2014 Comprehensive Series.

8/12/2019 2014 Comprehensive Series.

1/26

2014YOUR GUIDE TO THE COMPREHENSIVE SERIES

ComprehensiveSeries2014


2/26

Regards

Milton Streak

Principal Ofcer:

Discovery Health Medical Scheme

Dr Jonathan Broomberg

CEO:

Discovery Health

YOUR HEALTHCARE COVER IN 2014

Dear Member

Thank yo fo giving s the oppotnity to ook ae yo heathae ove needs

O aim is to keep yo heathy and povide yo with the best of ae when yo need it most.

We design o integated podt soons to make se yo get the most vae fom yo heath pan, and to assist yo in avoiding ot-of-poket payments wheeve possibe,

espeiay when yo o yo oved ones expeiene a ia iness o majo hospita admission. This integated appoah to yo heathae is made possibe by the ombined

powe of the Disovey Heath Media Sheme and Disovey Heath (both efeed to as Disovey Heath in this bohe), as we as Disovey Vitaity.

The Disovey Heath Media Sheme oes the widest ange of heath p ans in the maket. It is Soth Afias agest open media sheme with ove 2, 5 miion membes and

moe than 50% shae of the oa open media shemes maket. As a membe of the Disovey Heath Media Sheme, a poon of yo monthy ontibons goes into yo

individa Media Savings Aont (depending on yo hosen pan) to be sed by yo to ove yo day-to-day media expenses. The emainde goes into the Shemes aont,

and is sed to pay a membes appoved media aims. Whateve is e ove at the end of eah yea emains in the Sheme to be sed to pay aims in fte.

Disovey Heath is the administato of the Disovey Heath Media Sheme, esponsibe fo many fnons, inding aims poessing and payment, and ient sevie toh

points sh as the website and a ente.

Vitaity is a sepaate Disovey ompany that oes a weness pogamme that yo may hoose to join as a Disovey Heath Media Sheme membe. Vitaitys abiity to make

peope heathie and give them geat ewads has made it the wods eading weness pogamme, with ove ve miion membes on fo onnents.

This gide gives yo a smmay of the heath pans we oe and the ih benets avaiabe within the dieent pans, so yo an hoose the one that is ight fo yo heathae

needs and those of yo famiy. Yo wi aso nd infomaon abot the addiona benets and toos povided by Disovey Heath and Vitaity. Pease famiiaise yosef with the

infomaon we have povided yo with so yo an make the best hoies when it omes to yo heathae.

Stay in touch with us

twie.om/disovey_sa

faebook.om/disoveyheathsa

www.disovey.o.za


3/26

TEN REASONS WHY YOUR BEST CHOICE ISTHE DIScOVErY HEAlTH MEDIcAl ScHEME

Thisboheis onyasmmay ofthe keybenetsandfeatesof theDisoveyHeathMediaS hemepans,awaingfomaappovafom theconifo MediaShemes.Fdetaisan befondin theDisoveyHeathMedia Shemeres.It asosmmaisesotheDisoveypodtsand vae-addedsevies. Whenefeeneismade towe intheontextof benets,membes,paymentsoove inthisbohe,this isefeeneto theDisoveyHeathMedia Sheme. Foompianeqesons,emaiompiane@disovey.

o.za.DisoveyHeathMediaS heme,egistaonnmbe1125,is administeedby DisoveyHeath(Pty) ltd,egistaonnmbe1997/013480/07,an athoisednaniaseviespovide.Vitaityis notpatof theDisoveyHeathMedia Sheme.Vitaityis asepaatepodtsodand administeedby DisoveyVitaity(Pty)ltd, egistaonnmbe1999/007736/07,anathoisednaniaseviespovide.

R

EASON

SWe oe the widest range of health plansinthe maket, so yo an est assed that theeis one that is exaty ight fo yo and yofamiys heathae needs.

The widest range of healthplans in the market

Ove 2,5 miion Soth Afians entst thei

heathae fnding to s. One of the benets of this

sae is the abiity it gives s to ontain heathae

osts and pass these savings on to yo. On a ike-

fo-ike basis, Disovey Heath Media Sheme

plan contribuonsae as mh as15% lowerthan

those of any othe Soth Afian media sheme.

The most compevecontribuons

The Disovey Heath Media Sheme has moe

than r9 biion in eseves. Goba cedit rangs

has onnay given s the highest possibe

media sheme ang (AA+) fo o abiity to

pay yo aims.

The Discovery Health MedicalScheme has the highest credit rang

We believe in giving you every opportunity

to engage and interat with us and with your

heath pan, and to get the most out of it.

Our Discoveryappand our websitehave

both been ppose-bit to do exaty that.

Discovery HealthID, o awad-winning

tabet appiaon fo dotos, aows yodoto to digitay aess yo heath

eods ae yo have given pemission.

Your dotor an gain insight into your

benets, study your bood test resuts and

write eetroni presripons, a with the

touh of a nger.

Our technology unlocksthe best of care

We beieve that pevenon is bee than

e, and so we avey enoage yoto detet and teat any iness as eay aspossibe. Thats why we ove a ange ofpevenve tests fom hoesteo to HIVseening withot sing the money inyo Media Savings Aont.

We help you to stay healthy

Yo have the best ove among Soth

Afian media shemes fo aneteatment. In addion, with an Exeve

o compehensive Pan, yo get exta ove

for new and expensive medicinesand for

etain teatments that ae avaiabe ony

otside Soth Afia.

We give you access to themost advanced medical care

Emegeny HeathID enabes emegeny

pesonne to seey aess yo essenainfomaon when yo ae not abe to give it

to them, by sanning yo niqe Qr ode

on yo a ske.

