Discovery Classic Smart

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Carsomyr

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I am looking to downgrade from Classic Saver to Classic Smart to save us a bit of money. Switching schemes is not currently an option to pregnancy waiting periods.

I'm posting here to get some experience from people. I've sent a query about the maternity stuff to discovery as well, but I'm still waiting for an answer so figured I'd try and get some opinions on that and other things here.

The prescription and GP questions are simply for interest as the premium savings are more than the MSA on the saver is anyway.

Does anyone have any experience with the following parts of the plan :
* Maternity claims (non delivery related): They seem to cover the same things from risk here as the other plans in terms of gyne visits etc. Are there any catches here that are not listed?
* Prescriptions : How often does the medicine that doctors prescribe actually come from their list and get paid for?
* Smart GP Network : Do you manage to get appointments in a reasonable time with this process (Pretoria in particular?) They have sent me a list of the doctors near me and it looks ok, but ensure how that works out in practice.
 
It's very dependant on your location and local providers. I moved my family on to it this year and we've been fine.

1. Hospital is important but the local smart are our ones of choice anyway
2. The local smart gp is quite a good chap and our off visits of R50 are good
3. All medicine he prescribed was paid for with the co-payment R10 per item ( we done it about 4 x ) - Keep in mind to go to your DESIGNATED PROVIDER not the local pharmacist.
4. The OTC benefit is not bad as well.
5. Maternity is the same accross most of the plans except very high ones, whats not covered as standard would have come out of your MSA. From what I read recently, the newer maternity benefits are actually quite decent.

May be a bit late but I would have suggested getting gap for any shortfalls. Note that the classic smart works the same as classic saver, inhospital and arangements are covered in full and up to 200%
 
Kosmik said:
It's very dependant on your location and local providers. I moved my family on to it this year and we've been fine.

1. Hospital is important but the local smart are our ones of choice anyway
2. The local smart gp is quite a good chap and our off visits of R50 are good
3. All medicine he prescribed was paid for with the co-payment R10 per item ( we done it about 4 x ) - Keep in mind to go to your DESIGNATED PROVIDER not the local pharmacist.
4. The OTC benefit is not bad as well.
5. Maternity is the same accross most of the plans except very high ones, whats not covered as standard would have come out of your MSA. From what I read recently, the newer maternity benefits are actually quite decent.

May be a bit late but I would have suggested getting gap for any shortfalls. Note that the classic smart works the same as classic saver, inhospital and arangements are covered in full and up to 200%
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1. Same here, one the network hospitals is 5 mins away and is our preferred hospital anyway
2. We'll see how this works out for us, but even if it fails completely I'm not worse off.
3. That's pretty awesome to hear. Designated providers are close enough that this won't be an issue.
5. New benefits are nice so far (Gyne visits not eating savings adds up). They look the same on paper between all the plans.

Gap: I'll probably be adding it now that there's a bit more room in the budget, but that obviously won't cover things like an existing pregnancy. But on the other hand the first one using the same providers was covered with no shortfalls, so it's not currently a worry. I'll shop around anyway, but do you have a recommendation?
 
Carsomyr said:
1. Same here, one the network hospitals is 5 mins away and is our preferred hospital anyway
2. We'll see how this works out for us, but even if it fails completely I'm not worse off.
3. That's pretty awesome to hear. Designated providers are close enough that this won't be an issue.
5. New benefits are nice so far (Gyne visits not eating savings adds up). They look the same on paper between all the plans.

Gap: I'll probably be adding it now that there's a bit more room in the budget, but that obviously won't cover things like an existing pregnancy. But on the other hand the first one using the same providers was covered with no shortfalls, so it's not currently a worry. I'll shop around anyway, but do you have a recommendation?
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For gap we are with Ambledown. There is also complimed, similar products. Gap has changed in that no matter what gap you get, they are capped at R150k max whereas before it was 2Mil+ . However, to keep customers they have extended the benefits quite a bit: copayments, sublimits, casualty etc. Either of those two are fine but last I looked at Discoverys one I would avoid as there was some funny limit around amount of cover, whereas the other two offer up to 500% medical aid rate. The nice thing about gap is its PER FAMILY, so you pay one for all and it doesn't change by number of dependants. I'm lucky enough to have it as part of my group benefit.
 
Thanks for all the feedback Kosmik.

Not planning on Discovery's Gap because they are clearly trying to avoid covering co-payments(for obvious reasons from their side). And they won't give you gap for two years after a downgrade anyway, so they've taken themselves out of the running.
 
I'm changing to Classic Smart for 2019. The saving of nearly R5k pm offsets the loss of the other benefits for my family of 4. (I'm downgrading from Classic Priority).
 
FWIW the wife and I are on Essential Smart.

