Discovery, is the leading company of South Africa's medical insurance company that has developed a very complete mobile app. You can log in to the Discovery mobile App to view the benefits you have-the benefits that have not been used, and the benefits that have been used. Note: The benefits of each insurance option may be slightly be different. If you have not downloaded the Discovery App, please check this link for steps: How to download the Discovery App If you have not registered yet, please click on the link :Registering for Discovery When you log in to the mobile app, you can see the following screen: 1. Click the menu in the upper left corner 2. Click on medical aid 3. Then select Your plan, then select benefit used 4. The following is an example of Different health insurance options as they may have different benefits. 0/1 means that there is an unused item, 1/1 means that there is a benefit that has been used. Some benefits may not be in line with you (for example: female clients cannot use "prostate examination") 5. You can also click "Medical aid Details" 6.Then click on your option, the arrow on the far right. 7. You will see this screen: You can choose the benefits you want to view. 8. The following takes "daily benefits" as an example If you have any other queries regarding your benefits please contact Namhla or Tammy in our Health department email; [email protected] call (011) 658 1333.
![]() Did you Know! That when you leave a medical aid as a member on Medical aid savings plan, as a member you have the following options • To request the refund which normally gets refunded back in 4 to 5 month • Members can request early payment on their Medical Aid Savings if they have financial problems, but they need to guarantee the scheme that should any claims arise after that they will be held accountable. • To request a transfer of Medical aid savings if they will be joining another medical aid that has the same component, Medical aid savings The other thing that members should know about their Medical aid savings - is that it works like a bank account, What you do not spend you carry over to the next year. But members needs to make sure they are on the New Generation scheme , options that offer Medical Aid savings not the Traditional scheme. Member can refer to their scheme website as the is different terms and conditions. If you have any queries regarding your medical aid, please contact Namhla in our Health Department, email [email protected] , tel (011)658-1333 ![]() Picking a new plan partway through the year is usually not allowed. As medical costs continue to rise, the last thing you want is to find out that you are on the wrong medical scheme plan. But, depending on the rules of your scheme, you may not be able to change medical scheme options partway through the year, says Damian McHugh, executive head of sales and marketing at Momentum Health. When considering a change of medical aid cover, it might mean moving between schemes — from Momentum to Discovery, for example — or staying with the same medical scheme and changing your plan or option — such as moving from Discovery’s Coastal Core plan to the Classic Saver plan. The main reason for limiting when members can change options is to prevent the practice whereby “everyone stays on the cheapest option and when they get sick, they jump onto the highest plan. That’s like only buying insurance after you crash your car,” says McHugh. “So most medical schemes are likely to say no if you want to move from one plan to another within a year. “In October or November, you can choose your scheme and plan for the following year, and then you can’t change until the following year,” he says. Jill Larkan, the head of health-care consulting at financial services company GTC, says you may realise you are on the wrong plan when: • You reach the middle of the year and find you have a huge balance in your savings and you are paying a large medical aid premium every month. In this case, you are probably on an expensive plan even though you don’t have many health-care needs; • Your finances are taking strain and you need to find cheaper cover. This is probably relevant for many medical aid members right now; • You are facing a future medical or hospital event and realise you are on a plan with few benefits (for example, a hospital plan) when you actually need one with much higher benefits (for example, a comprehensive plan); or • You have a chronic condition or a severe illness, such as cancer, and your current benefits don’t match up to your treatment requirements. TOWARDS YEAR-END YOU CAN CHANGE OR KEEP YOUR PLAN FOR THE FOLLOWING YEAR Larkan notes that some medical schemes are more flexible. For example, Fedhealth will allow you to change your plan within the scheme within 30 days of a life-changing event, such as marriage of the main member, pregnancy or the diagnosis of a dread disease, like cancer, diabetes or HIV/Aids. “Discovery Health will allow you to downgrade if it is due to a reason such as death or divorce, where the premium or benefit level is simply no longer required. Discovery may also allow you to downgrade to a lesser plan if, for example, you decide you can use a lower-cost plan and you want to redirect the money you save on contributions towards a Discovery retirement annuity,” she says. However, she notes that there are set parameters for such downgrades. For example, if you are currently on a network plan that means you are restricted to a specific network of doctors and/or hospitals, you cannot “change to a plan that allows freedom of choice in hospital selection. “You will be required to stick within the original choice of plan network limitations,” Larkan says. Considerations when deciding to switch Changing to a medical scheme other than that