In South Africa, the hospital plan industry is alive and well. More and more people are discovering that they can’t afford a medical aid. The monthly premiums are way too high. The Discovery Smart Plan Hospital plan is designed to provide members with quality care at decent hospitals. A Smart Plan gives an affordable alternative for people who want cover in the event of an emergency.
Hospital plans from a medical aid provide more than hospitalisation cover. Members can benefit from other kinds of protection such as maternity cover and PMBs or prescribed minimum benefits as they are known, to ensure members have access to certain minimum health services, irrespective of the plan they select.
Discovery also offers hospital plans, and the Smart Plan pays 200% of the Discovery Health Rate. Other things to note with the Smart Plan are:
- Designed for those on hospital plans who want to see a doctor from time to time.
- People who are on the higher paying KeyCare range claim, the cheaper Smart Plan is a better choice even though it doesn’t have basic dentistry or a spectacle benefit.
Discovery is an insurance company whose purpose it is to enhance people’s lives. They cover more than 5.1 million clients. They offer different hospital plans in their Core series. These hospital plans are most often more affordable than medical aids and are for those people who can manage their day-to-day medical expenses.
What Discovery’s Smart Plan Offers
- Unlimited cover for GP consultations – there is an R50 co-payment in the network. The Smart Plan combines full in-hospital cover with the benefit of those much needed day-to-day medical expenses. If the Smart Plan member wants to see a specialist out of the hospital, they will need to pay for this themselves.
- Cover for any medical emergencies when travelling abroad.
- Unlimited private hospital cover with full cover for specialists – in their network.
- Full cover for chronic medicines on their medication list when you use Clicks, Dischem or MedXpress. The member will need to register on the Chronic Illness Benefit.
- Cover for acute medicine with only an R10 co-payment. On the Smart Plan, the critical medication benefit excludes certain drugs such as Lifestyle Enhancing Drugs.
- We look at in-hospital procedures with the Smart Plan:
-maximum payout rate – 200% scheme tariff
-overall annual limit – Unlimited
-Hospital choice – you can use a private hospital in the Smart Network, of which there is a generous number to choose from – some 32 private hospitals as part of the network.There is a co-payment if you use another hospital, not in the network.
-specialised radiology
-specialists are covered in full on a payment arrangement, otherwise at 200% scheme tariff
– supplementary services
More Smart Plan Benefits
- We look at Maternity benefits –
– in-hospital – 100% scheme tariff
– the main member in 2016 will pay roughly R1 300 for this Smart Plan
– if someone is discharged early from hospital, Discovery will pay for three home visits during the day as well as two-night visits - Cancer (Oncology) benefits
- Out-of-hospital benefits
- Dentistry
- Optometry
- Medication – PMBs
- Lots of other benefits such as trauma, international cover, wound care, among others.
Conclusion
If you want to find a Smart Plan network GP or hospital, Discovery offers their Discovery App for smartphones, and you can get all the information you need on doctor choices, ordering medicines and how to go about claiming from this hospital plan which now also offers doctors visits.
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