Discovery Health Application information

[fdaniels]

Section 11.14 of the application form asks:

"Any symptoms not yet diagnosed by a medical professional or any condition which is not covered by these questions? Yes [] No []"

So what exactly does this mean? It seems like it is a clause that allows them to 'catch you out' with in the future if you need medical attention that is expensive.

Last year, I think January or so I went to donate blood. The nurse there said that I couldn't donate because my heart was skipping beats. Concerned, I went to see a Heart Specialist (well after a few weeks as he was really busy). He did extensive testing (sonar, heart rate test, blood, etc) and found nothing wrong with me. I have a follow up appointment with him this May.

Would this constitute a symptom that is not diagnosed. I mean yes I had it investigated but the doctor didn't find anything wrong with me. I mean I don't want to diagnosed with heart failure ten years from now only to have my medical aid refuse to cover me because of this.

 

[PeterCH]

Section 11.14 of the application form asks:

"Any symptoms not yet diagnosed by a medical professional or any condition which is not covered by these questions? Yes [] No []"

So what exactly does this mean? It seems like it is a clause that allows them to 'catch you out' with in the future if you need medical attention that is expensive.

Last year, I think January or so I went to donate blood. The nurse there said that I couldn't donate because my heart was skipping beats. Concerned, I went to see a Heart Specialist (well after a few weeks as he was really busy). He did extensive testing (sonar, heart rate test, blood, etc) and found nothing wrong with me. I have a follow up appointment with him this May.

Would this constitute a symptom that is not diagnosed. I mean yes I had it investigated but the doctor didn't find anything wrong with me. I mean I don't want to diagnosed with heart failure ten years from now only to have my medical aid refuse to cover me because of this.

Symptoms are things you experience - for example if you feel the skipped beat - it's called a symptom or if you get short of breath with moderate exertion or you suffer chest pain. If the nurse was feeling your pulse and noted that you skipped a beat now and again, it would be a sign she picked up. It's not a symptom in the sense of symptoms if you felt nothing - you were then asymptomatic. 'Conditions' on the other hand could be interpreted widely. What if you had a dizzy spell a few years ago because you were dehydrated. That wouldn't necessitate a full blown investigation. Would Discovery reject you then? With these b-ggers you never know.

Since you had a cardiologist look at it, it should be good enough. He examined you, did a 12 lead ECG and an echocardiogram and found them all acceptable. See what he says at follow up but if the skipped beats don't bother you - they're not strictly speaking a symptom (unless Discovery has redefined medical jargon in their fine print). Besides you've had it checked out. If you're fine acc to him then you don't have any condition 'not yet diagnosed' - as your cardiologist investigated your heart and did not find anything - he ran a diagnostic workup and found nothing (if this is what he says).

 

[LancelotSA]

"Any symptoms not yet diagnosed by a medical professional or any condition which is not covered by these questions? Yes [] No []"

They ask the same thing with life insurance. My understanding is that the former is to prevent someone who "feels" that something is wrong with them from quickly signing up for life cover/ medical aid before getting it checked out. The latter is a catch all to ensure they have not let something slip through the cracks.

Remember also that if you had something like a dizzy spell, as pointed out by Peter, and you never saw anyone about it, then there will be no records so the medical aid would never know about it. Obviously they are free to check your medical records if something does go wrong and then if something comes up your claim may be repudiated.

The idea with a medical aid is that you will be excluded for a period of 12 months for any pre-existing condition of you were not a member of a medical aid for a certain period of time prior to this application. After the waiting period they'd need to cover you anyway.

 

[fdaniels]

Fantastic. Thanks for that very comprehensive reply Peter

Edit: I just saw your reply now LancelotSA. Thanks for the reply. It certainly helps me understand the motivation behind the question.

 

[Hosehead]

And what if a new medical condition is diagnosed during the waiting period between them taking your monthly fees and the time your actual coverage begins (after 90 days) ? They can't refuse coverage for treatment if you need like an operation or specialised testing or something or can they in their fine print?

 

[LancelotSA]

And what if a new medical condition is diagnosed during the waiting period between them taking your monthly fees and the time your actual coverage begins (after 90 days) ? They can't refuse coverage for treatment if you need like an operation or specialised testing or something or can they in their fine print?

There is usually a general waiting period of three months. You will not be able to claim for anything besides prescribed minimum benefits. So if your condition is not a PMB then you will not be covered.

 

[Chicken Boo]

Mention that story about a heart specialist to Discovery and it will be one of your exclusions, at least for the first year. I recently joined Discovery and hit that question with the consultant. I mentioned I'd had a mole removed when I was a kid, he immediately wanted the doctor's name, the time, the colour of bedsheets, etc.... and I had nothing to give them, and the fact that I've never had any skin issues since nor have any now meant nothing.
End result - no neoplasm cover of any kind for my first year.