Yes, it’s that time of the year again – time to choose your Discovery Health plan….all those options and all that paperwork to read and understand…
This article might save you a lot of reading and paging through all the web pages on the Discovery web site.
The new
https://new.discovery.co.za web site contains detailed information about each plan and the costs.
See my earlier posting on where to get detailed info on the health plans for 2010:
Discovery Health plans for 2010 are on the new Discovery web site You can also
download pdf files describing what each plan covers and the associated costs.
I have collated all the information on the various plans into a spreadsheet (calculator) which takes into account the number of people in your family and allows you to compare the actual cost of each plan.
Download HTT’s calculator that will assist you in
costing and understanding the various options:
DiscoveryHealthOptions2010calculator.xls Open the calculator to assist with narrowing your choice of plan as follows:
Use the
pyramids to compare the plans - note the
missing parts of the pyramids to see "what's missing" from each plan.
Note too, that the size of each segment shows smaller ATBs and larger SPGs.
So, if you want a plan with "out of hospital" cover, then you need a plan that has an MSA (Medical Savings Account) - so don't choose the Core plans (since Core plans don't provide MSA).
See this posting for explanations of these terms: Are you MSA, ATB, SPG ‘ed out with Discovery Health – here’s a brief explanation of these terms To summarise: If you need that "parachute" to kick in when out of hospital expenses get too much then you need a plan that offers the ATB facility (Above Threshold Benefit): so select from the Executive, Comprehensive or Priority plans (either: Executive, Classic Comprehensive, Essential Comprehensive, Classic Priority or Essential Priority).
Note: Priority plan has "limited ATB"
The Self Payment Gap is the amount that you need to pay once you have run out of MSA.
If you want a small SPG (Self Payment Gap) then you need to select one of the Comprehensive plans. If you want
zero SPG (Self Payment Gap) then you need to select the Executive plan
(as you can see the smaller the gap, the more expensive the plan becomes).
The DeltaSaver plans are similar to the Saver plans; and
the DeltaCore plans are similar to the Core plans except (mainly) that you are limited to the Delta network of hospitals (and you pay about 25% less). The Delta Hospital Network list is included in the
pdf files (refer to file “DiscoveryHealthDeltaNetworkHospitals.pdf” and also pasted at the bottom of this article.)
Using the spreadsheet (using the 'Figures2010_Pyramids' worksheet):
[Please read the disclaimer at the top of the spreadsheet :) ]
Modify the following “
purple” cells to suit your situation i.e. number of dependants, Vitality, Discovery card.
Compiling the spreadsheet has highlighted some points which I did not understand previously and I am sure the following pointers will assist you in choosing which plan is best for you:
· There are 8
categories of cover: Executive, Comprehensive, Priority, Saver, Delta Saver, Core, Delta Core and KeyCare.
· Each of these categories sometimes have
sub-categories: Classic, Classic Delta, Essential, Essential Delta, and Coastal.
The above 2 statements are very important in understanding how Discovery health plans have been organised… so read them and understand how categories have been split into sub-categories. · The "Saver" and “Core” plans are cheaper mainly because they have
no ATB (Above Threshold Benefit) which means when your out-of-hospital expenses have used up your MSA (Medical Savings Account) then you will need to pay all out of hospital costs out of your (after tax) pocket. All the other plans have an ATB which kicks in as soon as you have paid a certain amount (the “gap”).
· The “Priority” plans are cheaper mainly because they have co-payments for some hospital procedures (see
'04 PrioritySeriesPlansDiscovery2010.pdf' for details)
· If you only need a ‘hospital plan’, then the “core” or "saver" plans are for you… "Core" have no MSA nor ATB and "Saver" plans have a small MSA - remember that out of hospital expenses can add up very quickly e.g. MRI scans etc. and can wipe out the monthly savings of being on a cheaper plan (although a maximum of R1,800 will be paid out of your MSA (or out of your pocket if you're on the "Core" plan), the remainder comes out of your in-hospital benefit)
· “Classic” and “Essential” plans have almost the same in-hospital cover except for the rate paid: Classic pays up to 300% of the Discovery Health rate while Essential pays up to the Discovery Health rate. [In my experience, the doctors will charge the maximum that they can! So, if you have cover for the 300% then that’s what they’ll charge. It is no indication of their “rate”]
· The MSA amount is fixed according to the plan you're on (25% or 15% of your contribution).
