Alternative medical aid

This is the part that worries me that you have to pay X upfront for any planned admissions to any other private hospital outside of the Network hospital as all doctors don't work at any private hospital and if that Dr/Specialist doesn't work at your network hospital than you either have to place your trust in another Dr/Specialist or fork out..
Or am I wrong?
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shaggy_beef_on_a_tricycle said:
You have the wrong end of the stick and don't understand the conversation. You are talking about exploitation. The person I was responding says all their claims gets rejected. Those are two different topics.
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My bad, I should have quoted your full post, did not know you suffer from short term memory loss, see bold:
shaggy_beef_on_a_tricycle said:
You are making that up. If you claim is rejected, 95% of the time it is because the error is on your side, not understanding the product, lying to your insurance.

You are also spending other people's money, not only your own.

I think the problem we have here is entitlement.
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Now read my post again.

Medical fraud is rife, which also increase medical claims rejection, sometimes not the member fault.

Secondly, the medical aid brochures from all the medical aid does not clearly state what is covered and not covered. I know I tried, because I wanted to compare the different offerrings and oftentime you only find out when claiming about the hidden rules.

You claim entitlement but cannot show it. Just pontification from a high horse, would not be surprise if you work in the industry.
 
Stonemason said:
I have the same problem with Discovery. In my case they want to increase the contribution by 19% but they are reducing the cover quite drastically. My biggest problem is their so-called 'network hospitals'
I want to be able to go to any hospital I want, as I have been able to do in the past. Now, if I want to go to a hospital outside their 'network', I have to pay an extra R12 000 upon admission. This is BS, not all hospitals have the right equipment and doctors affiliated to them.

Discovery has looked after me and my family very well over the years, but I think it is time for me to look elsewhere. I have asked my broker to look for another medical aid that will give me proper cover.
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question: do you feel "scammed" ?
 
Tech_ said:
This is the part that worries me that you have to pay X upfront for any planned admissions to any other private hospital outside of the Network hospital as all doctors don't work at any private hospital and if that Dr/Specialist doesn't work at your network hospital than you either have to place your trust in another Dr/Specialist or fork out..
Or am I wrong?
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You are 100% right
 
Kosmik said:
Per family.

2024

View attachment 1617953

2024 Guide -> https://www.discovery.co.za/wcm/dis...ry-health-medical-scheme-smart-plan-guide.pdf
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So OTC is if I go buy panado, sinucon, acc200 etc and not if I get sick and the Dr prescribes antibiotics etc than I assume that comes out of Acute meds as I know when my kids get sick the Meds are more than the consult and R560/835 will only cover meds once and my kids get sick many times esp in Winter.
Another reason this Smart Plan may not be ideal for me is this having to go
to a Smart GP and MedXpress Network Pharmacy as what if my GP isnt one of their Smart GP's and what if the Pharmacy closest to me isn't a MedXpress Network pharmacy?
 
Gtx Gaming said:
Move to smart classic, lets you see unlimted doctors visits for R60 a month.

Saved me tons money as also covers over the counter medicine.
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Is smart classic worth the ~R700 more per month compared to smart essential for a single person? And that money could go towards gap cover instead? As someone who doesn't go to the doctor often, does not take chronic medication, and is mostly focused on protection from hospital fees in the event of an accident or illness that appears down the line, would smart essential + gap cover be the better option?
 
Tech_ said:
So OTC is if I go buy panado, sinucon, acc200 etc and not if I get sick and the Dr prescribes antibiotics etc than I assume that comes out of Acute meds as I know when my kids get sick the Meds are more than the consult and R560/835 will only cover meds once and my kids get sick many times esp in Winter.
Another reason this Smart Plan may not be ideal for me is this having to go
to a Smart GP and MedXpress Network Pharmacy as what if my GP isnt one of their Smart GP's and what if the Pharmacy closest to me isn't a MedXpress Network pharmacy?
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Yeah.

So I have a family of four ( Wife , two kids and I ). The OTC is exactly as you say: acc200, benelyn etc etc. Acute meds are basically prescription meds sched3.

Yep thier doctors and hospitals but you can check the MAPS for providers, we found and actually used ones we were happy with before doing the full switch. Medexpress is just direct, clicks or Dischem. Also I don't think acute falls into that.

Keep in mind, this plan is NOT a replacement for a plan with MSA. Its a plan with good hospital cover and decent minimum day to day benefits as a base but the rest you pay out of pocket. MY frustration with coastal saver was

1. Always having to fit about the claims and argue around medicine and even some chronic
2. MSA was just destroyed with doctor visits and the rest with medicine
3. Coastal gave 100% hospital vs 200% on Classic Smart.

MY idea here, was to pocket the differences in funds and that goes to my credit card. Then use it if I need to to pay or medication. Whether you use MSA or cash, its YOUR money. Only differences is that a MSA allows you to utilize the FULL amount from day one. If you work out the annual differance between plans , you will see what I mean. Yes, on MSA pans you get the insured benefit but its not really much and for example, my wife had a very persistent cough, she went to the doctor for four visits alone this month and it was covered as well as the acute. We paid R100 for some basic cough drop suppressants as we had used the OTC , but that would have easily cost about R3-R4k of MSA.

Typical disclaimer, not broker etc, this is MY personal experience and MY personal opinions. Use at own discretion.
 
What happened to the old medical aids before 1992 where you just got helped no problems which operated on the principle of not everybody is sick at once and the mostly healthy pays for those that needs medical care because they will need it one day too-?.

