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Discovery Health Essential Saver 2017

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2017
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 100 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited 100 % of scheme rate
Radiology and pathology: 
100% of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
100 % of scheme rate subject to R3 900 co-payment per admission
MRI and CT scans: 
Unlimited 100 % of scheme rate subject to R2 900 co-payment
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
Oncology / Cancer: 
100 % of scheme rate DSP
Neck and Back Operations: 
100 % of scheme rate
Joint Replacements: 
100 % of scheme rate
Prosthesis: 

All hospital admissions and prostheses are subject to pre-authorisation, protocols and case management. See brochure for full details.

Medical and Surgical Appliances: 
Subject to medical savings account
Maternity Confinements: 
Unlimited 100 % of scheme rate
In Hospital Dentistry: 
Dentistry: day clinic; R930 <13 years. R3 400 >13 years. In hospital: R2050 <13 years. R5 250 > 13 years
Take home Medicine: 
Subject to savings.
Rehabilitation, Hospice and Step-down facilities: 
Subect to pre-authorisation and prescribed by a medical doctor
Treatment for Mental Health: 
21 days for admissions or 15 out-of-hospital consultations for per beneficiary for major affective disorders and 12 out-of-hospital consultations for acute stress disorder.
HIV / AIDS: 
100 % of scheme rate
Ambulance Service: 
Netcare 911
International Travel Benefit: 
R5 million
Day-to-day benefits
GP consultations: 

Subject to medical savings account and above threshold benefit.

Specialist consultations: 

Subject to medical savings account.

Acute medicine: 

Subject to medical savings account.

Over-the-counter (OTC) Medicine: 

Subject to medical savings account.

Optometry benefits: 
Subject to medical savings account
Basic dentistry: 
Subject to medical savings account.
Specialised Dentistry: 
Subject to medical savings account.
Orthodontics: 

Subject to medical savings account.

MRI and CT Scans (Out of Hospital): 
First R2 750 of MRI or CT scan is paid from available Medical Savings Account. Balance of scan covered from Hospital Benefit, up to the scheme tariff.
Radiology and Pathology: 
Subject to medical savings account.
Pregnancy benefits: 
Subject to medical savings account.
Physiotherapy and Occupational Therapy day to day: 
Subject to medical savings account.
Chronic Conditions
Provider: 
Any pharmacy
Chronic Conditions: 

26 Conditions on Chronic Disease List.

Additional Chronic Conditions: 
No Benefit
Preventative Care Benefits
Preventative Benefits: 

One test per beneficiary per year. Covered at wellness providers, blood glucose, blood pressure, cholesterol, body mass index and HIV screening. Mammogram every 2 years (40+), Pap smear once every 3 years and a PSA test (prostate screening) each year. Screening for kids: Growth assessment tests, including height, weight, head circumference and health and milestone tracking at wellness providers.

Total Contributions
Total Contribution Main Member: 
2047.00
Total Contribution Adult: 
1536.00
Total Contribution Child*: 
819.00
Essential Saver
Annual Medical Savings Account
Annual Medical Savings Main Member: 
3684.00
Annual Medical Savings Adult: 
2760.00
Annual Medical Savings Child*: 
1464.00
Monthly Medical Savings
Savings Child*: 
122.00
Savings Adult: 
230.00
Savings Main Member: 
307.00
Risk Contributions
Risk Contribution Main Member: 
1740.00
Risk Contribution Adult: 
1306.00
Risk Contribution Child: 
697.00
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