The pregnancy thing, each gynaecologist will have a certain set of "codes" for what they include in their appointments and Discovery has a list of what they'll cover or not. If you phone the lady doctor's rooms then they'll be able to tell you what you'll have to pay. With ours it's R400 a pop IIRC.

I found Smart network GPs quite easy to find. I live in Cape Town but visiting my relatives earlier in the year the wife needed to see a GP and we found one in Wonderboom South who was quite pleasant to work with. Got an appointment same day.

As to prescriptions, I can't say, I don't think my level is eligible for that list of medications as Classic Smart is. But then we are generally healthy so I think since I got on this plan, basically when it was introduced, we have been given a prescription precisely once. That was for a specific bacterial infection though and I don't think antibiotics will be on the list.
 
I made the same change earlier this year and it’s the best thing I did. Doctors visit is paid with a co payment of R50 (injections in the room won’t be covered only consultation) meds are always paid for, the only thing they don’t cover is pro bioctics. I have gap cover with Turnberry. They have been awesome, even pay for ER visits
 
newby_investor said:
FWIW the wife and I are on Essential Smart.

The pregnancy thing, each gynaecologist will have a certain set of "codes" for what they include in their appointments and Discovery has a list of what they'll cover or not. If you phone the lady doctor's rooms then they'll be able to tell you what you'll have to pay. With ours it's R400 a pop IIRC.
Click to expand...
Awesome, thank for that. We currently only pay in R10 a visit, so if they covered it for you that way with the co-payment then sounds like that we should be fine.

Pricing on the Smart plans is interesting. Once you hit one child, Classic is only R70 more expensive than essential per month. Once you add two children classic is actually CHEAPER than essential, and thats my comparison currently.
 
Carsomyr said:
I am looking to downgrade from Classic Saver to Classic Smart to save us a bit of money. Switching schemes is not currently an option to pregnancy waiting periods.

I'm posting here to get some experience from people. I've sent a query about the maternity stuff to discovery as well, but I'm still waiting for an answer so figured I'd try and get some opinions on that and other things here.

The prescription and GP questions are simply for interest as the premium savings are more than the MSA on the saver is anyway.

Does anyone have any experience with the following parts of the plan :
* Maternity claims (non delivery related): They seem to cover the same things from risk here as the other plans in terms of gyne visits etc. Are there any catches here that are not listed?
* Prescriptions : How often does the medicine that doctors prescribe actually come from their list and get paid for?
* Smart GP Network : Do you manage to get appointments in a reasonable time with this process (Pretoria in particular?) They have sent me a list of the doctors near me and it looks ok, but ensure how that works out in practice.
Click to expand...

I dont have experience with maternity claims.

Prescriptions: Acute: Ive only claimed once and I only had a R10 co-payment. The medicines they covered were anitibiotics, cough medicine and even panado. (very happy with this)
However on chronic claims, they rejected my hyper tension condition, but I find the medicine reasonably priced so I didnt fight them to cover it despite my Dr saying I should fight them. (upset about this)

Smart GP Network. Unfortunately I dont have pretoria experience, but my Randburg Medicross is covered and I usually get an appointment with my GP next day, or same day when I've been really sick. Ive only paid R50 for these visits. However I have also had to cover 90% of my blood tests and stress ECG test costs. But still works out cheaper than the MSA on other policies. (Good on Dr coverage, not so great on day to day coverage)

Hospital cover: I had a kidney stone and got admitted to Fourways Life (part of hospital network) and they covered the ER visit(including diagnostic scans), urologist/specialist and hospital stay in full. I didnt pay a single cent for that trip.
However, despite the hospital being part of the network, when I have been to their ER and not admitted, I had to pay the emergency dr's in full because they aren't part of the dr network. (Ive only been to ER in serious situations so happy to pay when absolutely necessary. Knowing that when im admitted they cover the biggest stuff is great)

Overall I have found the cover to be very fair and I have 2 hospitals in the network close to my home and work. My only complaint is my chronic rejection.

EDIT: I am on classic smart. I am however considering classic essential with gap cover, but still evaluating it before the start of the new year.
 
Fcon_Vpro said:
I dont have experience with maternity claims.

Prescriptions: Acute: Ive only claimed once and I only had a R10 co-payment. The medicines they covered were anitibiotics, cough medicine and even panado. (very happy with this)
However on chronic claims, they rejected my hyper tension condition, but I find the medicine reasonably priced so I didnt fight them to cover it despite my Dr saying I should fight them. (upset about this)

Smart GP Network. Unfortunately I dont have pretoria experience, but my Randburg Medicross is covered and I usually get an appointment with my GP next day, or same day when I've been really sick. Ive only paid R50 for these visits. However I have also had to cover 90% of my blood tests and stress ECG test costs. But still works out cheaper than the MSA on other policies. (Good on Dr coverage, not so great on day to day coverage)

Hospital cover: I had a kidney stone and got admitted to Fourways Life (part of hospital network) and they covered the ER visit(including diagnostic scans), urologist/specialist and hospital stay in full. I didnt pay a single cent for that trip.
However, despite the hospital being part of the network, when I have been to their ER and not admitted, I had to pay the emergency dr's in full because they aren't part of the dr network. (Ive only been to ER in serious situations so happy to pay when absolutely necessary. Knowing that when im admitted they cover the biggest stuff is great)

Overall I have found the cover to be very fair and I have 2 hospitals in the network close to my home and work. My only complaint is my chronic rejection.

