I have used up my Medical Savings Account, can I still see a doctor? I am a loyal customer of Discovery and have been a member of Discovery Health since I entered the workplace in 1996. During my start-up years from 2006 to 2009, I moved to my wife's company medical aid Sasolmed, then later changed to Medicover. In 2009, I returned to Discovery Health. My medical aid option has been Classic Delta Saver for the last few years. I think this plan is value for money, suitable for our family of five. However, towards the end of the year, I often run out of Medical Savings Account, then I have to pay out of my own pocket to see a doctor or to buy medicine. This plan provides Day-to-Day Extender Benefits: even when the savings account is used up, you can still visit a designated GP and be covered by Discovery. Discovery Health covers up to 6 network GP visits, which is helpful. The protocol to access this extender benefit has changed since the end of last year, however. Although I am a healthcare broker, I forgot to keep up with the change. I still wanted to use the same procedure as I have used in the past. I then ran into a wall and the Discovery Health refused to pay. What is going on here? There were like R30 left in my MSA. In order to use the extender benefits, I went to Dis-chem pharmacy to buy over-the-counter medicine. The intention was to reduce the savings account to zero. I asked the pharmacist to deduct from my savings account first, and I would pay the balance in cash. I also asked the pharmacist to confirm that there was no money in my savings account. After that, I made an appointment for my son with a designated family doctor, to assess his spinal injury. After the consultation, the front desk staff said that the claim had been submitted to Discovery Health, so I didn't have to pay for it. I thought that this extender benefit was really good, only to receive a claim statement from Discovery a few days later that they did not pay. I thought there was some misunderstanding. Upon further investigation, it turned out that I didn't apply the knowledge acquired. At the end of last year, Discovery announced a new process to use extender benefits. The first is to go to a network pharmacy such as Dis-chem to see a nurse. Or download the Dr Connect app on your mobile phone to consult with a doctor online. The infographic below illustrates: Below are the steps of how DrConnect works 1. Download DrConnect on the smart phone 2. Open the APP and log in 3. Log in with your Discovery Username and Password 4. You will see 4 categories: Assess your symptoms, Talk to a doctor, Ask doctors your questions, Enrol in a care guide. 5. If the GP you have visited before is also a DrConnect network doctor, he/she will appear here. Click the doctor for more options. 6. You can choose to book an appointment, send them a message about your queries, or connect for a video consultation (when they are online). 7. Or, on the main page (home), choose to ask a question. 8. Type in the question you would like to ask. 9. Answer a quick health survey or click Skip to skip it. 10. There may be other people have asked a similar question, which already has an answer to, see if you can find your answer here, if not, click to send your question.
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It is now time to review your medical aid scheme cover for 2021. This means you have a window within which you can switch to a different plan for the new year. This window usually closes at the end of November (depending on your current provider), so don’t delay collecting the necessary information. This is not a decision to be rushed.
Why do I have to decide now? Medical aid providers allow you to switch to a higher plan once a year (at the end of the year) without penalties or consequences. If you want to save on premiums or you need to increase benefits, now is the time to do it. Generally, medical schemes give you until the end of the year to change your plan. What if I want to change providers altogether? If you are unhappy with your medical aid provider, you can switch to another at any time of the year. But before you do, consider the following: Waiting Periods Medical Aids by law must accept anyone who applies to join their scheme. To protect themselves from older or sickly members that join without having contributed to the risk pool, they usually impose a waiting period of between 3 and 12 months. Waiting periods will apply if 1) you have not been a member of another South African medical aid for the past three months or more, 2) if you change medical schemes before 2 years of being covered with your previous medical aid provider and 3) if you have a pre-existing medical condition. Finding out about any waiting periods is extremely important before deciding to change providers. Late joiner penalty As an additional means to manage the risk of older or sickly members joining without having contributed to the risk pool, medical schemes (according to the Medical Schemes Act) are entitles to add a late joiner penalty to your premium if you were not part of a medical scheme before 01 April 2001. The late joiner penalty is calculated (using a prescribed formula) based on the number of years that you were not on a registered South African medical scheme. The late joiner fee can range between 5% and 75% of the total contribution, depending on the number of years that you were not covered by a medical scheme. It is important to keep proof of all your previous medical scheme membership, as it would help reduce or remove the Late Joiner Penalty. General considerations When reviewing your medical aid plan, you should consider the following factors: - benefits - exclusions - co-payments and deductibles - provider network restrictions - financial soundness of the medical scheme - the medical scheme's service and ability to pay claims - premium (affordability) - gap cover product to supplement your medical aid. Please contact our health team, Tel 011-658-1333, Option 2, or email [email protected] , to find out about different medical aid options. ![]() Sirago is one of the leading medical gap cover providers in South Africa. If you have medical aid, then Sirago gap cover is an essential supplement to your medical aid, to cover payment shortfalls. Sirago offers some of the premium, benefit-rich products. Overall, the premium increase will be 8.6%. It has some great updates and additions in 2021. These are:
Continuing with their focus on specific niche markets, they will be launching the following products:
2021 Sirago Gap Cover Premium Momentum Medical Scheme focuses more than ever on keeping benefit design stable and ensuring that their members continue to enjoy comprehensive and affordable benefits. The 3rd largest open medical aid scheme in South Africa, Momentum Medical Scheme has announced an average annual contribution increase of 3.9% for 2021. This is substantially lower that the weighted average annual contribution increase of 8.2% for 2020.
