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Discovery Health Classic Smart 2017

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Medical Aid Year: 
2017
Day to day Benefits: 

Unlimited private hospital cover in a Smart network hospital Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 200% of the DHR on the Classic Plan and up to 100% of the DHR on the Essential Plan for other healthcare professionals Day-to-day cover for GP consultation fees, acute medicine, eye and dental check–up and sports–related injuries with fixed payments. Cover depends on the plan you choose. Full cover for chronic medicine on our medicine list for all CDL conditions when you use MedXpress, Clicks or Dis-Chem Cover for medical emergencies when travelling

Co-payments: 
You will have to pay 20% of the cost on all further treatment once costs for cancer treatment go over 200 000. Prescribed Minimum Benefits are covered in full.
In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospitals: 

Unlimited private hospital cover in the Smart Network.

Upfront Payments to hospitals: 

For planned admissions at hospitals outside of the Smart Hospital Network, you must pay an upfront payment of R8 200 to the hospital.

Specialists: 
Full cover
Other healthcare professionals eg. Physio, Occupational, Dietician: 
200% of the DHR
Radiology and pathology: 
100% of the DHR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
You must pay the first 3 900 of the hospital account. We pay the balance of the account and related accounts from the Hospital Benefit.
MRI and CT scans: 
If done as part of an approved hospital admission, we will pay up to 100% of the DHR from the Benefit.
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. Available on Classic only. 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, limited to one procedure for each person each year. Available on Classic only.

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 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. 21 days fo
Day-to-day benefits
GP consultations: 

Unlimited GP consultations, with a 50 payment for each consultation

Specialist consultations: 

Cover for sports-related injuries: basic X-rays, two specialist visits and a total of four visits to either a physiotherapist, biokineticist or chiropractor when referred by a Smart Network GP. You will have to pay 100 for each visit.

Acute medicine: 

Cover for defined acute medicine categories, with a 10 payment for each medicine item

Optometry benefits: 
One eye test at an optometrist with a R50 payment for the test
Basic dentistry: 
One dental check-up with a R100 payment for the check-up
MRI and CT Scans (Out of Hospital): 
You must pay the first 2 900 of MRI or CT scan from your pocket. We cover the balance of the scan from the Hospital Benefit, up to the DHR. For conservative back and neck scans, specific rules and limits may apply.
Chronic Conditions
Additional Chronic Conditions: 
You have cover for the 27 CDL conditions according to the Prescribed Minimum Benefits 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 screening is 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: 
1535.00
Total Contribution Adult: 
1209.00
Total Contribution Child*: 
612.00
Classic Smart
Risk Contributions
Risk Contribution Main Member: 
1535.00
Risk Contribution Adult: 
1209.00
Risk Contribution Child: 
612.00
Benefit: 
We cover the first 200 000 of the approved cancer treatment in full over a 12-month cycl
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: 
No