recommended by your employer may mean your employer is unlikely to continue to pay your medical scheme subsidy, which will increase your contributions greatly. If you switch partway through the year, your benefits may be calculated from the date of joining the new option or scheme. For example, says Bianca Viljoen, spokesperson for Health Squared Medical Scheme, the new plan may have a R500,000 limit for cancer, but if you switch at the end of June, you will only be able to access 50% or R250,000. “You would have proportionately lower benefit limits for the remainder of the year,” she says. If you have pre-existing conditions such as asthma or cardiac issues, the new medical scheme is allowed by law to provide three underwriting conditions: 1. A three-month general waiting period where no claims are covered except the prescribed minimum benefits (PMBs) and chronic medicines. Note that your chronic medicines might be covered but the new medical scheme might pay for a different product. 2. A 12-month, condition-specific waiting period if you have pre-existing conditions such as cholesterol, for example. The new scheme may not cover any costs related to that condition for a year. This waiting period can only be applied if you have not been a member of a scheme for 24 months or if you don’t join a new scheme within three months. 3. A late joiner penalty — this only applies if you did not previously belong to a medical scheme and are 35 or older. The late joiner penalty is percentage-based on a sliding scale, depending on how old you are and for how long you had no medical aid after 35. Damian McHugh, executive head of sales and marketing at Momentum Health, says you can switch from one medical scheme to another halfway through the year if you are self-employed or your company gives you a choice of schemes. He says applying to a new medical scheme costs you nothing. “My recommendation would be to fill out the form and see what the new medical scheme comes back with. If they impose restrictions, you are under no obligation to move just because you applied to a scheme. “Don’t cancel your existing medical scheme cover until you have made a final decision,” he says. Please contact Tammy in our Health Department, email [email protected],to find out about different Medical aid options Source: Business Live ![]() All South African medical schemes are now regulated to cover the Covid- 19 as a PMB condition. Below is how Momentum & Discovery will cover their members. Discovery Members Members can do 2 tests per Annum Members will follow the below process:
Payment decision on the WHO Global Outbreak Benefit Discovery designed the WHO Global Outbreak Benefit to respond to global health emergencies, such as the COVID-19 virus. What the WHO Global Outbreak Benefit is The WHO Global Outbreak Benefit covers the out-of-hospital management and appropriate supportive treatment of global World Health Organisation (WHO) recognised disease outbreaks and out-of-hospital healthcare services related to COVID-19. This benefit offers cover for the Prescribed Minimum Benefits (PMB) as well as additional cover, and does not affect your day-to-day benefits as long as it meets the Scheme’s benefit entry criteria. Your benefit confirmation Use of the relevant networks as per your chosen health plan will apply for healthcare services paid from the WHO Global Outbreak Benefit. The benefits covered from the WHO Global Outbreak Benefit are outlined below: Healthcare services not covered by the WHO Global Outbreak Benefit will pay from available day-to-day benefits, depending on your Discovery Health Medical Scheme plan.
Momentum members.
![]() Benefits can become complicated. For your own good, here’s what you should know. Medical schemes undertake liability in return for a premium or contribution. They are required to help their members in obtaining healthcare services and defraying expenditure for such services. The benefits that a scheme may grant must be registered in its rules. Schemes typically cover the following healthcare services:
Common tariff structures
Private health insurance allows people to protect themselves from the potentially extreme costs of medical care if they become ill. It also gives people access to healthcare when they need it. The exclusion list of scheme options (Annexure C of scheme rules) deals with limitations of entitlements. Schemes must ensure that there is good reason for these exclusions and limitations, and that they are not too broadly worded. Otherwise, they may lead to arbitrary or unreasonable denial of care. But why exclusions and limitations? Entitlements in any option are discretionary (optional) or non-discretionary (compulsory). The latter are covered by the prescribed minimum benefits (PMBs). The Regulations in the Medical Schemes Act 131 of 1998 deal with the entitlement to PMBs: they must be paid in full under certain circumstances, such as when the member obtained the service from a designated service provider. The standard of care (and entitlement to it) is determined by protocols based on the principles of evidence-based medicine or, where these do not exist, the protocols of the public sector. Non-PMB conditions and entitlements are dealt with in scheme rules, and limitations and exclusions are applicable to them. Exclusions The following principles should be considered when deciding whether an exclusion is justified or not: best practice, evidence-based healthcare, clinical protocol, cost-effectiveness (affordability), and the laws of the country.Conditions or circumstances that should definitely not be excluded are those that are medically necessary, with little discretion from the member and/or service provider. Put differently, consider whether urgent treatment is needed to prevent death or permanent