your health benefits documentation/single pages.pdf · your health benefits for 2012 health health...

Executive Plan Comprehensive Series Priority Series ** Saver Series Core Series KeyCare Series

* Optical (spectacles, frames, contact lenses, surgery or any healthcare services to correct refractive errors of the eye, for example excimer laser) R4 450 for each

person R3 050 for each person R2 850 for each person Limited to funds in MSA No benefit

One eye test and pair of single vision, bi- or multi-focal glasses with basic frame for each person or one pair of basic contact lenses 24 months from your last claim only at an optometrist within the Discovery KeyCare Optometry network.

* Dentistry (in- and out-of-hospital and related accounts)

Discovery pays the hospital account from the Hospital Benefit. Discovery pays for related accounts, for example dentists and anaesthetists, from the available funds in your MSA/ATB. Limited to R30 500 for each person (applies to the hospital and related accounts)

There is no overall limit for dental treatment. However, all dental devices, appliances and orthodontic treatments (including related accounts for orthographic surgery) are paid from the available funds in your MSA/ATB, up to an annual sub-limit of Comprehensive - R17 400 Priority – R10 850 per person.

You need to pay a portion (deductible) of your hospital/day clinic account upfront for dental admissions:

Members younger than 13Hospital R1 300Day clinic R650

Members older than 13Hospital R3 300Day clinic R2 200

The balance of the hospital account and related accounts (dental surgeon and anaesthetist) will be paid from the hospital benefit up to 100% of the Discovery Health rate.

There is no overall limit for dental treatment. However, all dental devices, appliances and orthodontic treatments (including related accounts for orthographic surgery) are paid from the funds available in your MSA.

You are responsible for paying the costs of all dental devices, appliances and orthodontic treatment including related accounts for orthographic surgery.

Discovery covers selected dental procedures done by a dentist within the Discovery KeyCare dentistry network.

MRI and CT scans(must be referredby a specialist)

Discovery pays these claims from your MSA/ATB.

Paid from the hospital benefit if scan is part of an approved hospital admission. If admitted for conservative back or neck treatment, the first R2 300 of the scan code is paid from the MSA/ATB. The balance is paid from the hospital benefit.

Paid from the hospital benefit if scan is part of an approved hospital admission. If admitted for conservative back or neck treatment, you will need to pay R1 750 of the hospital account as a deductible, the first R2 300 of the scan code is paid from the MSA/ATB. The balance is paid from the hospital benefit.

Paid from the hospital benefit if scan is part of an approved hospital admission. If admitted for conservative back or neck treatment, the first R2 300 of the scan code is paid from funds available in your MSA. The balance is paid from the hospital benefit.

Paid from the hospital benefit if scan is part of an approved hospital admission. Not covered if admitted for conservative back or neck treatment or unrelated to an approved hospital admission.

Discovery pays the scan from your Specialist Benefit up to R2 300 for pbpa.

Allied and therapeutic healthcare service(acousticians, biokenticists, chiropractors, councillors, dieticians, homeopaths,Nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and hearing therapists)

M – R12 500M+1 R15 000M+2 R17 500M+3 R21 000

M – R10 000M+1 R13 500M+2 R16 500M+3 R19 000

M – R6 000M+1 R8 500M+2 R11 000M+3 R13 000

M – R4 000M+1 R6 000M+2 R7 500M+3 R9 000

Limited to funds in your MSA No Benefit Paid from Specialist Benefit up to R2 300 pbpa

Antenatal Classes R1 000 pfpa Limited to funds in your MSA No Benefit No Benefit

External Medical Items R45 500 pfpa R45 500 pfpa R30 250 pfpa R30 250 pfpa R20 500 pfpa Limited to available funds in your MSA No Benefit

R3 800 pfpa(wheelchairs,long-leg callipers,crutches and walkers)

* Prescribed medicine Payment from MSA: 100% of the Discovery Health Medication Rate. Accumulation to and payment from ATB: 100% of the Discovery Health Medication Rate for generics and 90% of the Discovery Health Medication Rate for non-generic.

Payment from MSA:100% of the Discovery Health Medication Rate.

Accumulation to and payment from ATB:100% of the Discovery Health Medication Rate for generics and 75% for non-generics.

Limited to funds in your MSA. Paid up to a maximum of100% of the Discovery Health Medication Rate.