I know exaxtly what happenned, and its a shamefull disgusting situation today. My last big operaperation they made a small profit from me, although their book dont reflect it as such(Wonderfully Digital), however my books do.
You tell what you think is going on 1992+ slowly+++-? NHI, everything is going to hell over TIME. Someting seriously is wrong, and the World over for that matter.
 
Lefty309 said:
Is smart classic worth the ~R700 more per month compared to smart essential for a single person? And that money could go towards gap cover instead? As someone who doesn't go to the doctor often, does not take chronic medication, and is mostly focused on protection from hospital fees in the event of an accident or illness that appears down the line, would smart essential + gap cover be the better option?
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For a single? If you healthy probably not but check the family, if essential you pay the same rate for children and adult dependants which makes a no brainer as well as the differences if visit price.

Your acute and OTC are a bit lower though and a few other things but if it a choice of GAP/ no GAP, I'd go GAP as the GAP @ 500% will cover the hospital @ 100% and there are a few other benefits as well depending on your provider.
 
Moto Guzzi said:
What happened to the old medical aids before 1992 where you just got helped no problems which operated on the principle of not everybody is sick at once and the mostly healthy pays for those that needs medical care because they will need it one day too-?.

I know exaxtly what happenned, and its a shamefull disgusting situation today. My last big operperation they made a small profit from me, although their book dont reflect it as such(Wonderfully Digital), however my books do.
You tell what you think is going on 1992+ slowly+++-? NHI, everything is going to hell over TIME. Someting seriously is wrong, and the World over for that matter.
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Gone bye bye for many years. I started on Key Care in the early 00's, what a absolute pleasure, no stress about money or hoops.
 
Kosmik said:
Yeah.

So I have a family of four ( Wife , two kids and I ). The OTC is exactly as you say: acc200, benelyn etc etc. Acute meds are basically prescription meds sched3.

Yep thier doctors and hospitals but you can check the MAPS for providers, we found and actually used ones we were happy with before doing the full switch. Medexpress is just direct, clicks or Dischem. Also I don't think acute falls into that.

Keep in mind, this plan is NOT a replacement for a plan with MSA. Its a plan with good hospital cover and decent minimum day to day benefits as a base but the rest you pay out of pocket. MY frustration with coastal saver was

1. Always having to fit about the claims and argue around medicine and even some chronic
2. MSA was just destroyed with doctor visits and the rest with medicine
3. Coastal gave 100% hospital vs 200% on Classic Smart.

MY idea here, was to pocket the differences in funds and that goes to my credit card. Then use it if I need to to pay or medication. Whether you use MSA or cash, its YOUR money. Only differences is that a MSA allows you to utilize the FULL amount from day one. If you work out the annual differance between plans , you will see what I mean. Yes, on MSA pans you get the insured benefit but its not really much and for example, my wife had a very persistent cough, she went to the doctor for four visits alone this month and it was covered as well as the acute. We paid R100 for some basic cough drop suppressants as we had used the OTC , but that would have easily cost about R3-R4k of MSA.

Typical disclaimer, not broker etc, this is MY personal experience and MY personal opinions. Use at own discretion.
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I can't seem to find a public reference for the GPs on the smart network.. do you know if there is one..?

I am considering moving from coastal saver to smart classic, but my wife is particular about her GP so she will want her GP to be on the network..

Discovery only tells you in network GPs based on your current plan when logged in..
 
Kosmik said:
For a single? If you healthy probably not but check the family, if essential you pay the same rate for children and adult dependants which makes a no brainer as well as the differences if visit price.

Your acute and OTC are a bit lower though and a few other things but if it a choice of GAP/ no GAP, I'd go GAP as the GAP @ 500% will cover the hospital @ 100% and there are a few other benefits as well depending on your provider.
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What I mean about the family cost regarding dependants.

1700043419738.png

And if you look at that, compare the first column going up. Classic for main member is cheaper than classic or costal savers sans MSA. Rate per rate , it made sense to me, keeping in mind BANKING the differences, effectively self insuring MSA.
 
Kosmik said:
Dental is basic checkup once a year per member.

Keep in mind, there is no MSA. For Classic Smart:

  1. You get hospital cover @ 200% MAR. In the network yes but make that call before hand so you know which hospitals are covered. NOTE in emergency, standard discovery, any hospital until stabilized and transferred.
  2. R60 per doctor visit, unlimited.
  3. OTC medication has a annual limit of about R750
  4. Acute perscribed medication has a annual limit of aprox R2.5k
  5. Chronic is covered same as chronic normal plans
  6. Usage of medexpress, clicks, dischem mandatory.
So you can pocket the MSA differance however you like and at least have basic out of hospital cover but the same as a hospital only plan, you will pay out of pocket, which is EXACTLY what a MSA is, just you have the annual balance available upfront.
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What is this product called?

I don't see it on their website.
 
Many are saying "Drop the MSA", I had a look for myself.

Assuming two adults and two kids, comparing the 2024 Essential Saver plan (which is probably OP's plan as it's the one with the specific increase he mentioned) and 2024 Essential Core plan (same benefits without delving into "network hospitals" territory with the only difference being no MSA on the core) :

Monthly contributions : R8549 vs R7288

MSA : R10212
vs
Savings over 12 months : R15132

Of course the savings accumulate every month instead of being available at the start, but it does appear significant. It might vary depending on plans though (edit: actually it definitely varies depending on plan, because Classic Saver vs Classic core with the same benefits minus the MSA is only roughly a R750 difference per annum).
 
Discovery 2024 rate increase. Bastards. I'm going to move away from them. Not paying 12%+ increase so they can have overseas holidays.
 

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