disability, and whether the attending doctor has some discretion as to the timing of treatment, and whether the treatment should be given at all. It would, for example, be entirely inappropriate to include an exclusion for the treatment of acute appendicitis, whereas an exclusion for cosmetic surgery in the absence of clinical indications would be appropriate. Not forgetting affordability, clinical protocols based on evidence-based medicine should be the bottom line when deciding whether funding is justified or not. Fair exclusion? You decide. Limitations on cover are appropriate where they permit a degree of financial risk management. But they are inappropriate where their application allows for the selective targeting of specific people or vulnerable risk groups. Thus, reasonable financial management should be permitted, but not to the extent that it allows risk selection and unfair discrimination. Limitations should be permitted where they achieve the following:
Limitations are inappropriate where they achieve the following:
Source: Medicalaide.co.za ![]() Discovery announced a number of key product enhancements that respond specifically to insurance needs around COVID-19, as well as the results of two critical research papers on COVID-19 in South Africa. Hylton Kallner, Discovery South Africa CEO says, “Our response to the COVID-19 pandemic has been guided by our core purpose of making people healthier. In the context of this pandemic, it is more critical than ever that we work hard every day to support clients with access to healthcare cover and comprehensive financial protection, and that we provide them with the necessary tools to promote behaviour that encourages healthy lifestyle choices.” The Group earlier introduced healthcare cover specific to COVID-19 through the WHO Global Outbreak benefit and tailored Vitality to help encourage people to stay healthy and active at home. In partnership with Vodacom, the Group made online doctor consultations available to South Africans through a virtual healthcare platform that gives free access to reliable information, risk screening and the ability to effectively ‘dial a doctor’ from the safety of their home. Kallner explains, “Discovery has access to one of the largest population data sets on a variety of factors relevant to the COVID-19 experience. Ranging from clinical, to financial and behavioural data, we are in a unique position to understand the long-term impact of COVID-19 in South Africa, and to design the necessary product structures to better support clients.” Together with emerging experience from other parts of the world, Discovery data highlights the importance of regular screening, appropriate testing and understanding and managing an individual’s health risk. This has informed the expansion of new benefits in response to changes brought about by COVID-19. These provide clients with proactive risk monitoring and assistance; providing cover for different severe illness outcomes due to COVID-19; adequate health protection over a longer term; and rewards that adapt to new lifestyles. A new COVID-19 risk assessment tool to be made available to all South Africans “We have undertaken the analysis to create an accessible COVID-19 risk assessment tool, that will be released on the Discovery app and the website helping people to understand their risk for COVID-19, to know their health risks that increase the likelihood of hospitalisation, and access funding for testing and health monitoring for those at a high risk for compilations,” says Kallner. The assessment will look at a member’s risks compared with that of the membership base in an area. “Members will be able to complete the assessment over time and keep track of their history. When testing is recommended, the assessment tool guides them to an online doctor consultation in a network. More than 6 500 members of Discovery Health Medical Scheme (DHMS) have consulted with their doctors online over the past couple of months, helping to contain the spread of the virus,” he says. “What we know now is that high blood pressure, cholesterol, blood glucose and body mass index are leading risk indicators of developing complications. We want to help members on all health plans to understand and manage these factors to mitigate the risk of complications from COVID-19. From June, any result from a Vitality Health Check that places someone at a high risk for complications will trigger a referral for advice through one online doctor or nurse consultation in the network, which the Scheme will fund in full,” says Kallner. In addition to the forthcoming COVID-19 risk assessment tool, other key enhancements announced by the Group include: Discovery Health expands access to fully funded COVID-19 testing and high-risk monitoring The WHO Outbreak benefit, first announced in early March, has been enhanced further to provide comprehensive cover for COVID-19 over the longer term. It now provides cover for two PCR tests for each beneficiary in a year, following screening by a healthcare professional and will be funded from the risk benefit regardless of the result. Healthcare professionals who are members of DHMS, will have cover for four PCR tests in a year. Discovery Health will assist members at higher risk of COVID-19 complications with funded telephonic consultations with a wellness specialist to monitor their current physical and mental wellbeing and make referrals to virtual healthcare services. DHMS will fund a pulse oximeter– used to monitor oxygen saturation from an early stage – for members at high risk of COVID-19 complications. This will be funded in full if obtained from a network provider. Members will also have access to three consultations with a wellness consultant to monitor oxygen and make a referral to a GP when