Discovery Health – ‘Coastal Core’ and ‘Coastal Saver Options’
Perspective on Discovery Health’s Coastal Core and Coastal Saver options.
We presume you have read the details of both the Coastal Core and Coastal Saver options on the website ‘www.medicalaidcomparisons.co.za’, as well as the background we have given in our ‘introductory background’. You should please read the comments below which will amplify the clarity of our perspective:
- All hospitals in the coastal provinces of South Africa will form the network which these options utilise. The payment levels of 100% of Discovery’s rate
(a) means that hospital ward fees will be paid in full, also
(b) that surgery and anaesthetics for emergency treatment will be fully paid,
(c) that planned procedures will be paid in full if a practitioner from a network provider list is used by the member, and
(d) further, if a planned procedure utilises the services of a provider not on the Discovery network, the member will personally pay any shortfall (excess).
- If the member is hospitalised while not in a coastal province, then, if the hospitalisation is for an emergency procedure, the benefit is paid at 100%, but in the event of the hospitalisation being for a planned procedure, the benefit will be reduced to 70% because it has taken place outside of a coastal province.
- To deal with 1(d) or para. 2 above, it is an absolute necessity for the member to have a GAP Cover policy in place, which will absorb the excesses for which the member will be liable.
- MRI and CAT scans are fully covered only when the member is first hospitalised as the result of, for instance, a motor accident. Scans for diagnostic purposes are only covered under the Saver option but with the member having to pay a co-payment. This could also be covered by a special GAP policy.
- Under the Saver option, 25% of the total premium is set aside as the savings amount which the member may utilise for the payment of any medical expenses to, or in respect of medical accounts from registered practitioners.
- Once the savings are exhausted, the member still has 6 visits available for General Practitioners services in the case of a family, or 3 in the case of single members. Also available is special Trauma Cover under the Coastal Saver option.
Return to Introducation to ‘Coastal Core’ and ‘Coastal Saver Options’ from Discovery