Discovery Health with 23 Health Plans is a proudly South African company striving to make the world healthier through rewarding healthy living choices. Adrian Gore founded Discovery in 1992 with an idea for a health-insurance model that would make people healthier. The South African start-up quickly grew into a global player, with a market cap of over $8 billion and a foothold in major markets, including the United Kingdom and China.
However, do you understand the Discovery Health Plans and Series? As a rule I have personally found that if you do not like Discovery - it is usually because you on the wrong plan or did not understand your plan. So please find a nice explanation that I use to assist my clients - please note this is not an "in-depth" overview of Discovery - it is pointers and a summary to help you understand Discovery Health better.
Discovery Health have 7 Series and 23 Health Plans. Confusing right? Not at all.
7 Series Explained
- Executive - Offers you the most extensive cover for in-hospital and day-to-day benefits with extended chronic medicine cover and an unlimited Above Threshold Benefit.
- Comprehensive - Comprehensive cover for in-hospital and day-to-day cover with extended chronic medicine cover and an unlimited Above Threshold Benefit.
- Priority - Cost-effective in-hospital cover, essential chronic medicine cover and day-to-day benefits with a limited Above Threshold Benefit.
- Saver - The most economical in-hospital cover, essential chronic medicine cover and day-to-day benefits through a Medical Savings Account.
- Core - A value-for-money hospital plan that provides unlimited private hospital cover and essential cover for chronic medicine with no day-to-day cover.
- Smart - The most cost-effective in-hospital cover, essential chronic medicine cover plus limited day-to-day cover if you’re willing to use providers in a specified network.
- KeyCare - Income based, affordable medical cover if you’re willing to use providers in a specified network for both in-hospital and out-of-hospital treatment.
23 Health Plans within the Series
- The Executive Series only has one (1) plan - no problem
- Comprehensive Series has five (5) plans - Classic, Essential, Classic Delta, Essential Delta & Smart
- Priority Series has two (2) plans - Classic & Essential
- Saver Series has five (5) plans - Classic, Essential, Classic Delta, Essential Delta & Coastal
- Core Series has five (5) plans - Classic, Essential, Classic Delta, Essential Delta & Coastal
- Smart Series has two (2) plans - Classic & Essential
- KeyCare Series has three (3) plans - Start, Core, Plus
The Easy Explanation of 23 Health Plans
- Classic - Hospital reimbursement at 200% medical aid rates + most savings in that Series
- Essential - Hospital reimbursement at 100% medical aid rates
- Delta - Discovery Network Hospitals - you can get Classic Delta or Essential Delta (as above explanation)
- Smart - Discovery Smart Hospitals - you can get Classic or Essential, fixed co-pays or limits for day-to-day
- Coastal - Hospital reimbursement at 100% medical aid rates in the four Coastal Provinces
- KeyCare Start - Discovery Start Network Hospitals at 100%, Chronic at State Facility
- KeyCare Core - Discovery KeyCare Network Hospitals at 100%, Chronic at Network Pharmacy
- KeyCare Plus - Discovery KeyCare Network Hospitals at 100%, Network day-to-day and Chronic
Notes to Help Understand
Even if you are on a Network Plan, in an Emergency go straight to a hospital. If you need medically equipped transport, call 0860 999 911. Highly qualified emergency personnel manage this line. They will send air or road emergency evacuation transport to you, depending on which is most appropriate. Remember that you, a loved one or the hospital must let Discovery Health know about your admission as soon as possible. If you have a medical emergency while overseas, call International SOS on +27 11 541 1222 with your membership number as printed on your membership card.
Benefit or Limit? A benefit is a pool of funds in a medical scheme reserved for specific healthcare services. For example, the Hospital Benefit pays for healthcare services when you are admitted to hospital as part of an approved admission. A limit is the maximum amount or a cap on what the scheme will pay for a particular type of healthcare service. This applies when the service is paid from a specific benefit. For example, your optometry claims either pay from the Medical Savings Account or Above Threshold Benefit but Discovery will only pay these claims up to the optometry limit for your health plan.
The Self-payment Gap (SPG) is a temporary gap in cover when you run out of funds in your Medical Savings Account (MSA) but have not yet reached your Annual Threshold. You will have to pay for day-to-day claims from your own pocket during this period. You must still submit claims to Discovery Health so that they know when to start paying from your Above Threshold Benefit.
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