If you have any queries or are interested in joining Momentum Medical Scheme, please contact us on 011-658-1333, 076-200-5488 or email [email protected]. Bonitas, the second-largest open medical scheme in South Africa, has recently released their 2021 updates and increment across all plans. Bonitas recognises that it has been a tough year. It has settled on lowest increase possible to maintain consistent service to the clients for 2021. With the guideline from the Council for Medical Schemes, Bonitas has settled on an average increase of 4.6% across all plans which will range between 0% and 7.1%. The BonFit Select plan has 0% increase. It is to ensure affordability and sustainability for all the members going forth as Bonitas has noted that 7 of its current options are priced between R1500 and R3000 per month, which is where the medical scheme market is experiencing growth currently. "Member behaviour has changed significantly, and demand is for innovation, accessibility and technology. This has the benefit of attracting, a younger, target audience and driving sustainability,” it said. Bonitas has introduced 2 new medical aid plans for 2021, these plans are induced by technology, called Edge.
BonStart and Bonstart Plus, are designed for economically active singles or couples, living in the larger metros, which include access to: • Private hospital network and full cover for emergencies • PMB chronic medicine • Day to day benefits including unlimited GP consultations • Layers of virtual care, dental and optical benefits; preventative care • Wellness screenings • Contraceptives and so much more… The above monthly premium is R1452 and R1731 for principal member respectively. This year has been a challenging year for most due to global pandemic hence personal assurance on safety is where Bonitas will develop and focus their core services like home-based care and day hospitals to reduce risks. Other developments for 2021 include: • Developing its WhatsApp channel and virtual technology platforms • Continuing with the virtual care platform, which provides access to GP consultations and free delivery of chronic medicine • Promoting mental health and mental wellbeing, with screening via the app and providing effective care where necessary • Using the Wellness Extender benefit to pay for up to three months of subscription fees for Run/Walk for life to help members get healthier. To speak to a Medical Aid Consultant, please email [email protected], Tel 011-658-1333, Option 2 for Medical Aid. Discovery continues to lead the industry by rolling out exciting benefits and offerings: Mental wellbeing Shari'ah compliance arrangement Infertility and assisted reproductive therapy benefit Hospital network and day surgery updates New clinic and other services for employers Diabetes care programme Chronic Illness Benefits Co-payments and deductibles To find out more, please click on each tab below.
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Mental wellbeing Statistics according to WHO shows one in four people in the world will be affected by mental disorders at some point in their lives, this positions mental disorder amongst one of the leading causes of ill-health worldwide. Mental ill-ness often left undiagnosed and with 84% of adults never receiving treatment and this impacts society and WHO estimates cost to global economy may exceed $16 trillion by 2030. Discovery’s approach to alleviate this disorder, they have introduced management in mental wellbeing. Below programs offered are:
Shari’ah compliant arrangement From 2021 members from our Muslim community can appoint to have their contribution and claims across all plans to conform with Shari’ah principles through the Shari’ah compliant arrangement. • Model is compliant and is based on Takaful principles • Process flow happens in an acceptable manner • No interest earned or paid at any stage • No ambiguity in contracts • Members’ interests are protected • Investments are managed in Shari’ah Compliant manner • No interest earned or paid on Shari’ah Compliant arrangement. Funds will be invested in a compliant manner allowing members opportunity to earn profit on Medical Savings Account balances. • Members that partake in this arrangement attain affirmation on their contribution and balances remaining after settlement of claims and other expenditure will be invested in Shari’ah compliant investments. Infertility and assisted reproductive Therapy benefit When a couple is looking forward to building a family and the incapability to fall pregnant is aggravating. It affects many families and takes a emotional toll, however, many infertility cases can be remedied through treatment such as drug, surgical repair and assisted reproductive techniques including intra-urine insemination (IUI) and in vitro fertilisation (IVF). Taking a leap of faith on possibility to become a parent can come with a price tag, an average of R65000.00 – R85000.00 for a single IVF treatment cycle, this may be a hefty cost for many families in which will hinder and or have reservations from taking on this treatment. Discovery would like to support couples/ families distressed from infertility with introducing cover for Assisted Reproductive Technologies (ART) and the benefit will include cover for: • Up to two cycles of ART if Scheme’s benefit and clinical entry criteria are met. • This includes a series of care for the progress of the full duration: consultations, ultrasounds, oocyte retrieval, embryo transfers, admission costs including lab fees, medication and embryo and sperm storage. • The total limit of R110 000.00 per person per year at Discovery health rate applies. • Members will be subject to 25% of the costs and any excess above the Discovery Health Rate. • This benefit will be attainable at Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG) accredited centres only and subject to clinical pathways and protocols. • Lastly, the benefit is only available to female members that has been on Executive and Comprehensive Plans for at least 2 years and the age between 25-42 years old.