necessary. Employer groups also have access to a variety of benefits that can help to manage COVID19 in the workplace. A comprehensive information hub, management of high-risk employees, contact tracing and access to screening and online doctor consultations are all available to employers through Discovery Healthy Company. Discovery Insure rewards clients for driving less Premium cash back even when driving shorter distances through the Dynamic Distance cash back that rewards low kilometres. Clients can earn up to 25% motor premium cash back every month when they drive between 0km and 249km in a month and they can still earn up to 50% fuel cash back when they drive more. Vitality Drive Active Rewards has been enhanced so that a client’s drive goal each week is based on their driving behaviour and not on the number of kilometres driven. Discovery Vitality tailored for seniors Vitality Health Check tailored for people aged 65 years and older, recommending specific and age-appropriate health screenings, preventive tests and vaccinations, including a risk assessment score for COVID-19. Three clinically validated screening tests help with early detection of age-related risks of hearing loss, visual perception, and balance and leg strength to prevent injuries from falling. The standard set of preventive tests follow, which include blood pressure, blood glucose, cholesterol, weight and smoking status. The acceptable ranges for weight and blood pressure are altered to consider the changes at an older age. Preventive steps include recommended vaccines such as the flu vaccine and the pneumococcal vaccine to prevent pneumonia. Results are summarised in reports and provide targeted health tracking, clinical risk projections and healthcare referrals based on the health assessment. It can be accompanied by a Vitality Functional Assessment which is an eight-part physical assessment to identify the risk of early frailty or disability and offers tailored workout routines to support healthy ageing. Discovery Life enhances Severe Illness Benefit to automatically cover multi-organ complications associated with COVID-19 Clients have full cover for COVID-19 related claims under their Discovery Life cover. A new multi-organ benefit has been included as a category under the Severe Illness Benefit to provide relevant cover for the complications associated with COVID-19. COVID-19 presents varying respiratory, cardiac, renal and liver complications. The multi-organ benefit is a category within the Severe Illness Benefit and complements existing severe illness body systems to provide payments by the level of acute multi-organ failure, resulting in payments of 50% to 100% of the severe illness benefit. Discovery Life is also taking a proactive approach to providing cover and is currently tracking 203 clients who haveCOVID-19 to manage claims from any of their available Life, Severe Illness and Income Continuation Benefits. If you would like more information on any of the products please contact Koketso email: [email protected] tel:(011)658-1333 Source: Discovery ![]() Discovery Health has launched a new Covid-19 Benefit across its plans. It is called World Health Organization Global Outbreak Benefit. Discovery Health Medical Scheme (DHMS) is taking proactive steps to make sure its members who need it have the necessary cover for COVID-19. Overview From time to time, there are viruses or diseases that affect world health. These outbreaks are closely monitored by the World Health Organization (WHO) and are, depending on the severity and spread, declared as epidemics that place the global population's health at risk. We recognise the importance of being prepared for these public health emergencies. Through careful benefit design and in support of public health initiatives aimed at containing and mitigating the spread of such outbreak diseases, our members now have access to supportive benefits during the outbreak period. The outbreak is actively monitored by a dedicated team within Discovery Health that closely assesses the evolution and progression of such outbreaks. Having a timely and effective response to global epidemics help to improve the health outcomes for our members. This document explains the cover and support we provide to you when faced with a WHO-recognised epidemic. WHO Global Outbreak Benefit The WHO Global Outbreak Benefit is available to all members of Discovery Health Medical Scheme during a declared outbreak period. This benefit ensures members with a confirmed diagnosis have access to the out-of-hospital management and appropriate supportive treatment as long as they meet the Scheme's Benefit entry criteria. The WHO Global Outbreak Benefit provides cover for a defined basket of healthcare services related to any outbreak disease. How you are covered from the WHO Global Outbreak Benefit When you are covered? The WHO Global Outbreak Benefit is available for the WHO-recognised outbreak period. All healthcare services covered by this benefit are available for confirmed outbreak diseases, as confirmed by a test and subject to the Scheme's benefit entry criteria. This benefit, available on all plans, is covered by the Scheme for confirmed cases of outbreak diseases and does not affect your day-to-day benefits, where applicable. What you are covered for? Cover includes access to a defined basket of care that includes: • The diagnostic tests • Consultations (which can also include video call consultations) • Defined supportive medicine list. Use of the relevant networks as per chosen health plan will apply for healthcare services paid from the WHO Global Outbreak Benefit. More information is available in the following two documents: Guide to Global Emergency Benefit Frequently Asked Questions |
AuthorKevin Yeh Archives
January 2025
Categories
All
|