics to prevent HIVinection rom mother-to-child transmission,

occupational and traumatic exposure to HIV

or sexual assault, call us immediately on

0860 99 88 77, as treatment must start as

soon as possible.

Cover or going to casualty

I you are admitted to hospital rom casualty,

we will cover the costs o the casualty visit

rom your Hospital Benet, as long as we

conrm your admission.

I you go to a casualty or emergency room

and you are not admitted to hospital, we will

pay the costs rom your day-to-day benets.

Some casualties charge a acility ee, which

we do not cover.

Cover while travellingoverseas

The International Travel Beneft provides

cover o up to R5 million or each person on

each journey or emergency medical costs while

you travel outside South Arica. This cover is

or a period o 90 days rom your departure

rom South Arica. Cover includes appropriate

emergency evacuation and transport i needed.

You pay the rst 100 or US $150 o

day-to-day medical expenses.

Please nd out how the International Travel

Benet works beore you travel overseas and

also read the scheme exclusions. Contact us

to get detailed inormation or go to

www.discovery.co.za

All emergency treatments outside the borders

o South Arica must be conrmed by calling

International SOS on + 27 11 541 1222. This

number is displayed on your membership card.

Call 0860 999 911 in an emergency

Let us know about your admission

within 12 hours o being admitted

Make sure you know how the

International Travel Benet works

beore going overseas

Beneft tips...

What is a medical

emergency?A medical emergency is the sudden

and, at the time, unexpected onset

o a health condition that needs

immediate medical or surgical

treatment, where ailure to provide

medical or surgical treatment would

result in serious impairment to bodily

unctions or serious dysunction o a

bodily organ or part, or would place

the persons lie in serious jeopardy.

Cover or evacuation

in AricaThe Arica Evacuation Beneft

covers you or emergency medical

evacuations rom certain sub-Saharan

Arican countries back to South

Arica. You can nd the list o Arican

countries this benet covers and the

details o the cover beore travelling on

www.discovery.co.za

All emergency treatments outside

the borders o South Arica must be

conrmed by calling International SOS

on+ 27 11 541 1222. This number is

displayed on your membership card.


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5

Hospital benefts

Important inormation about your hospital cover

Your hospital cover is made up o:the cover or the account rom the hospital, and

the cover or all other accounts, like accounts rom your admitting doctor, anaesthetist or

other healthcare expenses. We call these related accounts.

Limits, clinical guidelines and policies apply to some healthcare services and procedures.

1. How we pay the account rom the hospital

We cover you in a private hospital or emergency and planned hospital admissions that you

have conrmed with us. There is no overall limit to your hospital cover on the Classic Saver

Plan. We cover your hospital account (the ward and theatre ees) at the rate agreed with

the hospital. You have cover or a general ward, not a private ward.

2. Accounts rom your doctor and other healthcare services

Your doctor or treating healthcare proessionals accounts are separate rom the hospital

account and are called related accounts. Related accounts include any accounts other than

the hospital account. Examples o related accounts are the accounts rom the admitting

doctor, anaesthetist and any approved healthcare expenses, like radiology or pathology,

which you incur during your hospital stay. Reer to page 6 or detailed inormation on how

we cover related accounts.

Please contact us beore you receive treatment or which we have not conrmed yourbenets or to extend your hospital stay.

We cover you in hospitalor emergency and plannedhospital admissions. In an

emergency, go straight tohospital but call us or getsomeone to call us within

12 hours. For plannedhospital admissions, pleasecall us at least 48 hoursbeore you go to hospital

to conrm your admission.

Rememberthat you can reducethe risk o a co-payment byusing a doctor who participatesin one o our direct paymentarrangements. We cover yourapproved hospital proceduresand consultations with thesedoctors in ull. Healthcare

proessionals who participatein our payment arrangementsare also the designated services

providers or PrescribedMinimum Benefts. I youuse another specialist, we willcover your accounts up toa maximum o 200% o theDiscovery Health Rate on theClassic Saver Plan.