We provide you withlife-saving emergency support

Disovey Heath oes yo p to 25% ash bak on

ove-the-onte mediines (shede 1 and 2) atciks, essena honi ae items at Dis-chem, and

mbiia od bood and sse stem e banking at

Netes. Yo an enjoy moe savings of p to 20% on

fames and enses at an optometist in the Disovey

netwok of optometists.

We help you save on over-the-countermedicines, chronic care items,optometry and stem cell banking

By being a Disovey Heath Media Sheme

membe, yo have the oppotnity to joinVitaity, the wods eading siene-based

weness pogamme that both enoages

and ewads heathy behavio.

Vitality

Our extensive network of heathare providers,

ombined with our unique toos, mean you an

avoid o-payments when vising a speiaist or

GP, on day-to-day preferenay pried mediines,

bood tests or when going to hospita. look out for

the Fu cover choie stamp on our website and

in our guides to point you in the zero o-paymentdireon.

We give you thechoice of full cover


4/263

THE DISCOVERY HEALTH MEDICAL SCHEMEPrODucT PlATFOrM

The Disovey Heath Media Sheme oes a ange of opons to ate fo evey need fom the Exeve Pan to the Keycae

Seies. Eah pans ove anges fom hospitaisaon to honi mediine, with many pans oeing day-to-day ove as we.

Hospital coverThee is no ovea imit fo hospita ove on any DisoveyHeath Media Sheme pan. Yo an go to any pivate hospitaon most pans. The Deta, coasta and Keycae Pans oe

hospita ove in a dened netwok of hospitas.If yo se a speiaist who we have a payment aangementwith, we ove yo in f fo yo appoved poedein hospita.

Chronic illness cover

A Disovey Heath Media Sheme pansove appoved mediine fo the choniDisease list ondions. We pay appovedhoni mediines that ae on theShemes mediine ist in f, o p to aset monthy and amont fo mediinesnot on the mediine ist.The Exeve and compehensive Pansoe ove fo addiona ondions.On the Exeve Pan yo aso have exsiveaess to a dened ist of band mediines whih weove in f.

Screening and prevenon

The Seening and Pevenon Benet oves bood

gose, bood pesse, hoesteo and body mass indexmeasements at a Disovey Weness Netwok povide. Thebenet aso pays fo a mammogam, Pap smea, PSA (postateseening test) and HIV seening tests. If yo ae 65 yeas oode o ae egisteed fo etain honi ondions, we asoove a seasona vaine.

Discovery Vitality oers the worlds leading science-based programme with a personalised approach to wellness

Vitaity heps yo get heathie by giving yo the knowedge, toos and movaon to impove yo heath its been iniay poven that Vitaitymembes ae heathie, ive onge and have owe heathae osts.

Disovey Vitaity (Pty) ltd is an athoised nania sevies povide. registaon nmbe: 1999/007736/07.

The Above Threshold Benet further extends your

day-to-day coverThe Exeve, compehensive and Pioity Pans inde an Above TheshodBenet that gives fthe day-to-day ove one yo aims add p to aset amont (yo Anna Theshod). On the Exeve and compehensiveSeies, the Above Theshod Benet is nimited. On the Pioity Seies, theAbove Theshod Benet has an ovea imit.

Your Medical Savings AccountWe pay yo day-to-day media expenses fom yo Media Savings

Aont on Exeve, compehensive, Pioity and Save Pans. Anynsed fnds ae aied ove to the next yea nike tadiona

pans whee nsed ove is ost.

The Insured Network Benet extends

your day-to-day cover for essenal healthcare

servicesWe extend yo day-to-day ove thogh the Insed

Netwok Benet. When yo have spent yo annaMedia Savings Aont aoaon and befoe yoaims add p to the Anna Theshod, we ove

sevies sh as GP onstaon fees, bood tests,day-to-day ost-eeve mediine, matenity osts and

dabe extena media items fom a povide in o netwok.The heathae sevies oveed depend on the heath pan yo have

hosen.

Day-to-day cover


5/264

A FULL COVER CHOICEEXISTS ON EVErY PlAN

O extensive netwoks of heathae povides, ombined with o niqe sef-sevie toos, mean yo an aways

avoid o-payments. These ps wi gide yo to f ove. remembe to ook ot fo the f ove stamp thoghot this gide.

Use our extensive hospital networksYo ae oveed in f when yo se a netwok hospitaon pans that oe a dened netwok of hospitas. use

o onine MaPS too to nd a hospita in o netwok.

1

Go for prevenve screening testsWe ove pevenve seening tests sh as mammogams, bood pesseand hoesteo tests whih ae geat at deteng eay waning signs of seiosiness. Having these tests done heps yo to stay heathy, bease pevenon is

bee than e.

5

Use our preferred medicine

A Disovey Heath Media Sheme

pans oe a ompehensive ist ofmediine whih we ove in f.The Exeve Pan oes addionaove fo an exsive ist of bandmediines. unde the InsedNetwok Benet, we ove pefeedmediine one yo have spent theanna fnds in yo Media SavingsAont. use Disovey MedXpesso ask yo phamaist abot yoopons to avoid a o-payment.

3

Use a GP or specialist who we have a

payment arrangement with

We oe the boadest ange of GP and speiaistpayment aangements, whih povides f ove

both in and ot of hospita. Amost 90% of omembe inteaons ae with a GP o speiaistin o payment aangements. use o MaPS tooto nd a heathae pofessiona who we have anaangement with.

2

Use a network provider to access the

Insured Network Benet when you have

used up your Medical Savings AccountOne yo have spent yo anna Media Savings Aont(MSA) aoaon and befoe yo aims add p to theAnna Theshod, we extend yo day-to-day ovethogh the Insed Netwok Benet. Yo have ove fonimited GP onstaon fees, bood tests, ost-eeveday-to-day mediine, matenity osts and etain dabe

extena media items. cove fo these heathae seviesdepends on the heath pan yo have hosen. use MaPS tond a netwok povide.

