Am I being ripped off by Discovery?

[RVQ]

I've been on the Saver Series (Essential) since day one and never really used my medical aid. Thinking of moving to the Core Series (Essential or Delta Core Network) and taking the few hundred in savings and dumping it into a savings account or access bond...

 

[Humberto]

Discovery's products do seem rather gimmicky. The money they spend on their rewards programmes can rather be used for lower premiums and easier payouts.

 

[MagicDude4Eva]

...
Vs R3764pp for Executive.

That's an extra R3k a month in my pocket.

That's interesting - for anyone wanting to know specifics, here is the 2013 comparison chart: http://www.discovery.co.za/discovery_za/web/pdfs/health/disc_health_plan_comparison_eng_2013.pdf

@Sinbad - not sure if you have done any detailed analysis yet (I have not), but what would you miss out on when moving down to a Classic Zero? What I briefly picked up:
- No MSA (for 2013 on Classic Comprehensive I would pay R900 into MSA - never really bothered understanding the purpose of MSA / ATB)
- No Trauma Recovery Benefit (unsure what this actually is)
- Insured Network Benefit (also unsure what this is)
- Reduced cover for MRI / CT scans

 

[ClintZA]

That's interesting - for anyone wanting to know specifics, here is the 2013 comparison chart: http://www.discovery.co.za/discovery_za/web/pdfs/health/disc_health_plan_comparison_eng_2013.pdf

@Sinbad - not sure if you have done any detailed analysis yet (I have not), but what would you miss out on when moving down to a Classic Zero? What I briefly picked up:
- No MSA (for 2013 on Classic Comprehensive I would pay R900 into MSA - never really bothered understanding the purpose of MSA / ATB)
- No Trauma Recovery Benefit (unsure what this actually is)
- Insured Network Benefit (also unsure what this is)
- Reduced cover for MRI / CT scans

When compared to Executive, which is what Sinbad is on:

200% vs 300% cover. Fairly easily remedied with gap cover though.
Obviously no day to day benefits like GP visits until threshold reached. So a larger self payment gap due to not having savings.
MRI/CT scans only covered once you reach threshold.

Trauma recovery is for rehabilitation etc after a traumatic event ie once you have left hospital.

 

[Sinbad]

I think I need to look into this gap cover thing. Any suggestions pls?

 

[Kosmik]

I think I need to look into this gap cover thing. Any suggestions pls?

Look at Complimed Gap, a quick google will find it. My son surprised us this year and Medical Aid only paid out the hospital in full and 1/3 of the specialist, gap covered the balance.

 

[Sinbad]

Look at Complimed Gap, a quick google will find it. My son surprised us this year and Medical Aid only paid out the hospital in full and 1/3 of the specialist, gap covered the balance.

Fooook. Their list of options makes Discovery look simple.

 

[ClintZA]

Fooook. Their list of options makes Discovery look simple.

Ha ha, it is not actually that complex, there is a matrix that recommends the gap cover to take dependent on the plan you are on. If you have no objections I can PM you and arrange to send you the matrix via email.

EDIT: Scrap that, I just added it to our website so I will send you the link.

 

[Sinbad]

Ha ha, it is not actually that complex, there is a matrix that recommends the gap cover to take dependent on the plan you are on. If you have no objections I can PM you and arrange to send you the matrix via email.

EDIT: Scrap that, I just added it to our website so I will send you the link.

That will be fantastic - thank you!

 

[Sebulba]

My SO and I are on Bestmed's Beat 2, which is relatively cheap with a small savings for sundry uses. Haven't had any real emergencies so far, so not sure about whether they pay or not. But I see an increase of contributions of 9%, which concerns
me a little. . .

 

[MagicDude4Eva]

Obviously no day to day benefits like GP visits until threshold reached. So a larger self payment gap due to not having savings.

Sounds like you "play" in the insurance field and are well educated. So why would I pay monthly into the MSA - i.e. I could very well elect to have those R900 go into an existing money-market account and then use the funds as I need them. I currently have to pay cash for GP visits and claim later (and Discovery does not pay the full amount in any case). I assume without an MSA, I would still pay cash, submit the claims for discovery to determine once that threshold is reached - right? If so, the MSA is really just a convenient way for Discovery to have a better cash-flow - or?

I guess I need to do some more homework on this. Have asked my financial advisor in the meantime why I should not downgrade from a Classic Comprehensive to a Classic Zero MSA (comparing the two, the cover is exactly the same - with the exceptions I mentioned in my other post above). A downgrade would be a saving of 1K p.m. while still maintaining reasonable cover (in essence, I would save not paying for the MSA)

 

[the eskimo]

But I see an increase of contributions of 9%, which concerns me a little. . .

Medical Inflation > CPI and will always be that way.

Factors like the rising chronic disease burden and the increased cost of new medical technology are the main contributors to this. One will also find that people are using up more of their benefits each year. To combat the fraud that may be associated with increased benefit usage, medical aids have become far less leniant as to what is and what isn't covered.