Beore you go to hospital or any planned procedure, you must:see your doctor who will decide i it is necessary or you to be admitted

choose your admitting doctor

choose which hospital you want to be admitted to

nd out how we cover other healthcare proessionals, or example your anaesthetist see Remember on the right-hand side o this page.

call us on 0860 99 88 77 to conrm your hospital admission at least 48 hours beore you goin. We will give you inormation that is relevant to how we will pay your hospital stay.

I you do not conrm your admission, we will only pay 70% o the costs that we wouldnormally cover.

Please reer to page 4 or more inormation on emergencies.

What to dobeore you go to hospital

You can access the MaPS tool on

www.discovery.co.za

to search or healthcare

proessionals who are on our

payment arrangements

Beneft tips...


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6

Cover is subject to our rules

We pay medically appropriate claims. Your cover is subject to our scheme

rules, unding guidelines and clinical rules.There are some expenses that

you may incur while you are in hospital that your Hospital Benet does

not cover, or example private ward costs. Certain procedures, medicinesor new technologies need separate approval while you are in hospital.

You can nd out more about our clinical rules and policies or cover by

contacting us at www.discovery.co.za/portal/individual/benets-dwc

Cover or Prescribed Minimum Benefts

According to the Prescribed Minimum Benets, in certain circumstances

you have the right to get a basic level o cover or a list o medical

conditions and treatments. These benets include cover or a list

o 271 listed conditions, most emergency conditions and 27 listed

chronic conditions that include HIV and AIDS. Medical schemes must

provide cover or the diagnosis, treatment and costs o the ongoing

care o these conditions.

To access Prescribed Minimum Benefts, there are certainrules that apply:

Your medical condition must be part o the list o dened

conditions or Prescribed Minimum Benets

The results o your medical tests and investigations must match the

requirements or diagnosis o your medical condition

The treatment you need must match the treatments listed in the

Prescribed Minimum Benets as appropriate or your medical condition

You must use a doctor, specialist or other healthcare proessional in

the Discovery Health network. This does not apply in lie-threatening

emergencies. However, even in these cases, once your conditionstabilises you must access a healthcare proessional in the Discovery

network as soon as possible otherwise you may be responsible to

pay part o the treatment costs yoursel.

Contact us or more inormation on our approach to Prescribed

Minimum Benets or go to www.discovery.co.za

How we cover your healthcare proessionals

Full cover or specialists participating in our paymentarrangements

You can benet by using healthcare proessionals participating in

our payment arrangements because we will cover their approved

procedures in ull. I you are a Classic Saver Plan member, you

benet rom access to the broadest range o specialists who we

pay in ull, which represents over 87% o specialist interactions.

Healthcare proessionals who participate in our payment

arrangements, appropriate to your plan, are also the designated

service providers or Prescribed Minimum Benets.

You can access the MaPS tool on www.discovery.co.za to

search or healthcare proessionals who participate in our

payment arrangements.

You may have a co-payment i you use other specialists

I you are treated in hospital by a specialist who does not

participate in one o our payment arrangements, we cover

your accounts up to 200% o the Discovery Health Rate on

the Classic Saver Plan.

Other healthcare proessionals

We cover GPs and other healthcare services up to 200% o theDiscovery Health Rate on the Classic Saver Plan.

We cover radiology and pathology up to 100% o the Discovery

Health Rate.

You can benet by using healthcareproessionals participating in our paymentarrangements because we will cover theirapproved procedures in ull.

You must call us at least 48 hours

beore any planned procedure

You will be covered in ull i

you use doctors in our payment

arrangements relevant to your

plan type

Go to Do We Cover on

www.discovery.co.za to nd

out more about our clinical

rules and policies

Some treatments you receive while

in hospital may need separate

approval or benet conrmation

Beneft tips...


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7

Cover orinvestigations

Scopes (gastroscopy, colonoscopy, sigmoidoscopy andproctoscopy)

We pay the rst R2 375 o your hospital account rom your day-to-day

benets. We pay the balance o the hospital account and your related

accounts rom your Hospital Benet. We pay related accounts up to

200% o the Discovery Health Rate on the Classic Saver Plan.