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Chronic Illness Benefits
Diabetes Care Programme 2021 Premier Plus GP network will become the Designated service provider for members with Diabetes on the comprehensive plans. It is supported by the extensive coverage offered by the Premier Plus GP network and the clinical outcomes achieved by the diabetes care programme. The chosen GP will be member’s DSP for the ongoing management of diabetes as well as cardiovascular conditions. Statistics has shown in improvement when member’s care is coordinated by a single doctor. Hospital Network Updates and Day Surgery New hospitals will be added, and some existing hospitals will be replaced with region specific substitutions for 2021 to ensure continued optimisation of the Delta, Smart and KeyCare hospital networks In the Day Surgery, they will extend this offer to Comprehensive plans given focus on provider and patient safety because of COVID-19. The 2021 new hospital network and day surgery lists will be published by the end of October 2020.
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Limits, Co-payments, deductible and Thresholds
Next: Vitality 2021 - To Help members stay motivated Co-payments For Endoscopic Procedures
New Clinic and Other Services for Employers Daily monitoring of COVID-19 exposure, prevalence, and disease progression:
![]() On 30 September 2020, Discovery hosted its first ever virtual workshop with over 10,000 brokers, to announce Discovery Health's benefits and contribution update for 2021. Discovery reiterates that its core purpose is to make people healthier and enhance and protect their lives. 2020 has been a very challenging year from the healthcare perspective. According to Discovery Health's statistics, during the lockdown period over the last few months, the number of elective surgeries has drastically reduced as members chose to delay these treatments and avoid going to the hospital. The COVID pandemic meant most of the healthcare resources were directed towards the testing and treating COVID patients. No increase in contributions up until 30 June 2021Discovery Health understands that everyone has gone through financial strain during the lockdown, so we are excited to announce that Discovery has decided to freeze all scheme contribution increase across all plans for the first 6 months of 2021. However, this alleviation is not long term, thus the contribution increase will be announced during the second quarter of the year and implemented on 1 July 2021. The expected increase will be CPI + 2%, capped at 5.9%. Doing so, they are looking to assist members in affordability, sustainability and spreading the financial impact everyone has gone through during 2020. Based on its data analysis and observations during the pandemic, four trends have emerged: Utilisaiton discontinuity - how the COVID pandemic has disrupted the normal medical utilisation pattern. Technology - the pandemic has pushed the use of technology to the fore, to enable digital healthcare services from the comfort of one's home. Quality care Access - recognising that millions of South Africans don't have medical aid, Discovery announces a solution to make healthcare affordable and accessible to all. We use a few infographics to illustrate these trends: Discovery Health's experience shows the COVID pandemic peaked around June to August. What has helped the scheme was from late March to now the number of non-COVID hospital admissions have reduced by 20% to 30% compared to last year. Discovery Health has always been innovative and progressive with technology. Since the lockdown began, virtual consultations have increased by 8-fold. Discovery Health now introduces Connected Care, where it enables a range of appropriate home-based healthcare services for all levels of care. The picture above shows the TytoHome diagnostic device Discovery is bringing into the country and offering its members. Discovery's research shows 50% of South Africans are on "pre-paid" healthcare. They have launched Prepaid Health to cater for all South Africans. This new offering launching at the end of December 2020 is one of the exciting products where good healthcare is available to anyone on a pay-as-your-go basis. Discovery leverages on its network, so you have access to good healthcare at a discounted rate. For members on hospital plans only, they can also purchase these vouchers for their day-to-day benefits. Discovery Health Plan Guides 2021Below are the Discovery Health Plan Guide brochures for 2021 (note these are still subject to approval by the Council for Medical Schemes): Next: Other highlights in Discovery Health Product Update 2021
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AuthorKevin Yeh Archives
January 2025
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