 

[Sinbad]

Sounds like you "play" in the insurance field and are well educated. So why would I pay monthly into the MSA - i.e. I could very well elect to have those R900 go into an existing money-market account and then use the funds as I need them. I currently have to pay cash for GP visits and claim later (and Discovery does not pay the full amount in any case). I assume without an MSA, I would still pay cash, submit the claims for discovery to determine once that threshold is reached - right? If so, the MSA is really just a convenient way for Discovery to have a better cash-flow - or?

I guess I need to do some more homework on this. Have asked my financial advisor in the meantime why I should not downgrade from a Classic Comprehensive to a Classic Zero MSA (comparing the two, the cover is exactly the same - with the exceptions I mentioned in my other post above). A downgrade would be a saving of 1K p.m. while still maintaining reasonable cover (in essence, I would save not paying for the MSA)

My thinking is very similar to yours. The advantage i guess of MSA is that your full year's contributions are available to you up front, interest free.

 

[Bernie]

...

You may find this site useful in comparing the different medical aid offerings:

http://www.msit.org.za/newsite/index.php?mod=12&action=compareschemes

Great link - thank you.

 

[ClintZA]

Sounds like you "play" in the insurance field and are well educated. So why would I pay monthly into the MSA - i.e. I could very well elect to have those R900 go into an existing money-market account and then use the funds as I need them.

I often advise clients of exactly this. As mentioned by Sinbad the one benefit is that you get one year's "credit" upfront. In other words, in January you have access to the entire year's worth of savings. Not everyone would have this sort of cash at their disposal if something were to go wrong medically. If you have cash readily available then your solution may well be a better one for you. It would really depend on your personal circumstances.

I currently have to pay cash for GP visits and claim later (and Discovery does not pay the full amount in any case). I assume without an MSA, I would still pay cash, submit the claims for discovery to determine once that threshold is reached - right? If so, the MSA is really just a convenient way for Discovery to have a better cash-flow - or?

I say this without knowing your plan details specifically, but with Discovery plans you often choose to either have your day to day expenses reimbursed from savings at Discovery rates or in full. You possibly have the former.

Your claims also only accrue to the threshold limit at Discovery rate. And not all expenses accrue. But yeah, in effect savings on a medical aid are just that, a forced savings component.

I guess I need to do some more homework on this. Have asked my financial advisor in the meantime why I should not downgrade from a Classic Comprehensive to a Classic Zero MSA (comparing the two, the cover is exactly the same - with the exceptions I mentioned in my other post above). A downgrade would be a saving of 1K p.m. while still maintaining reasonable cover (in essence, I would save not paying for the MSA)

Just remember to keep that R1k aside for medical expenses that would have been paid from savings.

 

[Sinbad]

I'm strongly considering putting the difference into my bond...
Waiting for our company's PSG Konsult people to come back to me though - want to hear their advice first.

 

[fdaniels]

Why would anyone use an MSA? It just doesn't make sense. e.g.

SomePackage Core: R1000 per month
SomePackage Saver: R1500 per month then you get R4800 MSA per year

That just doesn't compute. Your MSA will always be less than the amount that your contribute towards your MSA. Then to top it off they want to dictate what medication they are willing to pay for, and what they will not. No thanks, I will just pay cash.

 

[MagicDude4Eva]

Just remember to keep that R1k aside for medical expenses that would have been paid from savings.

I am at the moment on a Comprehensive Classic. The Comprehensive Zero MSA did not exist until now (at least I have not heard of it until Sinbad mentioned it). I am still not sure if that link's info is correct - for example the "Upfront payments to hospitals"-sections seems to indicate that the Comprehensive Classic Zero MSA does not require upfront payment whereas the other Comprehensive ones do.

So in case of Comprehensive Zero MSA I would still pay upfront, submit the claim and once my claims reach the annual threshold Discovery would refund? I am asking this, as even when visiting ER at Fourways Lifestyle (they are part of the Delta Network) I had to pay for the ER charges (treatment for possible rabbies - don't ask) as well as all medication. Claims were refunded much later.

Other than the odd case at Clicks where I was able to offset medication via medical it's always pay upfront and claim later (Intercare in Fourways is another example). So perhaps one would also have to selective pick practitioners which contract with Discovery, but it seems the ones I pick don't seem to want anything to do with Discovery. Regardless of what scheme I was on, I always felt like I was getting shafted and not really getting value for money. Latest example was an eye-infection where I needed cortison drops (at 200 bucks a bottle) over a treatment course of 8 weeks (you use one bottle of eyedrops in 10 days) - but guess what, Discovery only covers that type of repeat medication every 17 days.

But one can't go without medical cover either - that's a step away from bankruptcy if something goes belly-up. (Two cases of cancer in circle of friends in the last two months and both on basic medical aid - will financially ruin those families now).

 

[ToxicBunny]

Meh... must get hold of someone and review my medical aid stuff......

 

[mike156]

Thanks for all the responses guys, I think I'll have a nice long look at that MSIT link and see where to go from here.