No benefit

KeyCare PlusUnlimited, subject to the KeyCare medicine list if prescribed by your chosen KeyCare network GP

KeyCare CoreNo benefit

Single member R20 800

Member + 1 R24 300

Member + 2 R27 850

Member + 3+ R31 400

ClassicSingle member R16 900Member + 1 R19 850Member + 2 R23 050Member + 3+ R26 300EssentialSingle member R10 950Member + 1 R13 250Member + 2 R15 950Member + 3+ R17 450

ClassicSingle member R10 950Member + 1 R13 250Member + 2 R15 950Member + 3+ R17 450EssentialSingle member R7 800Member + 1 R9 200Member + 2 R10 950Member + 3 R13 250

Day-to-day benefit limits for 2012KeyCare hospital network for 2012

As your health care consultants, we would like to welcome you to the Discovery Health Medical Scheme.

One of the most important benefits that your employer offers you is membership to a medical scheme. To try and help you make the right decision, we have put together this summary brochure on the 2012 Discovery Health product to give you a good idea of what benefit options are available and at what cost.

Please take the time to read through all the options and consider what benefits best suit you and your family’s needs. Because we are all unique and have different health care requirements, Discovery Health offers you a range of 19 benefit options to choose from. If you need more information on what each option offers and what it will cost, you can contact the Alexander Forbes Member Support Unit (MSU) for advice.

Making the right decision for you and your family is extremely important. We understand this and are committed to helping you make the most appropriate option selection for 2012.

Alexander Forbes Health

Inside this brochure

An easy guide to choosing your 2012 1. Discovery Health options Page 2Contact details 2. Page 6Day-to-day benefit limits 3. Page 8

Alexander Forbes Health (Pty) Ltd | Reg. No. 2007/015447/07 | FAIS FSP No. 33471 | CMS Reg No ORG 3064

A message from Alexander Forbes Health to our valued Edcon member

Your HealtH Benefits for 2012

HealtHHealtH

* Discovery Health pro-rates your benefits if you join partway through the yearThis brochure is a summary of the Discovery Health plans for 2012. Please contact the Alexander Forbes Health Member Support Unit or log onto www.discovery.co.za for detailed information.

Delta hospital network for 2012Gauteng

Arwyp Medical Centre Life Bedford Gardens Hospital Bougainville Private hospital

Life Brenthurst Clinic Life Carstenhof Clinic Clinix Private hospital – Lesedi

Clinix Private hospital – Sebokeng Clinton Clinic Emfuleni Medi-Clinic

Life Fourways hospital Legae Private hospital Lenmed Clinic Limited

Little Company of Mary Louis Pasteur hospital Midvaal Private hospital

Morningside Medi-Clinic Life Robinson Private hospital Life Roseacres Clinic

Suikerbosrand Clinic The Donald Gordon Medical Centre Life Wilgeheuwel Hospital

Plus 42 Day Clinics

Free State

Life Rosepark Hospital Universitas Private Hospital

Plus 3 Day Clinics

KwaZulu Natal

Life Chatsmed Garden Hospital Life Entabeni Hospital Ethekwini Hospital

Life Westville Hospital Midlands Medical Centre

Plus 8 Day Clinics

Western Cape

Cape Town Medi-Clinic Life Claremont Hospital Life Kingsbury Hospital

Mitchell’s Plain Medical Centre Panorama Medi-Clinic Vergelegen Medi-Clinic

Plus 13 Day Hospitals

Eastern Cape

Life New Mercantile Hospital

Contact Details

Discovery Health

Member Support Unit(Benefit and contribution advice and escalated query resolution)

Johannesburg

P O Box 787240,

Sandton 2146

Alexander Forbes Place

61 Katherine Street, Sandown

Tel: +27 11 269 2690

Fax: +27 11 263 2397

Email: [email protected]

Client Services(Claims queries, Hospital pre-authorisation, Chronic Illness Benefit queries)

0860 100 694

155 West Street,

Sandton

Send claims to:

Fax: 0860 329 252

Website: www.discovery.co.za

Eastern CapeEast London

Life Beacon Bay Hospital•Life East London Private Hospital•Life St James Operating Theatres•Life St Dominic’s Private Hospital•

