Jeffrey Wade
The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act and regulated by the Council for Medical Schemes. Discovery Health offers Flexicare, an affordable health insurance product for people in South Africa. Flexicare members can access high-quality yet affordable private primary healthcare, which covers their day-to-day health and medical needs. The monthly fees start at R350 and cover day-to-day medical expenses such as consultations with nurses or GPs, prescribed and chronic medicine, basic dentistry, optometry, and trauma cover. Discovery Health also provides unlimited hospital cover, emergency cover outside South Africa, and screening and prevention benefits for members and their children.
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What You'll Learn
International travel benefits
As a Discovery Health Medical Scheme member, you can take advantage of the International Travel Benefit. This benefit provides you and your family with medical emergency cover for 90 days from the date of your departure from South Africa. It is important to note that the cover ends when you return home or after 90 days, whichever comes first.
The International Travel Benefit covers costs associated with relevant health services obtained outside of South Africa for a condition or health event resulting from an accident or emergency. This includes emergency medical treatment and evacuation to South Africa, where you will receive further medical treatment according to your Health Plan and Scheme rules. The benefit is available on Executive, Comprehensive, Priority, Saver, Core, and Smart plans, but it does not include KeyCare plans.
The monetary limit for the Executive Plan is US$1 million per person per trip, while the Classic, Essential, Coastal, and Smart Plans offer up to ZAR 5 million in medical emergency cover for each person per trip. It is important to note that the International Travel Benefit only covers emergency treatment and does not extend to elective treatment or treatment received outside of the 90-day period.
To qualify for the International Travel Benefit, you must be an active member of the Scheme at the time of your claim and cannot be in a three-month general waiting period. Additionally, you must receive treatment from a qualified medical professional. To authorise admission and issue a payment guarantee, you should notify Medical Services Organisation International (MSOI) as soon as possible after the emergency. MSOI arranges direct payment to overseas healthcare professionals and, if necessary, will arrange your evacuation back to South Africa.
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$199.95 $245.95
Emergency services
In the event of a medical emergency, Discovery Health Medical Scheme members can call Discovery 911 on 0860 999 911. This line is available 24/7 and is managed by highly qualified emergency personnel who will assess each case and provide immediate feedback and assistance. If you are unable to speak, you can access the cellular phone-based panic alert system on the Discovery app. Once you push the "Emergency Assist" button, you can select from two options: "Call me back" or "Call an emergency operator". This service will signal an alarm without requiring verbal identification, and if there is no response, Discovery will use technology to locate you as long as your GPS location services are on.
If you need medically equipped transport in South Africa, Discovery 911 will send emergency transport (e.g. an ambulance or helicopter) to take you to the hospital, and the costs will be covered by your Hospital Benefit, whether or not you are admitted. In the case of an emergency, you can go to any private hospital, and if you are admitted, Discovery will cover your emergency hospital admission. There is no overall limit for hospital cover on your health plan.
If you go to a casualty or emergency room and are not admitted to the hospital, Discovery will pay the costs according to your health plan, unless it is related to a Prescribed Minimum Benefit condition. In the case of a Prescribed Minimum Benefit, the costs will be paid for by the Scheme. If you are on the KeyCare Plus Plan, you are covered for one casualty visit per year at a casualty unit in the KeyCare Hospital Network. However, you must pay an upfront amount of R475 to the casualty unit for each person needing care.
Flexicare, a health or medical insurance product offered by Discovery, also provides the option to add cover for emergency hospital cover for an additional monthly premium. This is called Discovery Emergency Cover.
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Chronic and acute medicine
As a Discovery Health Medical Scheme member, your cover for medicine includes acute and chronic medication. The extent of this cover depends on the plan you choose.
Acute Medicine
Acute medicine is prescribed for a short term to address a condition or illness that is not long-lasting. You have cover for prescribed acute medicine from your available day-to-day benefits. The scheduling status of the medicine and whether it is a generic or original brand product will determine how much of the cost is covered. An annual limit applies to prescribed acute medicines (schedule 3 and above). If you join the medical scheme after January, you will not receive the full annual limit as it is calculated based on the remaining months in the year. You are covered for over-the-counter (OTC) acute medicine obtained from your network pharmacy, up to a yearly limit.
