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Discovery Health Classic Delta Core 2018

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Type of Medical Aid Plan: 
Hospital
Medical Aid Year: 
2018
Day to day Benefits: 

No Benefit.

Co-payments: 
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) R4 200. Dental admissions in hospital younger than 13 - R2 200, 13 and older - R5 650 Day clinic Younger than 13 - R1 000 13 and older - R3 650
In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
200% of Scheme Rate
Hospitals: 

Private hospitals in the Delta Network.

Upfront Payments to hospitals: 

For planned admissions outside of the Delta Hospital Network, you must pay an upfront payment to the hospital of R7 650. Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) R4 200. Dental admissions in hospital Younger than 13 - R2 200 13 and older - R5 650 Day clinic Younger than 13 - R1 000 13 and older - R3 650

Casualty / Emergency Visits: 
No Benefit.
Specialists: 
In our network, full cover. Not in our network 200% of the Discovery Health Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
In our network, full cover. Not in our network 200% of the Discovery Health Rate.
Radiology and pathology: 
100 % of Discovery Health Rate.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
You must pay the first R4 200 of the hospital account. We pay the balance of the account and related accounts from the Hospital Benefit. If done in the doctor’s rooms, we pay the account from your Hospital Benefit.
MRI and CT scans: 
If done as part of an approved admission, we will pay up to 100% of the Discovery Health Rate from the Hospital Benefit.If not related to your admission or if for conservative back or neck treatment, we do not pay for it.
ICU and High Care: 
100 % of Discovery Health Rate.
Dialysis: 
We cover these expenses in full if we have approved your treatment plan and you use a provider in our network. If you go elsewhere, we will pay up to 80% of the Discovery Health Rate.
Organ Transplants: 
As per Scheme Protocols.
Oncology / Cancer: 
We cover the first R200 000 of the approved cancer treatment in full, over a 12-month cycle. You will be required to pay 20% of the cost on all further treatment once costs for cancer treatment go over R200 000. Prescribed Minimum Benefits fully covered.
Neck and Back Operations: 
There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R25 500 for the first level and R51 000 for two or more levels, limited to one procedure for each person each year.
Joint Replacements: 
There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, certain limits may apply to each prosthesis.
Prosthesis: 

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 R25 500 for the first level and R51 000 for two or more levels applies, limited to one procedure for each person each year. Shoulder joint prosthesis There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R40 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 Discovery Health Rate the hospital account. A limit of R30 000 applies to each prosthesis for each admission. This network will not apply to emergency and trauma-related,surgeries.

Medical and Surgical Appliances: 
No Benefit.
Maternity Confinements: 
100 % of Discovery Health Rate.
In Hospital Dentistry: 
Upfront payment. Balance of hospital account, dental surgeon & related accounts 100% of the DHR. Anaesthetists 200% of DHR. You pay for dental appliances & orthodontic treatment incl related accounts for orthognathic surgery.
Take home Medicine: 
No Benefit.
Rehabilitation, Hospice and Step-down facilities: 
21 days for each person.
Treatment for Mental Health: 
21 days for admissions or up to 15 out-of-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.
HIV / AIDS: 
When you register for our HIVCare Programme, you are covered for the care you need, which includes additional cover for social workers. Be assured of confidentiality at all times. You need to get your medicine from a DSP to avoid a 20 % co-payment.
Ambulance Service: 
911
International Travel Benefit: 
Cover up to R5 million for each person on each journey for emergency medical costs while travelling outside of South Africa, for a period of 90 days from your departure from South Africa. Specific rules apply and pre-existing conditions are excluded.
Day-to-day benefits
GP consultations: 

No Benefit.

Specialist consultations: 

No Benefit.

Acute medicine: 

No Benefit.

Over-the-counter (OTC) Medicine: 

No Benefit.

Optometry benefits: 
No Benefit.
Basic dentistry: 
No Benefit.
Specialised Dentistry: 
No Benefit.
Orthodontics: 

No Benefit.

MRI and CT Scans (Out of Hospital): 
No Benefit.
Radiology and Pathology: 
No Benefit.
Pregnancy benefits: 
You are covered for 8 consults at your gynaecologist, GP or midwife. 1 NIPT screening, 2x 2D ultrasound scans, a defined basket of blood tests, 1 flu vaccination, 5 pre- or postnatal classes or consults with a registered nurse
Physiotherapy and Occupational Therapy day to day: 
No Benefit.
Chronic Conditions
Provider: 
Designated Service Provider.
Chronic Conditions: 

Chronic Disease List: Addison’s disease, asthma, bipolar mood disorder, bronchiectasis, cardiac failure, cardiomyopathy, chronic obstructive pulmonary disease, chronic renal disease, coronary artery disease, Crohn’s disease, diabetes insipidus, diabetes Type 1, diabetes Type 2, dysrhythmia, epilepsy, glaucoma, haemophilia, HIV, hyperlipidaemia, hypertension, hypothyroidism, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, schizophrenia, systemic lupus erythematosus, ulcerative colitis

Additional Chronic Conditions: 
No Benefit.
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. Seasonal flu vaccine during pregnancy, or for members 65 years or older and/or registered for certain chronic conditions. Additional, and/or more frequent screening is available for those who meet our clinical criteria. Kids screening covers growth assessment and health and milestone tracking at any one of our wellness network providers.

Total Contributions
Total Contribution Main Member: 
1652.00
Total Contribution Adult: 
1301.00
Total Contribution Child*: 
660.00
Classic Delta Core
Risk Contributions
Risk Contribution Main Member: 
1652.00
Risk Contribution Adult: 
1301.00
Risk Contribution Child: 
660.00
How many times per annum do you and your dependants visit a doctor?: 
0
How much do you spend on Acute medication per annum?: 
0
How much do you spend on Chronic medication per annum?: 
0
Will you or any of your dependants require specialised Dentistry: 
No