4

Yo an aess MaPS and MedXpess at www.discovery.co.zao on the Disovey app.Disovey Vitaity (Pty) ltd is an athoised nania sevies povide. registaon nmbe: 1999/007736/07.


6/26

5 5

Discovery Health Rate (DHR)

This is a ate set by the Disovey Heath Media Sheme at whih aims and sevies fo heathae povides

(hospitas, phamaies and heathae pofessionas) wi be paid.

Hospital cover

We ove yo in hospita fo emegeny and panned hospita admissions. Yo have to get

athoisaon fom s fo yo hospita stay. Yo hospita ove is made p of yo hospita

aont and eated aonts. A eated aont is an aont fom yo teang doto,

anaesthest and any othe appoved heathae sevies ike pathoogy o adioogy sans.

Networks

Some pans, benets and heathae sevies eqie yo to se the Shemes netwok povides. If yo se

these povides we ae abe to keep yo ontibons as aodabe as possibe whie ensing f ove.

Limits

Most in- and ot-of-hospita heathae benets ae nimited bt thee ae some heathae sevies

sh as densty and optomety that ae sbjet to anna imits. It is impotant fo yo to famiiaise

yosef with these imits and to tak yo sage by ogging onto www.disovey.o.za o heking

yo statements.

DHR

Payment arrangements

The Sheme has enteed into payment aangements with vaios heathae pofessionas that haveageed to be eimbsed at the Disovey Heath rate. This enses no o-payments fo yo. Yo

benet fom aess to the boadest ange of GPs and speiaists, whih epesents amost 90% of

membes inteaons with these heathae pofessionas.

Day-to-day cover

Day-to-day ove indes yo visits to heathae pofessionas ot of hospita, adioogy, pathoogy and mediines phased

fo eveyday se. We ove yo day-to-day heathae sevies fom the Media Savings Aont, Insed Netwok Benet and

Above Theshod Benet. The eve of day-to-day ove depends on the pan yo hoose.

Medical Savings Account (MSA)This is an amont that gets set aside fo yo at the beginning of the yea o when yo join the Sheme.

Yo an se it fo day-to-day heathae expenses ike doto visits, optomety, mediine, pathoogy and

adioogy as ong as yo have money avaiabe. Money not sed at the end of the yea wi be aied

ove to the next yea.

Above Threshold Benet (ATB)The Above Theshod Benet gives yo exta ove at the Disovey Heath rate o a peentage of it

when yo aims add p to a set amont aed the Anna Theshod. The ATB appies to the Exeve

Pan, compehensive Seies and Pioity Seies. The ATB has a imit on Pioity Seies.

Insured Network Benet (INB)

This niqe benet gives yo nimited day-to-day ove fo a set of heathae

sevies at a netwok povide when yo have spent the anna fnds in yo

Media Savings Aont. These heathae sevies inde GP onstaon fees

day-to-day ost-eeve mediines, bood tests, matenity osts and dabe

extena media items. The eve of ove depends on the pan yo hoose.

Chronic Illness Benet (CIB)

The choni Iness Benet oves a ompehensive ist of honi ondions that indes asthma,

diabetes, high hoesteo and high bood pesse. The choni Disease list (cDl) is a dened ist of

honi ondions we ove aoding to the Pesibed Minimm Benets. Exeve and compehensive

Pans oe ove fo addiona honi ondions. Yo have f ove fo appoved mediine on the

Shemes mediine ist o p to a set monthy choni Dg Amont fo mediine not on the mediine ist.

The choni Dg Amont is a monthy maximm amont we pay fo a ass of mediine.

Medicine list

This is a i st of appoved honi mediines that the Sheme oves in f. The

ist indes an extensive ange of high-qaity mediines fo a oveed honi

ondions to ense yo aways have an opon of f ove.

IMPORTANT CONCEPTS TO HELP YOUuNDErSTAND YOur HEAlTH PlAN

PMB

Prescribed Minimum Benet (PMB) condions

These ae ondions whih a media shemes ae eqied to ove as set by the coni fo Media Shemes aoding

to inia gideines. Yo may be eqied to se a Designated Sevie Povide (DSP). A DSP is a hospita o heathae

povide who has an ageement with the Disovey Heath Media Sheme to povide teatment o sevies at a

ontated ate and withot any o-payments by yo.

Self-payment Gap (SPG)

This is a tempoay gap in ove when yo n ot of fnds in yo MSA bt have not yet eahed yo Anna

Theshod. Yo wi have to pay fo day-to-day aims fom yo own poket ding this peiod. Yo mst s

sbmit aims to s so that we know when to stat paying fom yo Above Theshod Benet.

use these handy denions to hep yo ndestand impotant onepts disssed in this gide.


7/266

cassi | cassi Deta | cassi Zeo MSA | Essena | Essena DetaPlan range

COMPREHENSIVE SERIESKEY FEATurES

unimited pivate hospita ove

Gaanteed f ove in hospita fo speiaists on a payment

aangement, and p to 200% of the Disovey Heath rate fo

othe heathae pofessionas

F ove fo honi mediine fo a cDl ps some addiona

honi ondions

A high savings aont and an nimited Above Theshod Benet

fo yo day-to-day heathae needs

Addiona ove fo GP onstaon fees, pefeed mediine,

bood tests, matenity osts and some dabe extena media

items

Aess to speiaised, advaned media ae in SA and aboad

cove fo media emegenies when taveing


8/267

COMPREHENSIVE SERIESHOSPITAl cOVEr

Yo hospita ove is made p of:

cove fo the aont fom the hospita

cove fo the aonts fom yo adming doto, anaesthest o any othe appoved heathae pofessiona.

Cover for your hospital accountWe ove yo in any pivate hospitas fo emegeny and peathoised hospita admissions. We ove yo hospita aont

(the wad and theate fees) at the ate ageed with the hospita. Yo have nimited ove fo genea wads.

