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Discovery Health Classic Comprehensive 2017

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2017
Co-payments: 
You will be required to pay 20% of the cost on all further treatment once costs for cancer treatment go over 400 000. Prescribed Minimum Benefits are covered in full.
In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
100 % of scheme rate
Hospitals: 

Any hospital

Upfront Payments to hospitals: 

Not applicable

Casualty / Emergency Visits: 
Paid from medical savings account
Specialists: 
Unlimited 200 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited 200 % of scheme rate
Radiology and pathology: 
100% of the DHR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
We pay the first 3 150 of the hospital account from your day-to-day benefits and the balance of the hospital account and related accounts from the Hospital Benefit.
MRI and CT scans: 
If done as part of an approved admission, we will pay up to 100% of the DHR from the Hospital Benefit.
ICU and High Care: 
Unlimited 100 % of scheme rate
Dialysis: 
Unlimited 100 % of scheme rate
Organ Transplants: 
Subject to pre-authorisation and clinical protocols Unlimited 100 % of scheme rate
Prosthesis: 

Shoulder joint prostheses: There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of 40 000 applies to each prosthesis. Major joints surgery: We cover planned hip and knee joint replacements in full when you use a provider in our network. If you go elsewhere, we will pay up to 80% of the DHR for the hospital account. A limit of 38 200 applies to each prosthesis for each admission. Prosthetic devices used in spinal surgery: There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of 25 500 for the first level and 51 000 for two or more levels applies, limited to one procedure for each person each year.

Medical and Surgical Appliances: 
Subject to medical savings account
Maternity Confinements: 
You have access to antenatal consultations and 2D pregnancy scans, provided you use a gynaecologist/obstetrician who we have a payment arrangement with
Rehabilitation, Hospice and Step-down facilities: 
Out-of-hospital claims for recovery after certain traumatic events are covered on this benefit for the rest of the year in which the trauma took place, and a year after the trauma.
Treatment for Mental Health: 
21 days for admissions or up to 15 outof- hospital consultations for each person for major affective disorders, anorexia and bulimia and up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma. 21 days for
International Travel Benefit: 
Up to 500 000 for each person travelling for evidence-based healthcare treatment not available in South Africa. A copayment of 20% and specific rules apply to this benefit.
Day-to-day benefits
GP consultations: 

Subject to medical savings account

Specialist consultations: 

Subject to medical savings account

Over-the-counter (OTC) Medicine: 

We pay these claims from the available funds in your Medical Savings Account. These claims do not add up to the Annual Threshold and are not paid from the Above Threshold Benefit.

Optometry benefits: 
Subject to medical savings account
Basic dentistry: 
Subject to medical savings account
MRI and CT Scans (Out of Hospital): 
We pay the first 2 900 of your MRI or CT scan from your day-to-day benefits. We cover the balance of the scan from the Hospital Benefit, up to the DHR. For conservative back and neck scans, where specific rules apply. On Classic Zero MSA, these are cover
Pregnancy benefits: 
Subject to medical savings account
Chronic Conditions
Additional Chronic Conditions: 
You have cover for the 27 CDL conditions according to the Prescribed Minimum Benefits list as well as additional conditions on our Additional Disease List. Your condition needs to be approved for it to be covered.
Preventative Care Benefits
Preventative Benefits: 

Covers certain tests at one of our wellness network providers, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram every 2 years, Pap smear every 3 years, PSA (a prostate screening test) once a year and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine. Additional, and/or more frequent screenings are available for those who meet our clinical criteria. Kid’s screening: Covers growth assessment and health and milestone tracking at any one of our wellness network providers.

Total Contributions
Total Contribution Main Member: 
4506.00
Total Contribution Adult: 
4264.00
Total Contribution Child*: 
898.00
Classic Comprehensive
Annual Medical Savings Account
Annual Medical Savings Main Member: 
13512.00
Annual Medical Savings Adult: 
12792.00
Annual Medical Savings Child*: 
2688.00
Monthly Medical Savings
Savings Child*: 
224.00
Savings Adult: 
1066.00
Savings Main Member: 
1126.00
Annual Threshold Amounts
Annual Threshold Main Member: 
15500.00
Annual Threshold Adult: 
15500.00
Annual Threshold Child*: 
2950.00
Risk Contributions
Risk Contribution Main Member: 
3380.00
Risk Contribution Adult: 
3198.00
Risk Contribution Child: 
674.00
Benefit: 
We cover the first 400 000 of approved cancer treatment in full over a 12-month cycle.
How many times per annum do you and your dependants visit a doctor?: 
15
How much do you spend on Acute medication per annum?: 
More than R 5000
How much do you spend on Chronic medication per annum?: 
More than R 5000
Will you or any of your dependants require specialised Dentistry: 
Yes