HumansdorpLife Isivivana Private Hospital•

Port ElizabethLife New Mercantile Hospital•

QueenstownLife Queenstown Private Hospital •

UitenhageNetcare Cuyler Clinic•

Umtata Life St Mary’s Private Hospital•

Free StateBethlehem

Hoogland Medi-Clinic•

BloemfonteinBloemfontein Eye Centre•Netcare Pelonomi Private Hospital•Life Rosepark Clinic•Life Pasteur Hospital•Netcare Universitas Private Hospital•

WelkomErnest Oppenheimer Hospital•Welkom Medi-Clinic•St Helena Hospital•

GautengBenoni

Life The Glynwood Hospital•

BoksburgBotshelong Empilweni Clinic (Clinix Vosloorus)•Sunshine Centre•

BrakpanLife Dalview Clinic•

GermistonLife Roseacres Clinic•

HeidelbergLife Suikerbosrand Clinic•

JohannesburgNetcare Rand Clinic•Johannesburg Eye Clinic•Netcare Garden City Clinic•Life Brenthurst Clinic•

Kempton ParkArwyp Medical Centre •

LakefieldNetcare Optiklin Eye Hospital•

LenasiaLenmed Clinic•

MidrandLife Carstenhof Clinic•

PretoriaNetcare Bougainville•Private Hospital•Centurion Eye Hospital•Life Eugene Marais Hospital•Netcare Jakaranda Hospital•Legae Medi-Clinic•Louis Pasteur Hospital•Medforum Medi-Clinic•Muelmed Hospital•Pretoria Eye Institute•Zuid-Afrikaans Hospital•