Contact us or a detailed explanation o how we cover scopes or

go to www.discovery.co.za

MRI and CT scans

I your MRI or CT scan is done as part o an approved admission, we

pay it rom your Hospital Benet. I you are admitted or conservative

back or neck treatment, or the scan is unrelated to your admission, we

pay the rst R2 100 o the scan code rom your day-to-day benets.

We pay the balance rom your Hospital Benet up to 100% o the

Discovery Health Rate.

Contact us or a detailed explanation o how we cover MRI and CT

scans or go to www.discovery.co.za

Your cover or dental treatment in hospital

You need to pay a portion (deductible) o your hospital or day clinic

account upront or dental admissions. This amount varies depending

on the members age and the place o treatment.

Members Hospital Day clinic

Members younger than 13 years R1 200 R600

Members 13 years and older R3 000 R2 000

We pay the balance o the hospital account rom the Hospital Benet

up to 100% o the Discovery Health Rate. You can access the MaPS tool

on www.discovery.co.za to search or day clinics that you can use.

We pay the related accounts, which include the dental surgeon and

anaesthetists accounts, rom the Hospital Benet up to 100% o the

Discovery Health Rate.

No overall dental limit

There is no overall limit or dental treatment. We will pay the costs o

all dental appliances and orthodontic treatment (including the related

accounts or orthognathic surgery) rom your Medical Savings Account

up to 100% o the Discovery Health Rate regardless o place o

treatment, as long as you have money available.

Severe dental and oral surgery

The Severe Dental and Oral Surgery Benet covers a dened list o

procedures, with no deductible and no overall limits. This benet is

subject to authorisation and the Schemes clinical entry criteria.

Unlimited healthcare services

Most o your in-hospital healthcare services have no overall limit.

These include:

GPs

Specialists

Allied healthcare proessionals, or example physiotherapists

Pathology and radiology

HIV cover i you are registered on the HIV Care Programme.

Only the ollowing healthcare services have an annual limit:

Hospital limits Annual limit

Cochlear implants, auditory brainimplants and processors

R133 000 or each person or each benet

Internal nerve stimulators R101 000 or each person

Hip, knee and shoulder jointprostheses

There is no overall limit i you get your prosthesisrom a preerred supplier. I you choose not to, a limito R33 000 will apply to each prosthesis.

Prosthetic devices used in spinalsurgery

R21 000 or the rst level, R42 000 or two or morelevels, limited to one procedure or each person

Mental health benet 21 days or each person

Alcohol and drug rehabilitation 21 days or each person

Terminal care benet R25 250 or each person

Chronic dialysis We cover these expenses in ull i we have approvedyour treatment plan and you use a provider in ournetwork. I you go elsewhere, you will be responsibleor a co-payment


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8

Chronic Illness Beneft

You have fexible cover or 27 Chronic Disease List conditions. You have

ull cover or approved medicine on Discovery Healths medicine list

(ormulary) or up to a set monthly amount (Chronic Drug Amount) or

medicine not on our list. You will be responsible or the balance i your

medicine costs more than the Chronic Drug Amount.

We need to approve your application

We need to approve your application beore we cover your condition rom

the Chronic Illness Benet. To apply, contact us to get an application orm

or go to www.discovery.co.za. Complete the relevant application orm

with your doctor and send it to us. We will send you a letter detailing thecover available to you.

We pay medicine up to a maximum o the Discovery Health

Medication Rate.

Please note that the medicine list (ormulary) and the Chronic Drug

Amount may change rom time to time. Visit www.discovery.co.za or

contact us or a detailed explanation o the cover oered through the

Chronic Illness Benet.

What we cover as a Prescribed Minimum Beneft

The Chronic Illness Benet covers certain diagnostic tests, consultations

and medicines each year or the chronic conditions listed in the Prescribed

Minimum Benets, called the Chronic Disease List. This cover includes testsand consultations during the year or both the diagnosis and ongoing

management or each condition.

I you do not use healthcare providers in the Discovery Health networks

(designated service providers) to receive the treatment, you will have to

pay part o the treatment costs yoursel.

