Discovery Smart Plans 2024 – November Newsletter

November 19, 2023
Posted by: Informed Healthcare Solutions
Category: Discovery Health Newsletters

Discovery Smart Plans 2024

Discovery Smart Plans 2024: There are 3 Discovery Smart Plans in 2024: Classic, Essential and Essential Dynamic. All Smart plans include the following:

WELLTH fund,
Screening Benefit,
Chronic medication formulary on the Chronic Disease List, supplied by MedXpress or a MedXpress Network Pharmacy,
Cover for medical emergencies when travelling.

Classic Smart:

Unlimited consultations with GPs in the Smart Network, with a R65 co-payment for each consultation.
One eye test at a network optometrist for R65.
One dental check-up at dentist, dental therapist or oral hyienest with a R120 co-payment, covered up to the Discovery Health Rate (DHR).
Over-the-counter medication paid up to R835 per family from a network pharmacy.
Cover for prescribed (by a Smart Network GP) schedule 3 and above medication up to R1820 per member and R3030 per family.
Cover for sports related injuries referred by a Smart Network GP: basic x-rays, two specialist visits, 4 physiotherapist / biokineticist / chiropractor visits. Member pays R120 per visit or x-ray.
Chronic Dialysis: Full cover if treatment approved, at a network provider. Other providers covered at 80% of DHR.
Cancer covered at any provider up to DHR.
Hospital cover at private hospitals in the Smart Hospital Network.
Professionals in hospital covered at 200% of DHR.
MRI and CT scans in hospital: If not related to admission or if for conservative back or neck treatment, first R3670 paid by member and balance paid from Hospital Benefit up to DHR.

Discovery Smart Plans 2024 – Essential and Essential Dynamic:

Essential and Essential Dynamic Smart:

Unlimited consultations with GPs in the Smart Network, with a R120 co-payment for each consultation.
One eye test at a network optometrist for R120.
One dental check-up at dentist, dental therapist or oral hyienest with a R180 co-payment, covered up to the Discovery Health Rate (DHR).
Over-the-counter medication paid up to R560 per family from a network pharmacy.
Chronic Dialysis: covered at a state facility.
Cancer covered at a network provider allocated on approval.

Hospital Cover for Essential Smart:

Hospital cover at private hospitals in the Smart Hospital Network.
Professionals in hospital covered at 100% of DHR.
MRI and CT scans in hospital: No cover if not related to admission or if for conservative back or neck treatment.

Hospital Cover for Essential Dynamic Smart:

Hospital cover at private hospitals in the Essential Dynamic Smart Hospital Network as referred by Ask Discovery via the app.
Professionals in hospital covered at 100% of DHR.
MRI and CT scans in hospital: No cover if not related to admission or if for conservative back or neck treatment.

Discovery Smart Plans In 2024 PDF

Discovery Rates And Benefits – 2024 Decisions

The last newsletter included the 2024 rates and benefits. Now is the time to make decisions regarding your plan for 2024.

3 Questions To Ask Yourself:

1. Were you happy on your plan, with most claims covered, or did you run out of benefits early in the year? If you were happy, then you will probably be happy on the same plan next year, unless there are changes in your circumstances.
2. If you ran out of benefits early, add up the medical costs that have not been covered thus far in 2023 (and add the average for the last months of the year). Then take the difference in 2024 premium between your current plan and a plan that would cover all of your costs, and multiply by 12 to get the annual amount. If the amount not covered is less than the extra premium you would be paying, then you might still want to stay on the plan you are on. If the difference is minimal, you need to see if there are any other benefits of a different plan that you would use. And if the premium increase is less than the amount you have not been covered for in 2023, then you might want to upgrade.
3. Has your family dynamic has changed? You may want to consider another plan. For example, if you have or are going to have small children in 2024, you need to make sure the plan you are on for 2024 includes paediatric care and facilities with no co-payments.

Chat to your medical aid broker about your options and the impact of changing or not changing your plan.

Vitality Check: What is normal range?

In 2024, the Health Check plays an important part in increasing your Vitality Benefits. Simply having the Health Check will increase your benefits, and Vitality points are awarded based on the number of in-range or high risk results from your Health Check.

	Blood Glucose	Blood Pressure	Cholesterol	Weight Status	Smoker Status
In-range	< 7.8 mmol/L	< 130/80 mmHG	< 5 mmol/L	Weight in relation to height 18.5 to 24.9 kg/m2 OR Weight in relation to height 25 to 29.9 kg/m2 and waist circumference of <94cm in men and <80cm in women	Non-smoker for at least the past 12 months
Intermediate Risk	7.8 mmol/L to < 11 mmol/L	130/80 mmHG to < 160/100 mmHG	5 mmol/L to < 7.5 mmol/L	Weight in relation to height <18.5 OR Weight in relation to height 25 to 29.9 kg/m2 and waist circumference of ≥94cm in men and ≥80cm in women	n/a
High Risk	≥ 11 mmol/L	≥ 160/100 mmHG	≥ 7.5 mmol/L	Waist in relation to height ≥ 30	Smoker

Ranges are slightly different for those over age 65. These are listed on the website so if you are 65 or older, you can log in and find these on the Vitality Health Check page.