RandfonteinLife Robinson Hospital•Sir Albert Medical Centre•

SowetoClinix Soweto (Tshepo Themba)•Lesedi Clinic•

SpringsLife Springs Parkland Clinic•Life St Mary’s Women’s Clinic•

ThembisaZamokuhle Private Hospital•

VanderbijlparkEmfuleni Medi-Clinic•Ocumed•Netcare Vaalpark hospital•

WestgateMedgate Day Clinic•

VereenigingClinix Private Hospital Sebokeng•Midvaal Private Hospital•

KwaZulu-NatalAmanzimtoti

Kingsway Hospital•

ChatsworthLife Chatsmed Garden Hospital•

DurbanLife City Hospital•Life Entabeni Hospital•McCord Hospital•

EmpangeniLife Empangeni Garden Clinic•

IsipingoLife Isipingo Clinic•

KokstadKokstad Private Hospital•

LadysmithLa Verna Hospital•

NewcastleNewcastle Private Hospital•

PhoenixLife Mount Edgecombe•

PietermaritzburgMidlands Medical Centre•Netcare St Anne’s•

PinetownLife Crompton Hospital•Port Shepstone•Hibiscus Hospital•

Richards BayNetcare The Bay Hospital•

SydenhamNu Shifa Hospital•

TongaatVictoria Private Hospital•

LesothoWillies Hospital•

LimpopoBela Bela

St Vincent’s Hospital•

PhalaborwaClinix Phalaborwa Private Hospital•

PolokwaneLimpopo Medi-Clinic•

ThabazimbiThabazimbi Medi-Clinic•

TzaneenTzaneen Medi-Clinic•

MpumalangaBarberton

Barberton Medi-Clinic•

ErmeloErmelo Private Hospital•

MiddelburgLife Middelburg Private Hospital•

NelspruitNelspruit Private Hospital•

TrichardtHighveld Medi-Clinic•

WitbankLife Cosmos Hospital•Emalahleni Day Hospital•

North WestCarletonville

Leslie Williams Private Hospital•Western Deep Clinic•

KlerksdorpLife Anncron Clinic•

MafikengVictoria Private Hospital (Mafikeng Hospital)•

OrkneyWest Vaal Clinic•

PotchefstroomPotchefstroom Medi-Clinic•

RustenburgLife Peglerae Hospital•

Northern CapeKathu

Kathu Medi-Clinic•

KimberleyKimberley Medi-Clinic•

UpingtonUpington Private Hospital•

VryburgVryburg Private Hospital•

Western CapeBellville

Bellville Medical Centre•Louis Leipoldt Medi-Clinic•

Cape TownNetcare Christiaan Barnard Memorial •

HospitalNetcare UCT Medical Centre•

CeresCeres Private Hospital•

GatesvilleGatesville Medical Centre•

GeorgeGeneva Clinic•George Medi-Clinic•

HermanusHermanus Medi-Clinic•

Kuils RiverNetcare Kuils River Private Hospital•

MilnertonMilnerton Medi-Clinic•

Mitchells PlainMitchells Plain Medical Centre•

Mossel BayBayview Hospital•

OudtshoornCango Day Clinic•Klein Karoo Medi-Clinic•

PaarlPaarl Medi-Clinic•

West CoastLife West Coast Private Hospital•

WorcesterWorcester Medi-Clinic•

B AF Health Edcon-discovery Induction 5177 Sept2011.indd 1 9/27/11 9:44:32 AM

An easy guide to choosing your 2012 Discovery Health optionTo make the appropriate option selection for 2012, please use the following guide. This guide gives you an overview of the benefits and is not a definitive or comprehensive list.

What kind of hospital cover do you need?

PMB Chronic Disease List

The Additional Chronic Disease List

The 26 Prescribed Minimum Benefit Chronic Disease List conditions are covered on all Discovery Health options and are as follows:

The Executive and Comprehensive options offer chronic medication benefits for a further 34 chronic conditions over and above the 26 Prescribed Minimum Benefit Chronic Disease List conditions.

This brochure is a summary of Discovery Health’s 2012 annual benefits and monthly contribution rates, pending formal approval from the Council for Medical Schemes.

Executive Plan Classic Comprehensive Essential Comprehensive Classic Priority Essential Priority Classic Saver Essential Saver Coastal Saver Classic Core Essential Core Coastal Core KeyCare Plus KeyCare Core

Hospital Benefit(procedures must be confirmed with Discovery Health)

Covers the hospital account from the Hospital Benefit and related accounts, specialists and radiology, from the Medical Savings Account where applicable. Provides full cover if you use a specialist participating in a direct payment arrangement. Discovery covers other specialists up to 300% of the Discovery Health Rate.

Discovery covers radiology, pathology, GP and other healthcare services up to the Discovery Health Rate.

Provides full cover if you use a specialist who participates in a direct payment arrangement, subject to available benefits.

Provides full cover if you use a specialist who participates in a direct payment arrangement, subject to available benefits. Provides full cover if you use a specialist who participates in a direct payment arrangement. Covers procedures and consultations in a network of coastal hospitals in full if you use a specialist who participates in a direct payment arrangement, or up to 100% of the Discovery Health Rate if not. You are liable for 30% of the hospital account if you choose to go out of the network of coastal hospitals for an elective procedure.

Provides full cover if the member uses a specialist who participates in a direct payment arrangement.

Covers procedures and consultations in a network of coastal hospitals in full if you use a specialist who participates in a direct payment arrangement, or up to 100% of the Discovery Health Rate. You are liable for 30% of the hospital account if you choose to go out of the network of coastal hospitals for an elective procedure.

Covers medical expenses incurred when you are admitted to hospital within a network of KeyCare hospitals.

Provides full cover if you use a specialist who participates in the KeyCare direct payment arrangement.

Discovery covers other healthcare professionals up to 100% of the Discovery Health Rate.

Certain procedures are only covered in a network of day case facilities.

Discovery covers other specialists up to 200% of the Discovery Health Rate.

Discovery covers radiology and pathology up to the Discovery Health Rate.

Discovery covers radiology and pathology up to the Discovery Health Rate and other specialists up to 200% of the Discovery Health Rate.

Discovery covers radiology and pathology up to the Discovery Health Rate.Other specialists are covered up to 200% of the Discovery Health Rate.

Deductibles No deductibles For Delta only: Full cover at hospitals in the Delta Hospital Network. For planned hospital admissions at any other hospital, you must pay a R4 550 deductible.

You need to pay between R1 750 and R8 600 upfront to the hospital when you are admitted for a defined list of procedures.

Conservative back and neck treatment, myringotomy (grommets), tonsillectomy, adenoidectomy R1 750

Cystourethroscopy, colonoscopy, sigmoidoscopy, proctoscopy, gastroscopy R2 350

Arthroscopy, functional nasal procedures, hysterectomy (except for pre-operatively diagnosed cancer), laparoscopy, hysteroscopy, endometrial ablation R4 250

Nissen fundoplication (reflux surgery), spinal (back and neck) surgery, joint replacements R8 600

For Delta only: Full cover at hospitals in the Delta Hospital Network. For planned hospital admissions at any other hospital, you must pay a R4 550 deductible.