Network hospitals on Delta

OnClassic DeltaandEssenal Delta, yo ae oveed in f at pivate hospitas and day-inis in the Deta Hospita Netwok.

Fo panned admissions at hospitas otside the netwok, yo mst pay an amont of r5 450 pfont to the hospita. This does

not appy in an emegeny.

Cover for related accountsWe gaantee f ove when yo se heathae pofessionas who we have a payment aangement with. If yo ae on

a cassi Pan yo benet fom aess to the boadest ange of speiaists, whih epesents ove 90% of o membes

speiaist inteaons.

On the cassi Pans we ove speiaists who we dont have a payment aangement with and othe heathae pofessionas

p to 200% of the Disovey Heath rate.

On the Essena Pans we ove speiaists who we dont have a payment aangement with and othe heathae

pofessionas p to 100% of the Disovey Heath rate.

radioogy and pathoogy ae oveed p to 100% of the Disovey Heath rate on a pans.

Invesgaons are covered dierently

Cover for scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies)

We pay the st r2 500 of yo hospita aont fom yo avaiabe day-to-day benets. We pay the baane of the hospita

aont and yo eated aonts fom yo Hospita Benet.

We ove yo in hospita fo emegeny and panned hospita admissions. Thee is no ovea imit fo hospita ove.


9/26

8


Cover for MRI and CT scans

If yo MrI o cT san is done as pat of an appoved hospita admission, we pay fo it fom yo Hospita Benet at 100% of the Disovey

Heath rate.

If yo ae admied fo onsevave bak o nek teatment, o if the san is not eated to yo hospita admission, we pay the st r2 450

of the amont fo the san fom yo avaiabe day-to-day benets. We pay the baane of the san fom yo Hospita Benet, p to 100%of the Disovey Heath rate. Spei es and imits appy to onsevave bak and nek sans.

On the cassi Zeo MSA, MrI and cT sans ae oveed one yo eah yo Anna Theshod.

Cover for dental treatment

Severe dental and oral surgery

The Sevee Denta and Oa Sgey Benet oves a dened ist of poedes, with no pfont payment and no ovea imit. This benet is

sbjet to athoisaon and the Shemes inia es.

Dental treatment in hospital

Yo need to pay a poon of yo hospita o day-ini aont pfont fo denta admissions. This amont vaies, depending on yo age

and the pae of teatment:

Hospital

Younger than 13 R1 550

Day-clinic

Younger than 13 R750

13andolder R4 000 13andolder R2 600

We pay the baane of the hospita aont fom yo Hospita Benet, p to 100% of the Disovey Heath rate. We pay the eated

aonts, whih inde the denta sgeons aont, fom yo Hospita Benet, p to 100% of the Disovey Heath rate.

On cassi Pans, we pay anaesthests p to 200% of the Disovey Heath rate.

We ove one, onsevave densty, sh as pevenve teatments, simpe ings and oot ana teatments fom yo avaiabe

day-to-day benets.

No overall dental limit

Thee is no ovea imit fo denta teatment. Howeve, a denta appianes, thei paement, and othodon teatment (inding eatedaonts fo othogna sgey) ae paid at 100% of the Disovey Heath rate fom yo day-to-day benets, p to an anna imit of

r20 900 a peson. If yo join the Sheme ae Janay, yo wont get the f imit bease it is aated by onng the emaining

months in the yea.


10/26

9


Dental appliances, their

placement and orthodoncsr20 900 fo eah peson fom yo day-to-day benets. If yo join the Sheme ae Janay, yo wontget the f imit bease it is aated by onng the emaining months of the yea.

Cochlear implants, auditory

brain implants andprocessors

r170 000 fo eah peson fo eah benet

Internal nerve smulators r124 000 fo eah peson

Hip, knee and shoulderjoint prostheses

Thee is no ovea imit if yo get yo posthesis fom o pefeed sppies. If yo hoosenot to, a imit of r35 000 appies to eah posthesis.

Prosthec devices used inspinal surgery

r24 500 fo the st eve, r49 000 fo two o moe eves, imited to one poede fo eah peson

Mental health 21 days fo eah peson

Alcohol and drug

rehabilitaon21 days fo eah peson

Compassionate care r40 000 fo eah peson in thei ifeme

Some healthcare services have an annual limit


11/26

10

COMPREHENSIVE SERIEScHrONIc IllNESS, cANcEr AND HIV cOVEr

Cover for chronic condions

Yo have extensive ove fo a ompehensive ist of honi ondions whih indes the choni Disease list and the

Addiona Disease list. We need to appove yo appiaon befoe we ove yo ondion fom the choni Iness Benet.

Cover for condions on the Chronic Disease List

Yo have f ove fo appoved mediine on o mediine ist. If yo se mediine that is not on the mediine ist, yo an

se p to a set monthy amont fo eah ass of mediine.Cover for condions on the Addional Disease List

Yo an se p to a set monthy amont fo eah ass of mediine.

How we pay for medicine

We pay fo mediine p to a maximm of the Disovey Heath rate fo mediines. The Disovey Heath rate fo mediines

is the pie of mediine as we as a fee fo dispensing it. The Disovey Heath Media Sheme has negoated ontats with

ove 2 000 phamaies, who have ageed to hage no moe than this ate. If yo se a phamay otside of this netwok, yo

may have a o-payment on the dispensing fee haged by the phamaist.

On Classic Deltaand Essenal Delta, yo have ove fo appoved honi mediine, if yo se MedXpess. If yo dont seMedXpess a 20% o-payment appies.

Cover for diabetes

If yo ae egisteed on the choni Iness Benet fo diabetes, yo have aess to a f ange of sevies fo the ongoing

management of yo ondion thogh the cente fo Diabetes and Endoinoogy. We aso ove appoved betooth enabed

gose monitoing devies and test stips that hep yo and yo doto with ea-me management of yo ondion.

