Discovery Health Medical Aid Comparison - 2018 Plans

Discovery Health is by far the biggest medical aid scheme in South Africa and tends to dominate the industry. Their Global Credit Rating is the highest available (AA) and total membership is in excess of 2 million lives. They are an extremely innovative company and introduced a number of new concepts to the industry, including introducing the new generation savings plan schemes.

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Discovery
Health:
Essential Delta Core Essential Core Coastal Core
Essential Smart Plan
Classic Smart Plan
Classic Core
Coastal Saver Essential Saver
Classic Delta Saver
Classic Saver
Classic Priority
Classic Delta Comprehensive
Classic Comprehensive
Keycare Plus Keycare Core
 
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
       
     
     
     
     
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions   
  Subject to scheme formulary  
   Only from MedXpress  
     
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
               
               
               
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,417  
  Spouse/Adult dependant R 1,065  
  Per Child (Max 3) R 569  
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
               
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from MedXpress  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
       
     
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,773  
  Spouse/Adult dependant R 1,329  
  Per Child (Max 3) R 712  
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
       
       
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27  PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from MedXpress  
     
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
       
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,610  
  Spouse/Adult dependant R 1,209  
  Per Child (Max 3) R 641  
       
.
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
       
     
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27  PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from MedXpress,Clicks or Dischem  
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  Unlimited GP Benefit with  
  R100 co-payment for face-to-face  
     consultations  
     
     Video call consultations paid in full  
     
   1 Dental check up with a R150  
    co-payment  
   1 eye test with R100    
    co-payment    
       
       
       
       
       
       
       
     
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,180  
  Spouse/Adult dependant R 1,180  
  Per Child (Max 3) R 1,180  
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
               
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 MB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from MedXpress,Clicks or Dischem  
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  Unlimited GP Benefit with  
  R50 co-payment for face-to-face  
       consultations    
       
  Video call consultations paid in full   
     
  Prescribed medication limited to:  
  12 prescriptions p/person per annum  
   with a R10 co-payment per item  
     
  2 Specialist Consultations for sports  
   related injuries only with a R100  
   co-payment  
       
    1 Dental check up with a R100   
     co-payment    
       
    1 eye test with R50  
     co-payment    
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
       
  MONTHLY CONTRIBUTIONS  
  Principal Member R 1,647  
  Spouse/Adult dependant R 1,298  
  Per Child (Max 3) R 658  
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit    
  schedule    
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from MedXpres  
               
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  No Benefit  
     
       
       
       
       
       
       
       
     
     
     
     
     
     
     
     
     
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,064  
  Spouse /Adult R 1,626  
  dependant    
  Per Child (Max 3) R 826  
       
. 
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
   Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 MB Chronic Disease Conditions  
  Subject to scheme formulary  
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
  Member R 5,184  
  Member+Spouse R 9,072  
  Member+Spouse+Child1 R 11,160  
  Member+Spouse+Child2 R 13,248  
  Member+Spouse+Child3 R 15,336  
  Member+Child 1 R 7,272  
  Member+Child 2 R 9,360  
  Member+Child 3 R 11,448  
       
  Day-to-Day Extender Benefit  
       
       
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
     
     
               
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,160  
  Spouse/Adult dependant R 1,621  
  Per Child (Max 3) R 870  
       
       
       
       
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 MB Chronic Disease Conditions  
  Subject to scheme formulary  
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
  Member R 3,960  
  Member+Spouse R 6,924  
  Member+Spouse+Child1 R 8,508  
  Member+Spouse+Child2 R 10,092  
  Member+Spouse+Child3 R 11,676  
  Member+Child 1 R 5,544  
  Member+Child 2 R 7,128  
  Member+Child 3 R 8,712  
       
  Day-to-Day Extender Benefit  
       
       
  ANNUAL THRESHOLD BENEFIT  
            Does not apply    
       
       
       
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,203  
  Spouse/Adult dependant R 1,652  
  Per Child (Max 3) R 883  
       
       
       
       
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
   Network Hospitals to be used  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
     
     
     
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from MedXpress  
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
  Member R 6,636  
  Member+Spouse R 11,880  
  Member+Spouse+Child1 R 14,544  
  Member+Spouse+Child2 R 17,208  
  Member+Spouse+Child3 R 19,872  
  Member+Child 1 R 9,300  
  Member+Child 2 R 11,964  
  Member+Child 3 R 14,628  
       
  Day-to-Day Extender Benefit  
       
       
  ANNUAL THRESHOLD BENEFIT  
            Does not apply    
       
       
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,214  
  Spouse/Adult dependant R 1,749  
  Per Child (Max 3) R 890  
       
       
       
       
       
       
       
. 
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200 000 thereafter 20%  
   co-payment    
  Internal Prostheses:    
  See detailed benefit schedule  
     
     
     
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
  Limits per annum:  
  Member R 8,316  
  Member+Spouse R 14,868  
  Member+Spouse+Child1 R 18,192  
  Member+Spouse+Child2 R 21,516  
  Member+Spouse+Child3 R 24,840  
  Member+Child 1 R 11,640  
  Member+Child 2 R 14,964  
  Member+Child 3 R 18,288  
       
  Day-to-Day Extender Benefit  
       
       
  ANNUAL THRESHOLD BENEFIT  
       
   Does not apply    
       
     
  MONTHLY CONTRIBUTIONS  
  Principal Member R 2,773  
  Spouse/Adult dependant R 2,186  
  Per Child (Max 3) R 1,110  
       
       
       
       
       
       
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
  Co-payments apply for certain  
  procedures  
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R200,000 thereafter 20%  
   co-payment  
     
     
  Internal Prostheses: See detailed  
   benefit schedule  
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
     