EDIT: I am on classic smart. I am however considering classic essential with gap cover, but still evaluating it before the start of the new year.
Click to expand...

Just FYI, chronic cover is the same across all plans. Just some plans have more conditions or better medicine options but the approval/rejection of a condition is the same. I'm in the same boat, fought with them for years around other conditions which my doctor diagnosed and prescribed tablets but they refuse to cover. One of them I apparently missed the threshold by 0.1 or so on the test and the doc put me on medication to PREVENT it getting worse. Now the argument is I need to prove it's WORSE prior to them funding me. And apparently, if I lied and said I was a smoker, I'd get it easily which I'm not planning on doing.

Thats why I like Smart, you get to decide what to do with your savings ( diff in premuim ) and not have to fight about every little thing and you are still decently covered for day to day and good hospital.
 
Kosmik said:
Just FYI, chronic cover is the same across all plans. Just some plans have more conditions or better medicine options but the approval/rejection of a condition is the same. I'm in the same boat, fought with them for years around other conditions which my doctor diagnosed and prescribed tablets but they refuse to cover. One of them I apparently missed the threshold by 0.1 or so on the test and the doc put me on medication to PREVENT it getting worse. Now the argument is I need to prove it's WORSE prior to them funding me. And apparently, if I lied and said I was a smoker, I'd get it easily which I'm not planning on doing.

Thats why I like Smart, you get to decide what to do with your savings ( diff in premuim ) and not have to fight about every little thing and you are still decently covered for day to day and good hospital.
Click to expand...

Thanks for the info. The rejection reason was vague and I think it was regarding the medicine my dr prescribed. The problem was that the medicine prescribed was a generic, and my Dr said there wasnt another he could recommend.
The only time that MSA makes sense is when you exceed the thresholds and get unlimited cover afterwards.
But otherwise I agree with you and do the same, save the savings portion and choose what I want to do with it.
 
Fcon_Vpro said:
Thanks for the info. The rejection reason was vague and I think it was regarding the medicine my dr prescribed. The problem was that the medicine prescribed was a generic, and my Dr said there wasnt another he could recommend.
The only time that MSA makes sense is when you exceed the thresholds and get unlimited cover afterwards.
But otherwise I agree with you and do the same, save the savings portion and choose what I want to do with it.
Click to expand...

You can ask them for grounds of the rejection, it also wouldn't be based on medicine as they have a set formulary for it. They may not cover the exact medication but it won't stop cover for the condition. Also, little know fact, chronic cover also covers consulations and treatment with ANY doctor and specialists up to a point, so it's not just savings on meds. For hypertension, they cover doc visit once a year, tests and a cardiologist visit, all of that would be out of pocket if not.
 
the eskimo said:
I'm changing to Classic Smart for 2019. The saving of nearly R5k pm offsets the loss of the other benefits for my family of 4. (I'm downgrading from Classic Priority).
Click to expand...
Hi, I am in exactly the same situation that you were in last year, considering downgrading from Classic Priority to Classic Smart. Do you perhaps have any feedback regarding your experience with this for 2019? Thanks
 
We're on Smart Classic and don't have any complaints.

Doctor's visits cost us R50. Wife had an ER incident, so we went to a non-SMART plan hospital which they covered. Then transferred to a Smart plan hospital, and they covered that. Hospital was Netcare Waterfall, which we were really impressed with.
 
Also so pretty happy with smart. This last month was bad, like 8 doc visits with varied family but still only the R50 Co pay each :D
 
I am also in the Waterfall/Midrand area. How have you found the GP network?
 
schuits said:
We're on Smart Classic and don't have any complaints.

Doctor's visits cost us R50. Wife had an ER incident, so we went to a non-SMART plan hospital which they covered. Then transferred to a Smart plan hospital, and they covered that. Hospital was Netcare Waterfall, which we were really impressed with.
Click to expand...
Thank you. This is great feedback. Was there any co-payment for the ER visit. Did you by any chance go to Sunninghill and was then transferred to Netcare Waterfall?
 
Classic smart was great. Changes to next year not so good ito medication which is now capped. Doctors on the smart plan usually are sometimes not that smart
 
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