Cover for cancer

If yoe diagnosed with ane, we ove yo fom the Disovey CareOnoogy Pogamme one we have appoved yo

ane teatment. We do not imit yo ane teatment osts. We ove the st r400 000 of yo appoved ane

teatment ove a 12-month ye in f. If yo teatment osts moe than r400 000, yo wi need to pay 20% of theaddiona osts. cane teatment that is a Pesibed Minimm Benet is aways oveed in f.

A ane-eated heathae sevies ae oveed p to 100% of the Disovey Heath rate. Yo might have a

o-payment if yo heathae pofessiona hages above this ate.

Cover for HIV and AIDS

When you register for our HIVCarePogamme yo ae oveed fo the a-insive ae that yo need. Yo get aess

to iniay sond and ost-eeve teatment and yo an be assed of ondenaity at a mes. We ove fo GP

onstaons, a speiaist visit, bood tests, sans and x-ays at a netwok povide. Appoved mediines on o mediine ist

ae oveed in f. Mediines not on o ist ae oveed p to a set monthy amont. Yo wi need to get yo mediine

fom a Designated Sevie Povide to avoid a 20% o-payment.


12/26

11

COMPREHENSIVE SERIESDAYTODAY cOVEr

How we cover your day-to-day healthcare expenses

Yo ove is made p of thee eements:

Yo Media Savings Aont

The Insed Netwok Benet

The Above Theshod Benet

We pay fo day-to-day media expenses ike visits to heathae pofessionas, adioogy and

pathology from your Medical Savings Account, as ong as yo have money avaiabe.

When yo have spent yo anna Media Savings Aont aoaon and befoe yo aims

add p to the Anna Theshod, we extend yo ove fo essena heathae sevies thogh

the Insured Network Benet.

Yo wi have to pay fo othe day-to-day media expenses n yo aims add p to the

Anna Theshod. One yo have eahed the Anna Theshod, we pay the est of yo aims

from the Above Threshold Benet.

The Insured Network BenetYo have aess to a niqe set of heathae sevies that ae aways paid in f when yo se a netwok povide, even when yo MSA is

sed p. We ove:

Your GP consultaon fees

at a GP in our GP network

Classic, Classic Delta, Essenal, Essenal Delta

A dened ist ofdurable external

medical items at a network ofdesignated suppliers

Classic, Classic Delta, Essenal, Essenal Delta

Blood tests

at any of the foowing phamaies

Classic, Classic Delta

Preferenally priced generic and brand

medicines(schedule 3 and above)at our independent pharmay network or from:


Antenatal consultaons and two

2D pregnancy scans

at a gynaeoogist o obstetiian who

we have a payment arrangement with



13/26

12

COMPREHENSIVE SERIESDAYTODAY cOVEr

Classic Essenal

Professional services

Allied, therapeuc and psychology healthcare services*

(acouscians, biokinecists, chiropractors, counsellors, dieans, homeopaths,nurses, occupaonal therapists, physiotherapists, podiatrists, psychologists,psychometrists, social workers, speech and language therapists and audiologists)

Singe membe:With one dependant:With two dependants:With thee o moe dependants:

R11 950R16 180

R19 770R22 870

R 7 190R10 180

R13 180R15 580

Antenatal classes R 1 200for your family

Dental appliances and orthodonc treatment* R20 900fo eah peson

Medicine

Prescribed medicine*(over schedule3)

Singe membe:With one dependant:With two dependants:With thee o moe dependants:

R20 250

R23 800R27 650

R31 550

R13 100

R15 900R19 150

R20 900

Over-the-counter medicine(including prescribed medicineunder schedule 3 and lifestyle-enhancing products)

We pay these aims fom the avaiabe fnds in yo MediaSavings Aont.

Appliances and equipment

External medical items* Fo yo famiy: R53 000 R35 500

Hearing aids Fo yo famiy: R19 600 R15 700

Opcal*(includes cover for lenses, frames, contact lenses and surgery or anyhealthcare service to correct refracve errors of the eye, like excimer laser)

R3 500fo eah peson

* If you join the Scheme aer January, you wont get the full limit because it is calculated by counng the remaining months in the year.

The Above Threshold Benet oers extra day-to-day cover

One yo aims add p to the Anna Theshod, we pay the est of yo aims fom the Above Theshod Benet, at the Disovey

Heath rate. The compehensive Seies has an nimited Above Theshod Benet.

Some day-to-day healthcare services have limits

These imits appy to aims paid fom yo Media Savings Aont, Insed Netwok Benet (whee appiabe) and Above Theshod

Benets. These ae not sepaate benets.


14/26

13

COMPREHENSIVE SERIESBENEFITS THAT ENHANcE YOur cOVEr

We make your Medical Savings Account last longer

Prevenve screening

The Seening and Pevenon Benet oves etain tests ike bood gose, bood

pesse, hoesteo and body mass index when done at any one of the Disovey

Weness Netwok povides. We aso ove a mammogam, Pap smea, PSA (a postate

seening test) and HIV seening tests. Membes 65 yeas o ode and membes

egisteed fo etain honi ondions ae aso oveed fo a seasona vaine.

Addional allied,

therapeuc and

psychology services

The Aied, Theape and Psyhoogy Extende Benet gives yo aess to nimited

iniay appopiate ove fo biokineists, aosians, physiotheapists o

hiopatos, psyhoogists, opaona theapists and speeh and heaing theapists.

This ove is fo a dened ist of ondions. Yo may need to appy to make se of

this benet.

Claims related to

traumac events

The Tama reovey Extende Benet oves ot-of-hospita aims eated to etain

tama events. caims ae paid fom the Tama reovey Extende Benet fo the est

of the yea in whih the tama oed, as we as the yea ae the event oed.