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% Scheme Rate  
    Limits per annum:  
  Member R 9,636  
  Member + Spouse R 17,232  
  Member + Spouse + Child1 R 21,084  
  Member+Spouse+Child2 R 24,936  
  Member+Spouse+Child3 R 28,788  
  Member+Child 1 R 13,488  
  Member+Child 2 R 17,340  
  Member+Child 3 R 21,192  
     
   Day-to-Day Extender Benefit  
     
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member R 14,240  
  Spouse/Adult independant R 10,670  
  Per Child (Max 3) R 4,660  
       
  MONTHLY CONTRIBUTIONS  
              
  Principal Member R 3,214  
  Spouse /Adult R 2,534  
  dependant    
  Per Child (Max 3) R1,286  
       
       
       
       
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
   Network Hospitals to be used  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R400,000 thereafter 20%  
    co-payment  
   Specialised Medicine & Technology      
    benefit: R200,000  
   Internal Prostheses: See detailed  
    benefit schedule  
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from MedXpress  
   (Add. 23 Chronic Disease Conditions)  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
    Limits per annum:  
  Member R13,188  
  Member + Spouse R25,668  
  Member + Spouse + Child1 R28,284  
  Member+Spouse+Child2 R30,900  
  Member+Spouse+Child3 R33,516  
  Member+Child 1 R15,804  
  Member+Child 2 R18,420  
  Member+Child 3 R21,036  
       
  Day-to-Day Extender Benefit    
     
     
  ANNUAL THRESHOLD BENEFIT  
  Principal Member  R 16,790  
  Spouse/Adult independant R 16,790  
  Per Child (Max 3) R 3,200  
       
  MONTHLY CONTRIBUTIONS  
     
  Principal Member R 4,398  
  Spouse /Adult R 4,162  
  dependant    
  Per Child (Max 3) R 874  
       
     
       
       
       
       
       
 
 
  IN HOSPITAL BENEFIT  
  200% Scheme Rate  
  No Overall Annual Limit  
     
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 57,000  
  Oncology R400,000 thereafter 20%  
   co-payment    
   Specialised Medicine & Technology       
    benefit R200,000  
   Internal Prostheses:  
   See detailed benefit schedule  
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
     
   (Add. 23 Chronic Disease Conditions)  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
   100% scheme rate  
   Limits per annum:  
   Member  R14,640  
   Member+Spouse  R28,488  
   Member+Spouse+Child1  R31,404  
   Member+Spouse+Child2  R34,320  
   Member+Spouse+Child3  R37,236  
   Member+Child1  R17,556  
   Member+Child2  R20,472  
   Member+Child3  R23,388  
       
       
  ANNUAL THRESHOLD BENEFIT  
     
 
Principal Member                 R16,790
 
  Spouse /Adult dependant     R16,790  
  Per Child (Max 3)                R3,200  
     
  MONTHLY CONTRIBUTIONS  
     
  Principal Member R 4,882  
  Spouse /Adult R 4,618  
  dependant    
  Per Child (Max 3) R 974  
       
     
       
       
       
       
       
     
       
       
       
       
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Full Cover Network Hosp to be used  
  Certain procedures only covered at  
  Network Day Clinics  
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 40,450  
  Oncology PMB  
       
       
       
               
               
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
   Only from a Network Pharmacy or  
   chosen GP  
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  100% scheme rate  
   GP's:  No Limit from KeyCare  
     Network Providers  
     (4 out of network visits)  
  Specialists:  R 3,860 per person  
     from Network Providers  
      (must be referred by  
                           network GP)  
   Conservative Dentistry:  
                  No Limit from KeyCare   
                    Network Providers  
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
               
  MONTHLY CONTRIBUTIONS  
  Income p/m: R0 - R8,550  
  Principal Member R 990  
  Spouse /Adult R 990  
  dependant    
  Per Child (Max 3) R359  
       
  Income p/m: R8,551 - R12,200  
  Principal Member R 1,386  
  Spouse /Adult R 1,386  
  dependant    
  Per Child (Max 3) R 389  
       
  Income p/m: R12,201+  
  Principal Member R 2,064  
  Spouse /Adult R 2,064  
  dependant    
  Per Child (Max 3) R 553  
       
       
       
DISCOVERY HEALTH
  IN HOSPITAL BENEFIT  
  100% Scheme Rate  
  No Overall Annual Limit  
  Full Cover Network Hosp to be used  
  Certain procedures only covered at  
  Network Day Clinics  
     
     
  Annual Sub-limits per person:  
  Psychiatric Treatment 21 days  
  Hospice Care R 40,450  
  Oncology PMB  
       
       
       
               
  CHRONIC MEDICATION BENEFIT  
  100% Scheme Rate  
  27 PMB Chronic Disease Conditions  
  Subject to scheme formulary  
  Only from DSP   
     
               
  ANNUAL DAY TO DAY BENEFIT
(including savings)
 
  Does not Apply  
       
    Specialist benefit limited to R3,860  
    per person per annum. Must be  
     referred by GP    
     
     
       
       
       
       
     
  ANNUAL THRESHOLD BENEFIT  
  Does not apply  
               
               
               
               
  MONTHLY CONTRIBUTIONS  
  Income p/m:                R0 - R8,550  
  Principal Member R 792  
  Spouse /Adult R 792  
   dependant    
  Per Child (Max 3) R 205  
     
  Income p/m:        R8,551 - R12,200  
  Principal Member R 988  
  Spouse /Adult R 988  
  dependant    
  Per Child (Max 3) R 243  
       
  Income p/m:                    R12,201+  
  Principal Member R 1,525  
  Spouse /Adult R 1,525  
  dependant    
  Per Child (Max 3) R 345