Are you MSA, ATB, SPG ‘ed out with Discovery Health – here’s a brief explanation of these terms

When trying to explain to friends and family which Discovery Medical Aid plan to take, I find that the TLAs (Three Letter Abbreviations) are the main stumbling block.  So, here’s a short explanation of the ones that Discovery Health uses all over their web site and pamphlets:
MSA = Medical Savings Account
SPG = Self Payment Gap 
ATB = Above Threshold Benefit
CIB = Chronic Health Benefit

Some plans do cover out of hospital expenses – so they do have an MSA, SPG and ATB.
Some plans do not cover out of hospital expenses – so they do not have an MSA, SPG and ATB.  These plans are called “Hospital Plans”.

If you’re on one of the following plans, then you are on a “Hospital Plan” only: Core, or KeyCare plans.
ie: Classic Core, Classic Delta Core, Essential Core, Essential Delta Core, Coastal Core, KeyCare Plus, KeyCare Core.

If you’re on one of the following plans, then you are not on a “Hospital Plan”: Executive, Comprehensive, Priority, or Saver plans.
ie: Executive, Classic Comprehensive, Classic Delta Comprehensive, Essential Comprehensive, Essential Delta Comprehensive, Classic Priority, Essential Priority, Classic Saver, Classic Delta Saver, Essential Saver, Essential Delta Saver, Coastal Saver.

In other words, if you’re on a Discovery hospital plan, then they will not cover any out-of-hospital expenses, so you need not bother yourself with the meanings of MSA, SPG nor ATB… and you need not read on.

The MSA, SPG and ATB differs and depends on the following: i) the Discovery Health Plan; ii) how many people (adults and children) are covered.  
So, if you are on Classic Comprehensive plan (2010) with two adults, and 2 children, you then will have an MSA for the year of R16,512, and a SPG of R1,788, and an ATB of R18,300.

These figures are calculated as follows:
MSA: From the Classic Comprehensive plan page on the (new) Discovery Health web site: Comprehensive Series Plan click on “Your cover for day-to-day medical expenses” which gives the monthly MSA of:
R587 for the main member + R555 per adult + 2x R117 for 2x children = 587+555+117+117 = R1,376 per month.  So, that’s R16,512 for the year.
ATB: From that same section of the page: Refer to the section “Annual Threshold amounts”:
R7,700 for the main member + R7,700 per adult + 2x R1,450 for 2x children = R18,300.
SPG: The annual Self Payment Gap is calculated by subtracting the annual MSA from the annual ATB
ie: R18,300 – R16,512 = R1,788.  Which means that once your MSA has run out, you will need to pay R1,788 from your own pocket before Discovery Health pays for your out-of-hospital medical expenses again (at Discovery Health rates).
Note: there is no SPG for the Executive plan since the MSA is equal to the ATB.
Note: your SPG can go up – it is not necessarily static.  It goes up if you claim for non-prescription drugs, or if your doctor charges more than the Discovery Health rate.

HTT’s Discovery Health plan calculator calculates all these figures and plots them on a graph for easy reference.  See here for more: HTT’s Discovery Health plan calculator and remember to add your comment…

Here’s some more details:
All out of hospital claims (except chronic medication and blood tests and Vitality Health checks) get paid from your MSA ie: Doctors visits, medication, tests, spectacles, dentists, pretty much everything.

Once you have used up your MSA (Medical Savings Account), then you enter your SPG (Self Payment Gap).  Here you pay for everything yourself, but you still must submit the claims to Discovery so they can keep tally of your expenses and assign them to your SPG.  Once the amount you have paid out yourself, equals the amount of your SPG, then your above ATB kicks in, where they pay again (at Discovery Health rates).

There are limits to the amount you can claim for certain categories of healthcare services – refer to “Your cover for day-to-day medical expenses” and see what limits apply.  For example, on the Classic Comprehensive plan, the annual limit for ‘Optical’ is R2,600 per person.  This means that even if you have funds in your MSA, Discovery will still not pay more than R2,600 per person for say spectacles.