DISCOVERY HEALTH - afhealth.co.za

1 DISCOVERY HEALTH . DISCOVERY HEALTH has certain exclusions Accommodation the claims for alcohol and drug that the medical scheme does not pay Therapeutic sessions detoxification and rehabilitation will be for, except where stipulated under the Psychologist or psychiatrist paid in full without any co-payments. prescribed minimum benefits. Alcohol, consultations substance and drug abuse are general Medicine for withdrawal WHAT DISCOVERY HEALTH . scheme exclusions. However, the management and aftercare. COVERS. in-hospital management of alcohol, substance and drug detoxification and Please make sure you get authorisation The scheme covers alcohol, substance rehabilitation are prescribed minimum for admission. DISCOVERY HEALTH will and drug detoxification in full at one of benefits according to the Medical give you information about your cover, the DSPs for a maximum of three days Schemes Act.

2 As well as the closest DSP to you. for each approved admission. DESIGNATED SERVICE If you choose to use a facility that is The scheme covers alcohol, substance PROVIDERS FOR ALCOHOL, not a DSP, DISCOVERY HEALTH will pay up and drug rehabilitation at one of the to 80% of the DISCOVERY HEALTH Rate SUBSTANCE AND DRUG DSPs for a maximum of 21 days each and you will have to pay the difference. DETOXIFICATION AND year. This is the maximum allowable Please note that your co-payment REHABILITATION number of days per member per could be higher than 20% if your year. Members, in consultation with service provider charges more than the All SANCA facilities across South healthcare provider, can choose to be in DISCOVERY HEALTH Rate.

3 Africa, The Ramot Treatment Centre treatment for less than 21 days. and Nishtara Lodge are DISCOVERY If there is no DSP facility reasonably HealthMedical Scheme's designated DISCOVERY HEALTH does not pay for close to where you work or live, service providers (DSPs) for alcohol, the out-of-hospital management you may use any other accredited substance and drug detoxification and and treatment for detoxification or service provider. Please discuss this rehabilitation services. DISCOVERY HEALTH rehabilitation. with DISCOVERY HEALTH when you has an agreed rate that they pay the pre-authorise your treatment. They DSPs and this includes cover for: will tell you under what circumstances HEALTH . FAIS FSP No: 33471 l CMS No: ORG 3064.

4 Important things to remember If you are admitted for alcohol, substance and drug detoxification, it must always be followed by an admission for rehabilitation. If you do not authorise your admission before going into hospital, the scheme will only pay up to 70% of the DISCOVERY HEALTH Rate for this admission. You will need to pay the balance. Find a SANCA facility close to you Eastern Cape SANCA Central 043 722 1210. Free State Aurora Alcohol and Drug Centre 051 447 7271. Gauteng East SANCA Horizon 011 917 5015. Gauteng North SANCA Pretoria Society 012 542 1121. Gauteng West Phoenix House SANCA West Rand Alcohol and Drug Centre 011 673 0400 / 086 117 3422. Gauteng South Nishtara Lodge 011 854 5988. KwaZulu-Natal Lulama Treatment Centre/ Warman House Adolescent Unit 031 202 2274/41.

5 Mpumalanga Mkhondo Alathia Rehabilitation Centre 071 670 8536/7/8. North West Sanpark Alcohol and Drug Centre 018 462 4568. MENTAL HEALTH BENEFIT. DISCOVERY HEALTH 's mental HEALTH benefit provides cover in-hospital for 21 days per person per year, subject to authorisation. This benefit also depends on your medical aid plan as some plans restrict members to network hospitals or government facilities. Members on the Executive, Comprehensive, Priority and Saver plans may also have access to psychologists as part of the Allied, Therapeutic and Psychological benefit on an out-of-hospital basis. This benefit has specific limits based on plan type and family size. The ongoing treatment of certain mental HEALTH conditions may be covered either from the chronic illness benefit, prescribed medication benefit, or prescribed minimum benefit.

6 Access to the chronic illness benefit and prescribed minimum benefit depend on specific entry level factors and members will need to apply for access to these benefits. For conditions such as bipolar mood disorder, schizophrenia, anxiety or panic disorder and major depression, members need to apply for cover from the chronic illness benefit. DISCOVERY HEALTH does not cover attempted suicide as healthcare services related to wilfully self-inflicted illness or injury are a general scheme exclusion, unless they are prescribed minimum benefits, in which case cover will be subject to the scheme's prescribed minimum benefit guidelines and designated service provider rules. There are other mental HEALTH conditions, such as attention deficit hyperactivity disorder (ADHD), that affect mostly children and adolescents, where cover for ongoing treatment will be provided through the day-to-day benefit under prescribed medication.

7 For more information, please contact your Alexander Forbes HEALTH consultant. Yours in HEALTH , Alexander Forbes HEALTH