Introduction to the Discovery Health Coastal Core:
Discovery Health Coastal Core: It was long ago the contention of the actuaries charged with the responsibility of pre-estimation of costs and benefits of the various options provided by medical schemes, that the medical costs of urbanised members was more of a drain on the financial resources of schemes when compared with those in ‘the country’. Also, it was a statistical fact that members living in coastal areas were, on average, less costly than those in major ‘commercial dynamo’ regions such as Johannesburg.
The logical consequence was that slightly lower charges could be offered to persons living in coastal regions, and in terms of the Medical Schemes Act, this preferential advantage was, and still is, perfectly legal. Out of this facility was born the Discovery Health Coastal Core series of options, where the word ‘Coastal’ meant literally applicable to members living in the coastal provinces of South Africa.
Here’s what you get:
- 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 Cover policy.
- Full cover for approved chronic medicine for all conditions on our Chronic Disease List when you use MedXpress or a MedXpress network pharmacy.
- Comprehensive pre- and postnatal healthcare services for maternity and early childhood.
- Cover for medical emergencies when traveling.