No deductibles For Delta only: Full cover at hospitals in the Delta Hospital Network. For planned hospital admissions at any other hospital, you must pay a R4 550 deductible.

No deductibles No deductibles

Screening Benefit

Covers blood glucose, blood pressure, cholesterol and body mass index screening tests at a Discovery Wellness Network provider. Also covers a mammogram, Pap smear, PSA and HIV screening tests.

Discovery covers a seasonal flu vaccine if you are 65 years or older or if you are registered for certain chronic conditions, such as asthma.

Chronic Illness Benefit

You have extensive and flexible cover for a list of chronic conditions. You have full cover for approved medicine on Discovery Health’s medicine list or up to a set monthly amount for medicine not on our list. The Executive and Comprehensive Plans have a more extensive medicine list and higher monthly medicine amounts than other plans.

You have cover for a list of chronic conditions. You have full cover for approved medicine on Discovery Health’s medicine list or up to a set monthly amount for medicine not on our list.

You have cover for a list of chronic conditions as long as the medicine is on the KeyCare medicine list and you get your approved medicine from our courier pharmacy or your chosen dispensing GP. If you get your medicine anywhere else, you will need to pay 40% of the Discovery Health Medication Rate.

Day-to-day benefits

Funded from the Medical Savings Account or from the Above Threshold Benefit once medical expenses have reached the Annual Threshold.

Discovery further extends your day-to-day cover through the Insured Network Benefit by paying for the following when you have spent your annual Medical Savings Account deposit:

Discovery covers the full cost of your consultation fees if you go to a GP •in our network. We pay the claim directly to the GP.

Discovery covers blood tests at our network providers if your GP or •specialist requests the appropriate tests using the Discovery Health pathology form.

Funded from the Medical Savings Account or from the Above Threshold Benefit once day-to-day expenses have reached the Annual Threshold.

Discovery covers the full cost of your consultation fees if you go to a GP in our •network. We pay the claim directly to the GP.

Discovery covers blood tests at our network providers if your GP or specialist •requests the appropriate tests using the Discovery Health pathology form.

Funded from the Medical Savings Account or from the Above Threshold Benefit once day-to-day expenses have reached the Annual Threshold. The Above Threshold Benefit has an overall annual limit.

We pay all day-to-day benefits up to the overall Above Threshold Benefit limit or the amounts of benefits available, whichever applies first.

Discovery covers the full cost of your consultation fees if you go to a GP in our network. We pay the claim directly to •the GP.

Discovery covers blood tests at our network providers if your GP or specialist requests the appropriate tests using the •Discovery Health pathology form.

Funded from the Medical Savings Account.

Discovery extends your day-to-day cover through the Insured Network Benefit by paying for the cost of your GP consultations if you go to a GP in our network when you have spent your annual Medical Savings Account deposit. The maximum number of consultations that we cover for a single member and a family each year depends on your plan type:

Classic and Coastal plans: Single member: three consultations Family: six consultations

Essential plans: Single member: two consultations Family: four consultations

You do not have day-to-day cover.

Offers access to day-to-day cover through the KeyCare network of GPs, dentists and optometrists.

You can go to any casualty unit at one of the keycare network hospitals. You have to pay the first R185 of the consultation.

Mobility Devices Benefit covers any wheelchair, wheelchair batteries and cushions, transfer boards, mobile ramps, commodes, long-leg callipers, crutches and walkers on the KeyCare mobility list, from a network provider up to a limit of R3 800 per family.

No day-to-day benefits available to KeyCare Core members.

Trauma Recovery Extender Benefit

Discovery covers certain out-of-hospital claims for your recovery after certain traumatic events from the Trauma Recovery Extender Benefit. This cover applies for the rest of the year in which the trauma takes place, as well as the year after your trauma.

The Trauma Recovery Extender Benefit is not available.

Not available

Above Threshold Benefit

The Annual Threshold is R10 090 for a main member or adult dependant and R1 900 for each child (up to three children).

