Discovery Classic Comprehensive Zero MSA: 2017

Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Pay for maximum 3 children.

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IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:	Covered in full for specialists with payment arrangement with Discovery Otherwise, 200% scheme rate	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Hospital Choice:	Unlimited
Specialised Radiology:	Only covered once Annual Threshold is reached
Supplementary Services: (Physio, etc)	Covered in full for professionals with payment arrangement with Discovery Otherwise, 200% scheme rate
Transplants:	Covered
Co-payments:	Scopes: First R3,150 co-payment paid from day-to-day benefit. No co-payment if done in doctor's rooms.
Alternatives to hospitals:	Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered End of life care: R52,750 per person, per lifetime Cancer: Unlimited palliative care cover for approved care at home
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OUT OF HOSPITAL BENEFITS:
GP consultations:	Paid from day-to-day benefit	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Specialists consultations:	Paid from day-to-day benefit
Pathology:	Paid from day-to-day benefit
General radiology:	Paid from day-to-day benefit
Specialised radiology:	Only covered once Annual Threshold is reached
Supplementary Services: (Physio, etc)	Paid from day-to-day benefits. Includes allied, therapeutic and psychology services Main M1 M2 M3+ R15,560 R21,200 R25,900 R30,000 For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly
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MATERNITY BENEFITS:
Hospital stay:	Covered at 200% scheme rate for specialists Three day visits with midwife if discharged a day early from hospital	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Consultations:	Paid from day-to-day benefit Antenatal classes: R1,550 per family from day-to-day benefit
Scans:	Paid from day-to-day benefit
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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):	First R400,000. Thereafter, a 20% co-payment applies Unlimited palliative care cover for approved care at home Note: All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
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DENTISTRY:
Dentistry:	In-hospital: For severe dental and oral surgery, a defined list of procedures is included, with no upfront payment and no overall limit Otherwise, you need to pay a portion of your account upfront: If you are younger than 13, you pay R2,050 for admission to hospital, and R930 for admission to a day-clinic If you are 13 and older, you pay R5,250 for admission to hospital, and R3,400 for admission to day-clinic Balance of account is paid by scheme at 100% scheme rate Out-of-hospital: Standard dentistry: from day-to-day benefit Specialised dentistry: from day-to-day benefit, limited to R25,300 per person. This limit includes claims for orthognathic surgery	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Orthodontics:	See above
Maxillo Facial Surgery:	See above
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MEDICATION:
Chronic:	PMBs chronic: paid by scheme non-PMBs chronic: additional 23 conditions covered, up to a pre-set limit	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Acute (presrcibed) medication:	Schedule 3 and above Paid from day-to-day benefit, up to the limits below Main M1 M2 M3 R26,650 R31,300 R36,350 R41,450
Over-the-counter:	Not covered
Birth Control:
On Discharge:	See "Acute Medicine" benefit
Notes:	Discovery pays for medicine up to the scheme rate, which includes the dispensing fee Use MedExpress to have medicines delivered for free
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OPTOMETRY:
Optometry:	R4,600 per person, including surgery to correct refractive errors, paid from day-to-day benefit 20% discount on frames and lenses at a network optometrist	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
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MENTAL HEALTH:
In-hospital:	21 days per person	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Out-of-hospital:	Major affective disorders, anorexia and bulimia: 15 consultations per person paid by scheme as an alternative to in-hospital treatment Acute stress disorder due to recent significant trauma: 12 consultations per person paid by scheme as an alternative to in-hospital treatment Otherwise, paid from day-to-day benefit. Claims for psychologists and social workers fall into the supplementary benefit sub limit ie: M M1 M2 M3+ R15,650 R21,200 R25,900 R30,000
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OTHER BENEFITS:
General Appliances:	External appliances limited to R58,800 per family from day-to-day benefit Cochlear implants: R207,000	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
1.1. Hearing Aids:	R22,900 per family paid from day-to-day benefit
1.2. Wheelchairs:	See "General Appliances" limit
Dialysis:	Covered in full if you use network provider
HIV:	Covered if on the HIV Care program
Emergency Transport:	Discovery 911
International Coverage:	Up to R5 million per person on each journey for emergency medical costs while outside South Africa Up to R500,000 for treatment overseas that is not available in South Africa, with a 20% co-payment Emergency medical evacuations from certain sub-Saharan African countries back to South Africa
Other:	Internal nerve stimulators: R142,200 DNA Analysis: paid in full from day-to-day benefit or 50% from above threshold Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment
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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:	Covered, for 65yrs+	Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:	Covered
Child Immunisation:
Pap Smear:	Covered, every 3 years
Mammogram:	Covered, every 2 years If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
PAS Test:	Covered
HIV Test:	Covered
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PROSTHESIS:
Overal Limit:		Overall Annual Limit (OAL): Unlimited overall, with sub-limits Contributions: Main: Adult: Child: Total Cost: R3,380 R3,199 R674 Children: Pay for maximum 3 children Day-to-Day Benefit: Comprehensive cover with no savings, a self-payment gap and unlimited above threshold benefits that cover most out-of-hospital benefits (with sub limits). All else paid from out of pocket, unless PMB. Main: Adult: Child: (S) Savings: R0- R0- R0- (SP) Self Payment: R#VALUE! R#VALUE! R#VALUE! Threshold (S+SP): R15,500 R15,500 R2,950 Above Threshold: No limit No limit No limit Compare with these plans: Discovery Classic Comprehensive 2017
Sub-limits:

Important!
• Unless specified, assume that all benefits are paid are paid at 100% scheme rate
• No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
• “Unlimited” benefits are still subject to authorisation, protocols and sublimits
• Assume that all benefits need to be pre-authorised