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DISCOVERY HEALTH CLASSIC COMPREHENSIVE 2019

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Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2019
Day to day Benefits: 

25% of your monthly contribution goes into your Medical Savings Account (MSA) Face-to-face and video GP consultations Kids casualty visits We pay the first R2 900 from your day to-day benefits and the balance from your Hospital Benefit (for conservative back and neck scans, specific rules apply) Extends your cover for out-of-hospital claims for recovery after certain traumatic events for the rest of the year in which the trauma took place, and a year after the trauma

In Hospital Benefits
Hospital Rate of Payment: 
Covered in full at the rate agreed with the hospital
Hospitals: 

Any private hospital

Specialists: 
Specialists we have a payment arrangement with Full cover
Radiology and pathology: 
100% of the Discovery Health Rate (DHR)
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
We pay the first R3 750 of the hospital account from your day-to-day benefits and the balance of the hospital account and related accounts from the Hospital Benefit. If done in the doctor’s rooms, you won’t have to pay an amount upfront.
MRI and CT scans: 
We pay the first R2 900 from your day to-day benefits and the balance from your Hospital Benefit (for conservative back and neck scans, specific rules apply)
Oncology / Cancer: 
we cover the first R400 000. If your treatment costs more than the cover amount, we will cover up to 80% of the subsequent additional costs.
Joint Replacements: 
We cover planned hip and knee joint replacements in full when you use a provider in our network.
Prosthesis: 

There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R25 500 applies for the first level and R51 000 for two or more levels, limited to one procedure for each person each year.

Medical and Surgical Appliances: 
Subject to savings
Maternity Confinements: 
You are covered for your delivery from the Hospital Benefit. In addition, you have private ward cover up to R1 970 per day for your approved hospital stay for the delivery.
Take home Medicine: 
Subject to savings
Rehabilitation, Hospice and Step-down facilities: 
21 days for each person
Treatment for Mental Health: 
21 days for all other mental health admissions. All mental health admissions are covered in full at a network facility. If you go elsewhere, we will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account.
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: 

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 100% of the DHR

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 (ATB).

Optometry benefits: 
R5 500 for each person covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye)
Basic dentistry: 
we cover routine conservative dentistry, such as preventive treatment, simple fillings and root canal treatment, from your available day-to-day benefits.
Chronic Conditions
Provider: 
Designated Service Provider
Chronic Conditions: 

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: 
Ankylosing spondylitis, Behςet’s disease, Cystic fibrosis, Delusional disorder, dermatopolymyositis, Generalised anxiety disorder, Huntington’s disease, Isolated growth hormone deficiency, Major depression,muscular dystrophy and other inherited myopathies
Total Contributions
Total Contribution Main Member: 
5368.00
Total Contribution Adult: 
5077.00
Total Contribution Child*: 
1070.00
Classic Comprehensive
Annual Medical Savings Account
Annual Medical Savings Main Member: 
16104.00
Annual Medical Savings Adult: 
15228.00
Annual Medical Savings Child*: 
3204.00
Monthly Medical Savings
Savings Child*: 
267.00
Savings Adult: 
1269.00
Savings Main Member: 
1342.00
Annual Threshold Amounts
Annual Threshold Main Member: 
18800.00
Annual Threshold Adult: 
18800.00
Annual Threshold Child*: 
3600.00
Above Threshold Benefit Limits
Above Threshold Benefit Main Member: 
9999999.00
Above Threshold Benefit Adult: 
9999999.00
Above Threshold Benefit Child*: 
9999999.00
Risk Contributions
Risk Contribution Main Member: 
4026.00
Risk Contribution Adult: 
3808.00
Risk Contribution Child: 
803.00
Medical Aid Plan Name Term: 
Any