The Annual Threshold is R8 200 for a main member. R6 150 for an adult dependant and R2 690 for each child (up to three children).

The Above Threshold Benefit is subject to an overall annual limit based on family size: R7 000 for a main member, R4 950 for an adult dependant and R2 400 for each child (up to three children).

There is no Above Threshold Benefit. There is no Above Threshold Benefit.

There is no Above Threshold Benefit or Medical Savings Account.

We cover consultations at a specialist up to R2 300 for each person. You must call us to confirm your benefits.

We also cover four visits to your gynaecologist when you are pregnant, one routine pregnancy scan (between 10 and 20 weeks) and selected antenatal blood tests if requested by your gynaecologist.

Medical Savings Account (any unused funds are carried over to the following year)

MSA level is 25% of contributions.

The annual MSA deposits are:

R10 092 for a main member or adult and R1 908 for each child (up to a maximum of three children).

MSA level is 25% of contributionsThe annual MSA deposits are:

Main member: R8 280

Adult: R7 824

Child (up to three children): R1 656

Main member: R7 452

Adult dependant: R7 044

Main member: R4 176

Adult: R3 936

Child (up to three children): R828

Main member: R3 756

Main member: R5 544

Adult: R4 368

Main member: R2 856

Adult: R2 244

Main member: R4 956

Adult: R3 900

Main Member: R3 960

Adult: R3 108

Main member: R2 352

Adult: R1 764

Main Member: R1 884

Adult: R1 416

Main member: R3 828

Adult: R2 868

Child (up to three children): R1 536 There is no Medical Savings Account.

Executive Plan Comprehensive Series Priority Series Saver Series Core Series KeyCare Plus KeyCare Core

Classic Classic Delta Essential Essential Delta Classic Essential Classic Classic Delta Essential Essential Delta Coastal Classic Classic Delta Essential Essential Delta Coastal (R0 - R3 900) (R3 901- R6 250)

(R6 251- R8 300)

(R8 301+) (R0 - R6 250)

(R6 251- R8 300)

(R8 301+)

Main member R3 365 R2 760 R2 485 R2 320 R2 088 R1 850 R1 590 R 1 652 R1 320 R1 312 R1 049 R1 277 R1 229 R984 R1 056 R844 R892 R485 R581 R813 R1 211 R465 R579 R894

Adult dependant R3 365 R2 609 R2 350 R2 191 R1 972 R1 457 R1 249 R 1 300 R1 038 R 982 R 787 R 957 R 967 R773 R 791 R633 R669 R485 R581 R813 R1 211 R465 R579 R894

Child* R 638 R 552 R 494 R 463 R 417 R 740 R 635 R 660 R 529 R 524 R 418 R 513 R 491 R393 R 422 R339 R356 R129 R168 R228 R 324 R117 R144 R202

Do you need cover for any chronic conditions?

What kind of day-to-day cover do you need?

How much will your total monthly contribution be?

* Discovery Health counts a maximum of three children when we work out your contribution. The total contribution shown includes the company subsidy for those members who quality for a subsidy. The total contributions also include monthly medical savings account amounts, where applicable.