· The “prescribed medicine” sub-limit has some widely differing benefits so study these carefully when selecting your plan.
·
Check this year’s benefit usage by logging in on the Discovery web site:
http://www.discovery.co.za –> Discovery Health » Benefits and cover » Benefits used. This will give you an idea of what cover you have used this year (
Note: the past usage is
no indication of next year’s needs).
Bottom line: nobody can tell you which plan you need to take – it’s a decision based on
i) how much you can afford
vs ii) how much you
think you will need cover
vs iii) how much you think you can cover yourself from your own emergency funds.
Use the
calculator to compare the pyramids (cover differences) and
graphs to compare costs and
pdf’s to compare each plan’s detail.
If you see any errors in this article, or in the calculator, or suggestions for improvement, then please let me know so that everyone can benefit) by leaving a comment or emailing me: HandyTechTipper at gmail.com
See here for other HTT (HandyTechTipper) calculators: http://handytechtips.blogspot.com/search?q=calculator See here for more info on Discovery: http://handytechtips.blogspot.com/search?q=discovery Here’s the Discovery Health Delta Network Hospitals list (subject to change):
{Also included in the pdf files - DiscoveryHealthDeltaNetworkHospitals.pdf}
Hospitals in the Discovery Delta Hospital Network
Gauteng:
Arwyp Medical Centre, Bedford Gardens Private Hospital, Bougainville Private Hospital, Brenthurst Clinic, Carstenhof Clinic, Clinix Private Hospital – Lesedi, Clinix Private Hospital Sebokeng, Clinton Clinic, Emfuleni Medi-Clinic, Fourways Hospital, Legae Private Clinic, Lenmed Clinic Limited, Little Company of Mary, Louis Pasteur Hospital, Midvaal Private Hospital, Robinson Hospital, Roseacres Clinic, Suikerbosrand Clinic, The Donald Gordon Medical Centre, Wilgeheuwel Hospital.
KwaZulu Natal:
Chatsmed Garden Hospital, Entabeni Hospital, Midlands Medical Centre, Mount Edgecombe Hospital, Westville Hospital.
Free State:
Pelonomi Private Hospital, Universitas Private Hospital.
Western Cape:
Cape Town Medi-Clinic, Kingsbury Hospital, Mitchells Plain Medical Centre, Panorama Medi-Clinic, Vergelegen Medi-Clinic
Please note that this list is subject to change.
DHN 9Dec2008
In addition to hospitals mentioned above, there is a list of additional day facilities available in the network:
Gauteng:
Birchmed Day Clinic, Boksburg Medical & Dental Centre, Brooklyn Surgical Centre, Centurion Eye Hospital, Constantia Park Medical & Dental Centre, Cormed Clinic, Fauchard Clinic, Fordsburg Clinic, Johannesburg Clinic, Johannesburg Eye Hospital, Kilnerpark Narko Clinic, Mayo Clinic, Medkin Clinic, Mercidoc Day Clinic, Ocumed, Optimed, PJ Schutte Theatre Unit, Silverton Medical & Dental Centre, The Healthy Eye, Visiomed Eye Laser Clinic, Wierda Park Clinic, Wilgeheuwel Day Clinic.
KwaZulu Natal:
Bluff Medical & Dental Centre.
Western Cape:
Khangella Eye Theatre, Panorama Laser Clinic, Parow Medical & Dental Centre, Wesfleur Private Clinic.
Free State:
Bethlehem Medical Centre, CityMed Theatre, Medovs Day Clinic.
Please note that this list is subject to change.
DHN 9Dec2008
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