Yo may need to appy to make se of this benet.

Access to the most advanced medical cover

Specialised medicine and

technology

Yo have ove fo a dened ist of the atest teatments thogh the Speiaised

Mediine and Tehnoogy Benet, p to r200 000 fo eah peson eah yea. A

o-payment of p to 20% appies.

Overseas treatment

Yo have ove fo teatment not avaiabe in Soth Afia. The teatment mst be at a

egisteed heathae pofessiona and is paid p to a imit of r500 000 fo eah peson.

Yo wi need to pay and aim bak fom s when yo etn to Soth Afia. A o-payment of 20% appies.

Travel and evacuaon cover

Internaonal travel

Yo have ove of p to r5 miion fo eah peson on eah joney fo emegeny

media osts whie yo tave otside Soth Afia. This ove is fo a peiod of 90 days

fom yo depate fom Soth Afia. Pe-exisng ondions ae exded.

Africa evacuaon coverYo have ove fo emegeny media evaaons fom etain sb-Sahaan Afian

onties bak to Soth Afia. Pe-exisng ondions ae exded.


15/26

14

COMPREHENSIVE SERIESCONTRIBUTIONS

Tota ontibons (inding MediaSavings Aont amonts)

Anna Media Savings Aontamounts**

Anna Theshod amonts**

Main member Adt Child* Main member Adt Child* Main member Adt Child*

Classic r3 362 r3 180 r670 r10 080 r9 540 R2 004

r11 350 r11 350 r2 150

Classic Delta r3 028 r2 864 r602 r9 084 r8 592 r1 800

Classic Zero MSA r2 522 r2 385 r503 No Media Savings Aont

Essenal r2 825 r2 670 r568 r5 076 r4 800 R1 020

Essenal Delta r2 544 r2 403 r509 r4 572 r4 320 r912

* We count a maximum of three children when we work out the monthly contribuons, annual Medical Savings Account and Annual Threshold.

** If you join the Scheme aer January, you wont get the full amount because it is calculated by counng the remaining months in the year.


16/26

15

AddionalInformaon


17/26

16

UNIQUE SAVINGSONlY WITH DIScOVErY HEAlTH

Disovey Heath has patneed with ciks, Dis-chem and Netes to hep yo save p to 25% on heathae-eated spend. Weve aso set p a netwok of

pefeed optometists whee yo an save p to 20% on fames and eyegass enses.

If yo ae egisteed on the choni Iness Benet yo get p to 25% ash

bak on a ange of speiaised podts at Dis-chem Phamaies ontywide.

Yo get ash bak on a seeon of monitoing devies, speiaty food, heath

edaon, footwea and aessoies as we as tness and webeing items.

Go to www.discovery.co.za/info/chronicareto egiste, view the ataoge of

podts and fo moe infomaon.

Yo get p to 25% ash bak with MedSave on ove-the-onte (shede 1

and 2) mediines at ciks Phamaies. Go to www.discovery.co.za orwww.medsaver.co.zato avate MedSave now and stat eaning yo ash bak.

Yo get an exsive disont of 25% when yo pay pfont fo mbiia

od bood and sse stem e banking with Netes Biosienes. When

yo hoose to se a payment pan, yo get a disont of 20%. Go to

www.discovery.co.za fo moe infomaon.

Yo get p to 20% disont on fames and eyegass enses when vising an

optometist in the Disovey Heath Optomety Netwok. To view a ist of a

optometrists in our network go to www.discovery.co.za


18/26

17

MEDXPRESSDOOrTODOOr MEDIcINE DElIVErY

Home

Work

Holid

ay

Have your monthly

meds delivered to

your door.

Delivering wherever you are2014

Delivering the best of care

MedXpress, Discovery Healths convenient medicine delivery service

Now yo an take standing in a ong qee at the phamay o yo aeady-oveowing to-do ists. MedXpess ets yo ode mediine

onine o ove the phone and have it deiveed diety to yo doo. MedXpess is aso the onvenient way to ode epeatabe mediine

pesipons. Yo have f ove fo mediines on the Disovey Heath mediine ist (fomay). This means that yo wont have to make

any o-payments and yo wont be haged above the Disovey Heath rate fo mediines.

What Discovery MedXpress oers you

Convenience

Deivey to yo doo Thees no need

to wait in qees o eave home to get

yo mediine.

A simpe poess thee ae no

ompiated foms to ompete. A we

need is a vaid sipt and a phone a.

rega pdates we keep yo p to

date on any hanges that may aetyo ove fo honi mediine when

yo a s to ode thei mediine.

Advice to help you save

When sing MedXpess, Disovey Heaths

qaied sevie agents an aso advise yo

on the most ost-eeve atenaves. And

yo wi aways be haged at the Disovey

Heath rate fo mediines o ess in eet

geng id of a those sma o-paymentsthat add p ove me.

Important points to remember

Delivery

choni o epeatabe pesipon mediine

will be delivered to your preferred address

anywhee in Soth Afia.

One-o pesipon mediine deivey

odes ae enty ony avaiabe in

Johannesbg, Petoia and cape Town

metopoitan aeas.

Delta membersIn 2014 a Deta beneiaies need to ode

thei appoved honi mediine thogh

MedXpess, to avoid a 20% o-payment on

the ost of thei mediine.

How you can order medicine

If yoe paing yo ode fo the st

me, yo need to eay mak yo

pesipon with the wods MedXpess

and yo Disovey Heath Media Sheme

membeship nmbe. Yo an emai yo

pesipon to [email protected]

o fax it to 011 539 1020 and yo wi

eeive an SMS fom Disovey Heath

MedXpess. One yove paed yo st

ode fo honi mediine yo an se the

Disovey smatphone app (downoadabein the App stoe o Googe Pay) o yo an

log in to www.discovery.co.zato have your

monthy epeat mediine odes deiveed

to an addess of yo hoie.