1 Addison’s disease 14 Epilepsy

2 Asthma 15 Glaucoma

3 Bronchiectasis 16 Haemophilia

4 Bipolar Mood Disorder 17 HIV/AIDS (Antiretroviral Therapy)

5 Cardiac Failure 18 Hyperlipidaemia

6 Cardiomyopathy 19 Hypertension

7 Chronic Obstructive Pulmonary Disease 20 Hypothyroidism

8 Chronic Renal Disease 21 Multiple Sclerosis

9 Coronary Artery Disease 22 Parkinson’s Disease

10 Crohn’s disease 23 Rheumatoid Arthritis

11 Diabetes Insipidus 24 Schizophrenia

12 Diabetes Mellitus (Type 1 & 2) 25 Systemic Lupus Erythomatosis

13 Dysrhythmia (Irregular Heartbeat) 26 Ulcerative Colitis

1 Ankylosing spondylitis 18 Paget’s disease

2 Behçet’s disease 19 Panic disorder

3 Connective tissue disorder (mixed) 20 Paraplegia

4 Cushing’s disease 21 Pemphigus

5 Cystic fibrosis 22 Peripheral arteriosclerotic disease

6 Delusional disorder 23 Pituitary microadenomas

7 Dermatopolymyositis 24 Polyarteritis Nodosa

8 Generalised anxiety disorder 25 Post traumatic stress disorder

9 Huntington’s disease 26 Psoriatic arthritis

10 Hypoparathyroidism 27 Pulmonary interstitial fibrosis

11 Major depression 28 Quadriplegia

12 Motor neurone disease 29 Sjögren’s syndrome

13 Muscular dystrophy and other inherited myopathies

30 Stroke

14 Myasthenia gravis 31 Systemic sclerosis

15 Obsessive compulsive disorder 32 Thrombocytopaenia purpura

16 Organ transplantation 33 Valvular heart disease

17 Osteoporosis 34 Wegener’s granulomatosis

2 3 4 5

Screening Benefit

Day-to-day benefits

Discovery covers the full cost of your consultation fees if you go to a GP • in our network. We pay the claim directly to the GP.

Discovery covers blood tests at our network providers if your GP or • specialist requests the appropriate tests using the Discovery Health pathology form.

Discovery covers the full cost of your consultation fees if you go to a GP in our • network. We pay the claim directly to the GP.

Discovery covers blood tests at our network providers if your GP or specialist • requests the appropriate tests using the Discovery Health pathology form.

Discovery covers the full cost of your consultation fees if you go to a GP in our network. We pay the claim directly to • the GP.

Discovery covers blood tests at our network providers if your GP or specialist requests the appropriate tests using the • Discovery Health pathology form.

Not available

Main member: R8 280

Adult: R7 824

Main member: R7 452

Main member: R4 176

Adult: R3 936

Main member: R3 756

Main member: R5 544

Adult: R4 368

Main member: R2 856

Adult: R2 244

Main member: R4 956

Adult: R3 900

Main Member: R3 960

Adult: R3 108

Main member: R2 352

Adult: R1 764

Main Member: R1 884

Adult: R1 416

Main member: R3 828

Adult: R2 868

(R6 251- R8 300)

(R8 301+) (R0 - R6 250)

(R6 251- R8 300)

(R8 301+)

30 Stroke

2 3 4 5

Screening Benefit

Day-to-day benefits

Not available

Main member: R8 280

Adult: R7 824

Main member: R7 452

Main member: R4 176

Adult: R3 936

Main member: R3 756

Main member: R5 544

Adult: R4 368

Main member: R2 856

Adult: R2 244

Main member: R4 956

Adult: R3 900

Main Member: R3 960

Adult: R3 108

Main member: R2 352

Adult: R1 764

Main Member: R1 884

Adult: R1 416

Main member: R3 828

Adult: R2 868

(R6 251- R8 300)

(R8 301+) (R0 - R6 250)

(R6 251- R8 300)

(R8 301+)

30 Stroke

2 3 4 5

Screening Benefit

Day-to-day benefits

Not available

Main member: R8 280

Adult: R7 824

Main member: R7 452

Main member: R4 176

Adult: R3 936

Main member: R3 756

Main member: R5 544

Adult: R4 368

Main member: R2 856

Adult: R2 244

Main member: R4 956

Adult: R3 900

Main Member: R3 960

Adult: R3 108

Main member: R2 352

Adult: R1 764

Main Member: R1 884

Adult: R1 416

Main member: R3 828

Adult: R2 868

(R6 251- R8 300)

(R8 301+) (R0 - R6 250)

(R6 251- R8 300)

(R8 301+)

30 Stroke

2 3 4 5

Screening Benefit

Day-to-day benefits

Not available

Main member: R8 280

Adult: R7 824

Main member: R7 452

Main member: R4 176

Adult: R3 936

Main member: R3 756

Main member: R5 544

Adult: R4 368

Main member: R2 856

Adult: R2 244

Main member: R4 956

Adult: R3 900

Main Member: R3 960

Adult: R3 108

Main member: R2 352

Adult: R1 764

Main Member: R1 884

Adult: R1 416

Main member: R3 828

Adult: R2 868

(R6 251- R8 300)

(R8 301+) (R0 - R6 250)

(R6 251- R8 300)

(R8 301+)

30 Stroke

2 3 4 5

Screening Benefit

Day-to-day benefits

Discovery covers the full cost of your consultation fees if you go to a GP •in our network. We pay the claim directly to the GP.

