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Discovery Health Executive 2017

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Medical Aid Year: 
2017
Day to day Benefits: 

Unlimited cover in any private hospital, including private ward cover Guaranteed full cover in hospital for specialists on a payment arrangement, and up to 300% of the DHR for other specialists Full cover for chronic medicine for all CDL conditions plus some additional chronic conditions; plus access to an exclusive list of brand medicines Highest Medical Savings Account and an unlimited Above Threshold Benefit for your dayto- day healthcare needs Additional cover for GP consultation fees, kid’s casualty visits, preferred medicine, blood tests, antenatal consultations, video call consultations with paediatricians and some external medical items Cover for medical emergencies when travelling

Co-payments: 
You will be required to pay 20% of the cost on all state facilities. 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
Hospitals: 

Unlimited cover and private ward cover of up to 1 750 each day

Upfront Payments to hospitals: 

No upfront payment

Specialists: 
Full cover
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of the DHR
Radiology and pathology: 
100% of the DHR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
We pay the hospital account from the Hospital Benefit and all related accounts from the Medical Savings Account and Above Threshold Benefit
MRI and CT scans: 
Paid from day-to-day benefits up to 100% of the DHR.
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: 
External medical items* 58 800 for your family. Hearing aids 22 900 for your family
Rehabilitation, Hospice and Step-down facilities: 
Subject to medical savings account
Treatment for Mental Health: 
21 days for admissions or up to 15 out-ofhospital 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 co-payment of 20% and specific rules apply to this benefit.
Day-to-day benefits
GP consultations: 

GPs and all other healthcare services 100% of the DHR

Specialist consultations: 

Specialists we have a payment arrangement with Up to the agreed rate Specialists we don’t have a payment arrangement with 300% of the DHR

Acute medicine: 

We pay for medicine up to a maximum of the Discovery Health Rate for medicine. The Discovery Health Rate for medicine is the price of the medicine as well as the fee for dispensing it.

Over-the-counter (OTC) Medicine: 

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

Optometry benefits: 
Optical* (this limit covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye) 6 800 for each person.
Basic dentistry: 
Dental 48 350 for each person
MRI and CT Scans (Out of Hospital): 
Paid from your available Medical Savings Account or Above Threshold Benefit.
Pregnancy benefits: 
You have access to antenatal consultations and 2D pregnancy scans, provided you use a gynaecologist/obstetrician who we have a payment arrangement with.
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: 

Screening for adults: This benefit covers certain tests at one of our wellness network providers, like blood glucose, blood pressure, cholesterol, body mass index and HIV screening. We also cover a mammogram every 2 years, a Pap smear once every 3 years and a PSA test (prostate screening) each year. Screening for kids: This benefit covers growth assessment tests, including height, weight, head circumference and health and milestone tracking at any one of our wellness providers. If you meet our clinical entry criteria you get access to the following additional tests: Rapid HbA1c glucose test Lipogram cholesterol test Breast MRI or mammogram and once-off BRCA testing for breast screening Pap smear for cervical screening Seasonal flu vaccine for members 65 years or older or registered for certain chronic conditions

Total Contributions
Total Contribution Main Member: 
5544.00
Total Contribution Adult: 
5544.00
Total Contribution Child*: 
1055.00
Executive Plan
Annual Medical Savings Account
Annual Medical Savings Main Member: 
16632.00
Annual Medical Savings Adult: 
16632.00
Annual Medical Savings Child*: 
3156.00
Monthly Medical Savings
Savings Child*: 
263.00
Savings Adult: 
1386.00
Savings Main Member: 
1386.00
Annual Threshold Amounts
Annual Threshold Main Member: 
16600.00
Annual Threshold Adult: 
16600.00
Risk Contributions
Risk Contribution Main Member: 
4158.00
Risk Contribution Adult: 
4158.00
Risk Contribution Child: 
792.00
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