DHMS Basic Plan Comparison 2018 - afhealth.co.za

1 Alexander Forbes Health is a licensed financial services provider (FSP 33471).CMS registration number (ORG 3064)HEALTH12974-Health-YendCompa-2017-1 0 DHMS Basic plan Comparison 2018 Saver Series versus KeyCare Plus PlanBenefitDescriptionSaverKeyCare Plus PlanHospitalisationCover while you are admitted into a general ward in hospital, including theatre/ward fees, specialists and radiology for an authorised for specialists on a payment arrangement, up to the Discovery Health negotiated rate. Level of cover for specialistsClassic/Classic Delta: 200% of Discovery Health Delta/Coastal: 100% of Discovery Health networksDelta and Coastal plans have a hospital networkFor planned admissions outside hospital networks, you must pay an upfront amount to the hospital.

2 Delta plans = R7 = 30% of hospital accountLevel of cover for specialists100% of Discovery Health rate cover in the KeyCare Full Cover Hospital Network and 70% cover in the Partial Cover Hospital and related accounts are not paid if member is admitted to a non-network hospital for a planned is a list of procedures that are covered in the KeyCare day surgery Illness BenefitCover for 27 conditions on the Chronic Disease List (Prescribed Minimum Benefits).Condition needs to be approved to be / Medicine list medicine on medicine list.

3 Medicine not on list paid up to 100% of the Discovery Health rate, up to a maximum of the monthly Chronic Drug designated service provider is MedXpress for Delta medicine on medicine list only. Medicine not on list paid up to 100% of the Discovery Health rate. Medicine to be obtained from GP or network pharmacies and must be prescribed by chosen KeyCare / Cancer coverIf you re diagnosed with cancer and once Discovery Health Medical Scheme have approved your cancer treatment, you are covered by the OncologyCare 000 per beneficiary of the approved cancer treatment programme covered over 12-month cycle20% of cost payable once limit is exceeded.

4 Not applicable for Prescribed Minimum Benefits treatment is covered according to the Prescribed Minimum Benefits and if member goes to a cancer specialist in the Travel Cover BenefitThe International Travel Benefit covers you for medical emergency treatment outside South Africa for 90 days from your date of departure from South Africa. Specific rules apply and pre-existing conditions are to R5 million for each person for each BenefitMRI/CT ScansAn MRI (magnetic resonance imaging) scan produces detailed two- or three-dimensional images of organs inside the body, for example the spine or brain.

5 A CT (computed tomography) scan is a special radiography method that uses a computer to incorporate X-ray images into detailed two-dimensional images to assist with diagnosis, or to see the exact location of a tumour, for from the hospital benefit if the scan is part of an approved admissionIf not related to the admission, the scheme pays the first R2 750 of the scan from your Medical Savings Account and the balance of the scan from the Hospital Benefit, up to 100% of the Discovery Health conservative back and neck scans specific rules from the hospital benefit if the scan is part of an approved not related to the admission, the scheme will pay from the Specialist Benefit, up to a limit of R3 860 person each conservative back and neck scans specific rules purpose of this plan Comparison is to assist with the main differences between specific plans.

6 For full details of each plan , please refer to the DHMS member guide and scheme rules will always Forbes Health is a licensed financial services provider (FSP 33471).CMS registration number (ORG 3064)HEALTH12974-Health-YendCompa-2017-1 0 DHMS Basic plan Comparison 2018 Saver Series versus KeyCare Plus plan continuedBenefitDescriptionSaverKeyCare Plus PlanEndoscopes GastroscopyColonoscopySigmoidoscopy ProctoscopyR4 200 of the hospital account is paid from the Medical Savings Account and the balance of the hospital account and related accounts from the Hospital BenefitIf done in the doctor s room, the account will be paid from the Hospital Benefit, with no at the KeyCare day-surgery Savings Account (MSA)

7 A fixed percentage of your total monthly contribution is allocated to the Medical Savings Account. The percentage allocated depends on your plan type. The monthly amount is multiplied by the number of months left in the year and is available to you and your family for all day-to-day expenses such as GP and specialist consultations, dentistry, optical benefits and medication. Any unused funds will carry over to the next year. When you run out of Medical Savings Account funds, you ll have to pay for some healthcare expenses from your Delta: 25%Essential/Essential Delta: 15%Coastal: 20%Casualty fee payable by memberNo day-to-day services covered through KeyCare network of providers.

8 GP visitsBasic dentistryBasic optometryBasic X-rays and blood testsBasic services in the GP s roomsR325 co-payment payable by memberDay-to-day Extender Benefit (DEB)The Day-to-day Extender Benefit becomes available once the annual funds in the Medical Savings Account has been a network GP on HealthID who meets the digital criteria to access the Day-to-day Extender Benefit (DEB), and get cover for GP consultation on the plan you choose, you also have cover for two kids casualty visits, for each child under the age of 10 years at a network provider.

9 Classic/Classic Delta/Coastal PlansSingle member: 3 GP visits Family : 6 GP visits Classic/Classic Delta Two kids casualty visits, for each child under the age of 10 years at a network Delta PlansSingle member: 2 GP visits Family: 4 GP visits Not applicableSpecialist benefit out of hospitalBenefits for visits to a specialist out of from Medical Savings AccountBenefit of R3 860 per person. This is for the visit and any other services the specialist requests such as X-rays, blood tests and prescribed for external medical itemsBenefits for braces, crutches, wheelchairs, external prosthesis, and so from Medical Savings AccountKeyCare PlusCover wheelchairs and cushions, transfer boards and mobile ramps, commodes, long-leg callipers and crutches all from a network provider.

10 Overall limit of R5 400 per not covered by the exclusion listIn addition to the standard exclusion list, other exclusions apply to all KeyCare plans such as in-hospital dentistry, functional nasal surgery, joint replacements and monthly medical scheme contributionContributions are based on family size onlyContributions are based on monthly gross income and family : Whilst all reasonable care has been taken in compiling this plan specific Comparison , we have relied on information provided to us by the Discovery Health Medical Scheme (DHMS).