Thee is no addiona administaon o

deivey ost, so yo an take bak the

me spent in the phamay by paing

yo ode now.


19/26

18

THE DIGITAL WORLD OF DISCOVERY

www.discovery.co.za and the Discovery appO website has been designed to dispay opmay, whethe yo ae aessing it on a desktop,

aptop, tabet o smatphone. The Disovey app avaiabe on the App stoe and Googe Pay

pts yo heath pan in yo poket. Togethe they povide a weath of sef-sevie toos and

infomaon to hep yo to manage yo heath pan and yo heath.

Translate your travel cover

into one of ve languages

Watch our educaonal

videos

Access your health

records

Check medicine price

and alternaves

View other Discovery

products you have

View informaon on

hospital procedures

Track your benets and

medical spend

Plan and authorise

hospital admission

Find a healthcare

professional

Access important

documents

Order medicine for

home delivery

Submit and track

your claims


20/26

19

HealthID PUTTING YOUR MEDICALINFOrMATION IN YOur DOcTOrS HANDS

With Disovey Heaths HeathID tabet app dotos an:

To benet fom HeathID, yo doto wi need yo pemission to aess yo heath eods. Yo wi need to give onsent to eah doto

yo visit befoe that doto an aess yo heath eods on HeathID. Yo an og onto www.disovey.o.za to give yo onsent.

No nathoised peson wi have aess to yo pesona media infomaon.

Apply for chronic cover

If yo ae diagnosed with a honi ondion, yo doto an ompete an

eetoni choni Iness Benet appiaon sing the HeathID app. This appiaonis easy and onvenient, bease yo doto gets the infomaon they need fo

yo spei ondion when ompeng the appiaon and yo an get immediate

appova fo etain ondions.

Access medical histories and electronic health records

A doto an go into yo eetoni heath eods and aess yo heath

infomaon to see yo media histoy. So, if yo ae having tobe emembeing

paa mediines yove taken, this infomaon is avaiabe to yo doto

immediatey. Yo an save me and money by not having to epeat tests and

invesgaons, bease the ests of thei pevios tests ae avaiabe fo yo

doto to see.

View benet informaon

Yo doto aso has instant aess to yo heath benet infomaon to hep yo

get the most ot of yo benets. A these fnons ae designed to make dotos

visits easie and moe podve.

Write electronic scripts

Yo doto an pesibe mediine ding a onstaon with yo sing eetoni

sipng. Yo doto an aso see mediines on thei appoved mediine ist, as we as

the ost of those mediines. Yo an nd ways to ede o even avoid o-payments onyo mediines befoe yo even eah the phamay.

HealthID puts your health records in your doctors hands. This is the rst electronic health recordapplicaon of its kind in South Africa.


21/26

20

HOSPITAL NETWORKSDElTA HOSPITAl NETWOrK

Appiabe to cassi Deta compehensive, Essena Deta compehensive, cassi Deta Save, Essena Deta Save, cassi Deta coe andEssena Deta coe netwok opons.

Yo ae oveed in f at hospitas in the Deta Hospita Netwok. Fo panned admissions to any othe pivate hospita, yo mst pay anpfont amont of r5 450. This does not appy in an emegeny.

Gauteng

Awyp Media cente

life Bedfod Gadens Hospita

Netae Bogainvie Pivate Hospita

life Benthst cini

life castenhof cini

cinix Pivate Hospita lesedi

cinix Pivate Hospita Sebokeng

cinton cini

Emfeni Medi-cini

Netae Femina Hospita

life Foways Hospita

legae Pivate Hospita

lenmed cini

life lie company of May

lois Paste Hospita

Midvaal Private Hospital

Moningside Medi-cini

life robinson Pivate Hospita

life roseaes cini

Sikebosand cini

The Donad Godon Media cente

life Wigehewe Hospita

Plus 42 day-clinics

Free State

life rosepak Hospita

Universitas Private Hospital

Plus 3 day-clinics

KwaZulu-Natal

life chatsmed Gaden Hospita

life Entabeni Hospita

Ethekwini Hospital

Midands Media cente

life Westvie Hospita

Plus 8 day-clinics

Western Cape

cape Town Medi-cini

life caemont Hospita

life Kingsby Hospita

Mithes Pain Media cente

Panoama Medi-cini

Vegeegen Medi-cini

Plus 13 day-clinics

Eastern Cape

life New Meane Hospita

Delta network

Pease note that these ists ae sbet to hange. Go to www.discovery.co.zafo the atest ist of hospitas.


22/26

21

GENERALEXcluSIONS

The benets outlined in this guide are a summary of the plans registered in the medical scheme rules. These benets are reviewed annually and amended in line with the

requirements of the Medical Schemes Act and also take into account the requirements of the Consumer Protecon Act where it relates to the business of a medical scheme.

The Disovey Heath Media Sheme has etain exsions. We do not pay fo heathae sevies eated to the foowing,exept whee spated as pat of a dened benet o nde the Pesibed Minimm Benets.

General exclusion list

cosme poedes and teatments

Otopasty fo bat eas, pot-wine stains and bephaopasty

(eyeid sgey)

Beast edons o enagements and gynaeomasa

Obesity Fai ae

Infeity

Wify sef-inited iness o injy

Aoho, dg o sovent abse

Wif and mateia vioaon of the aw

Wif paipaon in wa, teoist avity, iot, ivi

ommoon, ebeion o pising

Injies sstained o heathae sevies aising ding tave too in a onty at wa

Expeimenta, npoven o negisteed teatments o paes

Seah and ese

Any osts fo whih a thid paty is egay esponsibe

We aso do not ove the ompiaons o the diet o indiet

expenses that aise fom any of the exsions isted above,

exept whee spated as pat of a dened benet o nde the

Pesibed Minimm Benets.Waing periods

If we appy waing peiods bease membes have neve beonged

to a media sheme o have had a beak in membeship of moe

than 90 days befoe joining the Disovey Heath Media Sheme,

they wi not have aess to the Pesibed Minimm Benets ding

thei waing peiods. This indes ove fo emegeny admissions.