Discovery covers blood tests at our network providers if your GP or •specialist requests the appropriate tests using the Discovery Health pathology form.

Discovery covers the full cost of your consultation fees if you go to a GP in our •network. We pay the claim directly to the GP.

Discovery covers blood tests at our network providers if your GP or specialist •requests the appropriate tests using the Discovery Health pathology form.

Discovery covers the full cost of your consultation fees if you go to a GP in our network. We pay the claim directly to •the GP.

Discovery covers blood tests at our network providers if your GP or specialist requests the appropriate tests using the •Discovery Health pathology form.

Not available

Main member: R8 280

Adult: R7 824

Main member: R7 452

Main member: R4 176

Adult: R3 936

Main member: R3 756

Main member: R5 544

Adult: R4 368

Main member: R2 856

Adult: R2 244

Main member: R4 956

Adult: R3 900

Main Member: R3 960

Adult: R3 108

Main member: R2 352

Adult: R1 764

Main Member: R1 884

Adult: R1 416

Main member: R3 828

Adult: R2 868

(R6 251- R8 300)

(R8 301+) (R0 - R6 250)

(R6 251- R8 300)

(R8 301+)

30 Stroke

2 3 4 5

M – R12 500M+1 R15 000M+2 R17 500M+3 R21 000

M – R10 000M+1 R13 500M+2 R16 500M+3 R19 000

M – R6 000M+1 R8 500M+2 R11 000M+3 R13 000

M – R4 000M+1 R6 000M+2 R7 500M+3 R9 000

No benefit

Member + 1 R24 300

Member + 2 R27 850

Member + 3+ R31 400

HealtHHealtH

Plus 42 Day Clinics

Free State

Plus 3 Day Clinics

KwaZulu Natal

Plus 8 Day Clinics

Western Cape

Eastern Cape

Contact Details

Discovery Health

Johannesburg

P O Box 787240,

Sandton 2146

Tel: +27 11 269 2690

Fax: +27 11 263 2397

0860 100 694

155 West Street,

Sandton

Send claims to:

Fax: 0860 329 252

Free StateBethlehem

GautengBenoni

LimpopoBela Bela

MpumalangaBarberton

Northern CapeKathu

M – R12 500M+1 R15 000M+2 R17 500M+3 R21 000

M – R10 000M+1 R13 500M+2 R16 500M+3 R19 000

M – R6 000M+1 R8 500M+2 R11 000M+3 R13 000

M – R4 000M+1 R6 000M+2 R7 500M+3 R9 000

No benefit

Member + 1 R24 300

Member + 2 R27 850

Member + 3+ R31 400

HealtHHealtH

Plus 42 Day Clinics

Free State

Plus 3 Day Clinics

KwaZulu Natal

Plus 8 Day Clinics

Western Cape

Eastern Cape

Contact Details

Discovery Health

Johannesburg

P O Box 787240,

Sandton 2146

Tel: +27 11 269 2690

Fax: +27 11 263 2397

0860 100 694

155 West Street,

Sandton

Send claims to:

Fax: 0860 329 252

Free StateBethlehem

GautengBenoni

LimpopoBela Bela

MpumalangaBarberton

Northern CapeKathu

M – R12 500M+1 R15 000M+2 R17 500M+3 R21 000

M – R10 000M+1 R13 500M+2 R16 500M+3 R19 000

M – R6 000M+1 R8 500M+2 R11 000M+3 R13 000

M – R4 000M+1 R6 000M+2 R7 500M+3 R9 000

No benefit

Member + 1 R24 300

Member + 2 R27 850

Member + 3+ R31 400

HealtHHealtH

Plus 42 Day Clinics

Free State

Plus 3 Day Clinics

KwaZulu Natal

Plus 8 Day Clinics

Western Cape

Eastern Cape

Contact Details

Discovery Health

Johannesburg

P O Box 787240,

Sandton 2146

Tel: +27 11 269 2690

Fax: +27 11 263 2397

0860 100 694

155 West Street,

Sandton

Send claims to:

Fax: 0860 329 252

Free StateBethlehem

GautengBenoni

LimpopoBela Bela

MpumalangaBarberton

Northern CapeKathu

your health benefits documentation/single pages.pdf · your health benefits for 2012 health health...

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