Contact us or the latest copy o the treatment guidelines or go to

www.discovery.co.za

Your cover or HIV and AIDS

For members living with HIV and AIDS, the HIVCare Programme provides

comprehensive disease management. We take utmost care to protect the

right to privacy and condentiality o our members.

To have access to cover or hospitalisation or conditions related to HIV,

and to antiretroviral therapy, you must enrol on the HIVCare Programme.

Your cover or cancer treatment

The DiscoveryCare Oncology Programme covers the rst R200 000 o

your approved cancer treatment over a 12-month cycle, in ull. Cover

is unlimited once your cancer treatment costs go over this amount, but

you will need to pay 20% o the costs o all urther treatment romyour pocket.

We cover chemotherapy and any oncology-related medicines up to the

Discovery Health Medication Rate. Consultations, radiotherapy, radiology,

pathology and scans are paid up to 100% o the Discovery Health Rate.

You may be responsible or a co-payment i your healthcare provider

charges more than the applicable Discovery Health Rate.

Cancer treatment that alls within the Prescribed Minimum Benets

is always covered in ull, with no co-payment.

Please call us to register on the Oncology Programme.

Visit www.discovery.co.za or a detailed explanation o the cover oered

through the Oncology Programme.

Cover or chronic conditions

You have fexible cover or chronic conditions, HIV and AIDS and cancer

Beneft tips...

Youmustregisterforcoverfromthe

Chronic Illness Benet. We oer you

comprehensive cover or a list o

conditions

Readmoreaboutthecoverfor

chronic conditions, HIV and AIDS and

cancer on www.discovery.co.za or

contact us

Youmustregisteronthe

DiscoveryCare programmes to accessthe benets

Moredetailsareavailableon

www.discovery.co.za or you can

contact us


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9

We frst pay your claims rom your

Medical Savings AccountWe pay or your day-to-day medical expenses like GP visits, x-rays and

blood tests rom your Medical Savings Account, as long as you have

money available. Your Medical Savings Account is an amount that you

get at the beginning o the year or when you join Discovery Health.

You have access to this amount rom day one. I you have unds in

your Medical Savings Account at the end o the year, we will carry

over these unds to the next year.

You may need to pay or your day-to-day medical expenses i you

have run out o money in your Medical Savings Account.

I you leave Discovery Health or downgrade your health plan beore

the year is up, you will owe Discovery Health the portion o the

Medical Savings Account you have used but have not yet paid back.

Annual Medical Savings Account amounts*:

Main member R4 548

Adult dependant R3 576

Child ** R1 812

* We prorate this benet according to when you join the medical scheme

** We count a maximum o three children when we calculate the annual Medical Savings

Account amounts

The Insured Network Beneft ensures youhaveno gaps in cover or GPs

We urther extend your day-to-day cover through the Insured Network

Benet by paying or GP consultation ees when you have spent your

annual Medical Savings Account deposit. We cover the cost o your

consultations i you go to a GP in our network. The maximum number

o consultations that we cover or a single member and a amily each

year depends on your plan type:

Health plan Single member Family

Classic Saver Plan 3 consultations 6 consultations

This GP benet only covers the consultation ee (code 0190, 0191 or

0192). We pay or any other healthcare services rom your available

day-to-day benets. The list o GPs participating in the Discovery

Health GP Network is available on www.discovery.co.za/MaPS

Further extensions to your day-to-day cover

Discovery Health pays claims or some day-to-day expenses to make

the money in your Medical Savings Account last longer.

The Screening and Prevention Beneft covers a range o

healthcare services, including the ollowing tests at a Discovery

Wellness Network provider: blood glucose, blood pressure,

cholesterol and body mass index. The benet also covers

a mammogram, Pap smear, PSA and HIV screening tests.Members rom the age o 65 and members registered or

certain chronic conditions are also covered or a seasonal fu

vaccine rom this benet

We will cover out-o-hospital claims or your recovery ater

certain traumatic events rom the Trauma Recovery Extender

Beneft. The cover applies or the rest o the year in which the

trauma takes place, as well as or the year ater your trauma.