KeyCare Series exclusions

In addion to the genea exsions that appy to a pans, the Keycae

Seies does not ove the foowing, exept if the Pesibed Minimm

Benets say shemes mst:

1. Hospita admissions eated to:

Densty

Nail disorders

Skin disorders

Invesgaons and diagnos wok-p

Fnona nasa sgey

Eeve aesaean seon, exept if mediay neessay

Sgey fo oesophagea ex and hiats henia

Bak and nek teatment o sgey

Joint epaements, inding bt not imited to hips,

knees, shodes and ebows

cohea impants, aditoy bain impants and intena neve

smatos this indes poedes, devies and poessos

Heathae sevies that shod be done ot of hospita

and fo whih an admission to hospita is not neessay

2. coeon of Hax Vags/Bnion and Taios Bnion/Bnionee

3. Athosopy

4. remova of vaiose veins

5. refave eye sgey

6. Non-aneos beast ondions

7. Heathae sevies otside Soth Afia

We aso do not ove the ost of teatment fo any ompiaons

o the diet o indiet expenses eated to any of these exdedondions and teatments.


23/26

KNOW YOUR HEALTH | IMPROVE YOUR HEALTH | GET REWARDED

Disovey Vitaity (Pty) ltd is an athoised nania sevies povide. registaon nmbe 1999/0077.


24/26

Discovery Vitality: The wellness programme that rewards you for geng healthier

Vitaity heps yo to get heathie by giving yo the knowedge, toos, pesonaised weness pogammes and movaon to impove yo

heath. Apat fom the fat that a heathy ifestye is geneay moe ewading, its been iniay poven that Vitaity membes have owe

heathae osts than non-Vitaity membes. So join today and stat the joney to a heathie yo and a moe ewading ifestye.

To join Vitalityo to nd ot moe, visitwww.discovery.co.za, a 0860 99 88 77, o ontat yo nania advise o yo ompanys Hr epesentave.To apply for your DiscoveryCard, a 0860 11 22 73. Pease note that a infomaon dispayed hee is ony a smmay of the Vitaity benets. Spei

tems and ondions appy to eah benet. *Sbjet to a fai sage poiy.


Find ot yo

Vitaity Age

Online health tools

and assessments

lean moe abot

yo eang habits

Do a Vitality

Heath chek

Find ot yo

tness eves

lean abot

hidens heath

Get p to 25% ash

bak on pesona

ae podts and

on adidas gear

Get ave

and save p to 80%

at gym partners

use the Disovey app

and tness devies

to monito tness

Save at

weight-osspartners

Save on

stopping smoking

Get p to 25% ash

bak on HeathyFood

at Pik n Pay and

Woolworths

Blu

es

tatus

Bronzes

tatu

s

Silverstatus

Goldstatus

Diamondstatus

Enjoy the ewadsof impoving yo heath.

Get heathie, eanVitaity points, inease yo

Vitaity stats and expeiene

ihe ifestye ewads.

Join the Vitaity liveWellPogammes, and se the

Vitality partners and

digital tools to get

great savings and

tak yo heathand wellness

avity.

Enjoytherewards

Imp

rovey

ourh

ea

lth

Know

you

rhea

lth

Do heath, tness

and ntionassessments to

understand how

heathy yo ae.

Vitality Age

up to 35% savings

on oa and

intenaona ights

Fee as* and

boosted data with

VitalityMobile

Even more

rewards with a

Disoveycad

Wide variety of

shopping rewards

up to 25% savingson a enta

Movies at less

than haf pie

up to 50% savings on a

wide range of hotelaommodaon

LOSEWEIGHT

MANAGEHEART HEALTH GET FIT

EATHEALTHILY

MANAGEDIABETES

The Vitaity liveWell Programmes are tailored to support

individual health needs


25/26

Start at Blue status

35 000 points

45 000 points

Maintain Gold for 3consecuve years

15 000 points

Start at Blue status

70 000 points

90 000 points

Maintain Gold for 3consecuve years

30 000 points

Fo eah addiona membe aged 18 yeas and ode, add: 10 000 (Bonze), 20 000 (Sive), 30 000 (God).

Single member Member plus onedependant aged 18 yeas and ode

DIAMOND STATUS

GOLD STATUS

SILVER STATUS

BRONZE STATUS

BLUE STATUS

The Vitality points guide

Stat at Be stats and move p the Vitaity adde as yo impove yo heath and ean Vitaity points thogh heathy avies.

Yo move fom Be stats to Bonze, Sive, God and nay to the highest Diamond Vitaity stats.



26/26

The benets expained in this bohe ae povided by the Disovey Heath Media Sheme, egistaon nmbe 1125, administeed by Disovey Heath (Pty) ltd, egistaon nmbe 1997/013480/07,

an athoised nania sevies povide. This bohe is ony a smmay of the key benets and feates of the Disovey Heath Media Sheme pans, awaing foma appova fom the coni fo

Media Shemes. When efeene is made to we in the ontext of benets, membes, payments o ove, in this bohe this is efeene to the Disovey Heath Media Sheme. Fo ompiane

qesons, emai [email protected]. Vitaity is not pat of the Disovey Heath Media Sheme. Vitaity is a sepaate podt sod and administeed by Disovey Vitaity (Pty) ltd.

registaon nmbe 1999/007736/07, an athoised nania sevies povide.

GM_23227DHl_11/09/13_V3

2014 Comprehensive Series.

Documents

Transcript of 2014 Comprehensive Series.