Chronic Medicine
The Discovery Health Medical Scheme covers approved medicine for the 27 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions on all plans. Approved medicine on the Chronic Illness Benefit medicine list will be funded in full up to the Scheme Rate. Medicines not on the medicine list will be funded up to the Chronic Drug Amount (CDA). The CDA does not apply to the Smart and KeyCare plans. On these plans, approved medicine that is not on the formulary will be funded up to the Reference Price for the specific medicine category. To access cover from the Chronic Illness Benefit, you must apply for it by completing a form with your doctor and submitting it for review.
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Medical Savings Account (MSA)
The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act and regulated by the Council for Medical Schemes. It offers a range of benefits to its members, including emergency medical cover outside South Africa, screening and prevention benefits, and cover for chronic, acute, and day-to-day prescribed medicine.
One of the key features of the Discovery Health Medical Scheme is the Medical Savings Account (MSA). The MSA is a type of consumer-directed Medicare Advantage Plan that combines a high-deductible insurance plan with a medical savings account to pay for healthcare costs.
Here's how the Medical Savings Account (MSA) works:
- When you join the Discovery Health Medical Scheme, an amount is set aside for you at the beginning of the year, known as your annual MSA allocation. This amount varies depending on your chosen plan.
- The money in your MSA is used to pay for eligible day-to-day medical expenses, such as GP and specialist consultations, medicine (except for registered and approved chronic medicine), radiology, and pathology.
- Any unused funds in your MSA at the end of the year will carry over to the next year, allowing you to accumulate savings over time.
- If you have to make a claim that is eligible for payment, the Scheme will use the money available in your MSA to pay for it.
- You are responsible for managing the money in your MSA and deciding whether to pay for healthcare services using your MSA funds or other sources of funding.
- If you downgrade your health plan or leave the Scheme before the year is up, you may owe the Scheme the portion of the MSA you have used but have not yet paid back.
- If you leave the Scheme, Discovery Health is legally required to pay any remaining balance in your MSA to your new medical scheme. If you join a plan without an MSA, they will pay you the amount you have contributed that is more than you have claimed after four months.
- The Self-payment Gap (SPG) comes into effect when you exhaust your MSA funds but have not yet reached your Annual Threshold benefit. During the SPG, you will need to pay for some healthcare expenses out of pocket.
- The Above Threshold Benefit (ATB) acts as a "safety net" and covers your healthcare costs once your claims exceed the Annual Threshold.
The Medical Savings Account (MSA) offered by Discovery Health provides flexibility and the ability to accumulate savings for future medical expenses. It empowers members to take responsibility for their healthcare costs and make informed decisions about their healthcare services and providers.
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Flexicare health insurance
Flexicare is a health insurance product offered by Discovery Health in partnership with Auto & General. It is not a medical aid product, which is a separate service offered by Discovery Health. Medical aid provides a broader range of benefits and cover options, including hospital stays, and costs more than health insurance.
Flexicare is designed to cover a range of everyday healthcare outside of the hospital. It provides access to high-quality yet affordable private primary healthcare, covering day-to-day health and medical needs. This includes unlimited consultations with nurses and GPs, as well as access to medicine and basic dentistry. Flexicare is available at competitive monthly fees, starting at R350 per month.
Flexicare also offers a trauma benefit, which is available on both plans. This benefit covers emergency private healthcare services at any private hospital facility for injuries resulting from a crime, sexual assault, car accident, or workplace accident.
Flexicare members can also add Discovery Emergency Cover for an additional monthly premium. This provides emergency hospital cover, including treatment for heart attacks, strokes, and an extended range of emergency medical conditions.
It is important to note that Flexicare is subject to Waiting Periods, which are applied to all new policies, including members of previous medical schemes and health or medical insurances.
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Frequently asked questions
Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Discovery Health offers Flexicare, an innovative and affordable health insurance product for people in South Africa. Flexicare covers day-to-day medical expenses, including consultations with nurses or GPs, and access to medicine. It also covers basic dentistry, optometry, and trauma. Discovery Health also offers unlimited hospital cover and emergency cover outside the borders of South Africa.
The MSA is an amount set aside for you when you join Discovery Health. You pay back this amount monthly as part of your medical scheme contribution. Any money remaining in the MSA at the end of the year will carry over to the next year.
To get started, you need to choose a plan and pay a monthly contribution. The amount you pay depends on the medical plan you choose. You can also integrate payments for out-of-pocket medical expenses with Health Pay from Discovery Pay.