We also cover scopes (gastroscopy, colonoscopy, sigmoidoscopy

and proctoscopy) done in your doctors room. Discovery Health

pays or these claims without using your Medical Savings Account

as we pay these accounts rom the Hospital Benet. We pay up

to 200% o the Discovery Health Rate on a Classic Saver Plan.Please call us beore you have a scope in your doctors rooms to

conrm your benets.

A detailed explanation o how these benets work is available on

www.discovery.co.za or you can contact us.

Your Medical Savings Account is an amountthat you get at the beginning o the year or whenyou join Discovery Health. You have access to thisamount rom day one.

Cover or day-to-day medical expenses

How to make the money in your Medical Savings Accountgo urther:

Choose a GP in the Discovery Health GP Network

Choose a specialist who is part o our payment arrangements

Use generic medicines and dont pay or over-the-counter

medicines (OTCs) rom your MSAAsk your healthcare proessional to use the Discovery Healthpathology orm

Beneft tips...


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10

Treatment in hospital that we cover rom your day-to-day benefts

We cover the ollowing treatment you get in hospital rom your Medical Savings Account:

Casualty treatment i you are not admitted

Medicine to take homeExternal medical items.

There is no annual limit on these healthcare services

We pay or these healthcare services rom your Medical Savings Account as long as you have unds available:

GPs

Specialists

Allied healthcare proessionals, or example physiotherapists

Radiology and pathology

Dentistry

Mental health benet (including psychologists and psychiatrists)

Private nursing

Prescribed and over-the-counter medicine

External medical items

Hearing aids

Optical care

We will pay the rst R2 100 o your MRI or CT scan code rom

your Medical Savings Account. We cover the balance rom your

Hospital Benet up to the Discovery Health Rate.

General exclusion list

1. Cosmetic procedures and treatments

2. Otoplasty or bat-ears, portwine stains and blepharoplasty (eyelid surgery)

3. Breast reductions or enlargements and gynaecomastia

4. Obesity5. Frail care

6. Inertility

7. Wilully sel-inficted illness or injury

8. Alcohol, drug or solvent abuse

9. Wilul and material violation o the law or during a period o imprisonment

10. Wilul participation in war, terrorist activity, riot, civil commotion, rebellion or uprising

11. Injuries sustained or healthcare services arising during travel to or in a country at war

12. Experimental, unproven or unregistered treatments or practices

13. Search and rescue

14. Any costs or which a third party is legally responsible

We also do not cover the complications or the direct or indirect expenses that arise rom any o the exclusions listed above, except where

stipulated as part o a dened benet or under the Prescribed Minimum Benets.

I we apply waiting periods because you have never belonged to a medical scheme or have had a break in membership o more than 90 days

beore joining Discovery Health, you will not have access to the Prescribed Minimum Benets during your waiting periods. This includes cover

or emergency admissions.

General exclusions

The Discovery Health Medical Scheme has certain exclusions. Discovery Health will not pay or healthcare services related to the ollowing,except where stipulated as part o a dened benet or under the Prescribed Minimum Benets.


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Important tips when claiming

Check with your healthcare proessional i they have sent your claims to us to avoid duplicates

Send your claims within our months, otherwise we will consider them expired and not pay them

When sending claims, please make sure the ollowing details are clear:

1. Your membership number

2. The service date

3. Your doctors details and practice number

4. The amounts charged

5. The relevant consultation, procedure or NAPPI code and diagnostic (ICD-10) codes

6. The name and birth date o the dependant or whom the service was done

7. I paid, attach your receipt or make sure the claim says paid

Remember to always keep copies o your claims or your records

To see the status o your claim, you can go to www.discovery.co.za

When claiming rom Discovery Health or your medical costs, whether these are hospital, chronic or day-to-day, these steps apply.

You can send us your claims in the ollowing ways

Email

You can scan and email your claims to [email protected]

Post

You can post your claims to the ollowing address:

Discovery Claims

PO Box 784262

Sandton

2146

Claims drop-off boxes

You can drop your claims in our claims drop-o boxes situated around the country in convenient places such as pharmacies

and medical practices, as well as at most Virgin Active or Planet Fitness gyms.

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Documents

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