meical aid (keycare series)

8/10/2019 Meical Aid (KeyCare Series)

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YOUR GUIDE TO THE KEYCARE SERIES

Plus | Access | Core

KeyCareSeries

2014


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The bene ts explained in this brochure are provided by Discovery Health Medical Scheme, registra on number 1125, administered by Discovery Health (Pty) Ltd, registraan authorised nancial services provider. This brochure is only a summary of the key bene ts and features of Discovery Health Medical Scheme plans, awai ng formal appSchemes. When reference is made our or we in the context of bene ts, members, payments or cover, in this brochure these are references to Discovery Health Medical [email protected]. Vitality is not part of Discovery Health Medical Scheme. Vitality is a separate product sold and administered by Discovery Vitality (Pty) Ltd.

nancial services provider. MedSaver and ChroniCare are brought to you by Discovery Vitality.


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YOUR HEALTHCARE COVER IN 2014

Our aim is to keep you healthy and provide you with the best of care when you need it most.We design our integrated product solu ons to make sure you get the most value from yourhealth plan, and to assist you in avoiding out-of-pocket payments wherever possible, especially

when you or your loved ones experience a cri cal illness or major hospital admission. Thisintegrated approach to your healthcare is made possible by the combined power of DiscoveryHealth Medical Scheme and Discovery Health as well as Discovery Vitality.

Discovery Health Medical Scheme o ers the widest range of health plans i n the market. It isSouth Africas largest open medical scheme with over 2,5 million members and more than50% share of the local open medical schemes market.

Discovery Health is the administrator of Discovery Health Medical Scheme, responsible formany func ons, including claims processing and payment, and client service touch pointssuch as the website and call centre.

Vitality is a separate Discovery company that o ers a wellness programme that you maychoose to join as a Discovery Health Medical Scheme member. Vitalitys ability to make

people healthier and give them great rewards has made it the worlds leading wellnessprogramme, with over ve million members on four con nents.

This guide gives you a summary of thabout the addi onal bene ts and toolyourself with the informa on we hav

comes to your healthcare.

Regards

Milton StreakPrincipal Ofcer:Discovery Health Medical Scheme

Stay in touch with us

Discovery Vitality (Pty) Ltd is an authorised nancial services provider. Registra on number: 1999/007736/07.

facebook.com/discoveryhealthsa twi er.com/discovery_sa

Dear MemberThank you for giving us the opportunity to look a er your healthcare cover needs


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KEYCARE SERIESPRODUCT PLATFORMDiscovery Health Medical Scheme o ers a range of op ons to cater for every need. The KeyCare Series o ers a ordable cover atof hospitals and doctors.

Hospital coverKeyCare Plans o er cover in a de ned network of hospitals.

On KeyCare Core and KeyCare Plus, we cover you in any private hospital for emergencies and planned hospital admissions that you haveauthorised with us in the KeyCare network of hospitals.

On KeyCare Access, we cover emergencies and trauma in the Keycare Access Hospital and KeyCare Hospital networks of private hospitals.We cover childbirth and care for your baby up to 12 months in the KeyCare Access Hospital Network, and all other hospital care iscovered in our contracted network of state facili es.

Chronic illness coverYou have cover for a list of 27 condi ons on our Chronic Disease List, as long as your chronic medicine is on theKeyCare medicine list. You need to get your approved medicine from one of our approved pharmacies or your chosen KeyCareGP (if they dispense medicine).

Screening and preven on

The Screening and Preven on Bene t covers blood glucose, blood pressure, cholesterol and body mass indexmeasurements at a Discovery Wellness Network provider. The bene t also pays for a mammogram, Pap smear, PSA(prostate screening test) and HIV screening tests. If you are 65 years or older or are registered for certain chroniccondi ons, we also cover a seasonal u vaccine.


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Members on KeyCare Plus and KeyCare Access have cover for day-to-day healthcare such as GP visits, basic x-rays, blood,urine, other uid and ssue tests, medicine, den stry and cover for eye care.

Day-to-day cover

Discovery Vitality (Pty) Ltd is an authorised


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THE FULL COVER CHOICEOur extensive networks of healthcare providers, combined with our unique self-service tools, mean you can avoid co-payments.These ps will guide you to full cover. Remember to look out for the full cover stamp throughout this guide.

Use our extensive hospital networks

You are covered in full when you use a network hospital. Use our MaPS tool to nd a hospital in our network.

1

Use a GP or specialist who we have a payment arrangement withWe o er the broadest range of GP and specialist payment arrangements, which provides full cover both in hospital and out of hospital. Use ouhealthcare professional who we have a payment arrangement with.

2

You can access MaPS and MedXpress at www.discovery.co.za or on the Discovery app.


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KeyFIT

Day-to-day medical care

Chronic Illness Bene t

Plannedhospital care

Cri calhospital care

Go for preven ve screening testsWe cover preven ve screening tests such as mammograms, blood prdetec ng early warning signs of serious illness. Having these tests dis be er than cure.

4

Use our preferred medicineAll Discovery Health Medical Scheme plans o er a comprehensive list of medicine whichyour pharmacist about your op ons to avoid a co-payment. If you choose medicine not

3

Discovery Vitality (Pty) Ltd is an authorised


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IMPORTANT CONCEPTS TO HELP YOUUNDERSTAND YOUR HEALTH PLANUse these handy de ni ons to help you understand important concepts discussed in this guide.

Discovery Health RatThis is a rate set by Discoservices for healthcare pr

professionals) will be pai

DHRChronic Illness Bene t (CIB)You have cover for a list of 27 condi ons on our Chronic Disease List, as longas your chronic medicine is on the KeyCare medicine list. The Chronic Disease

List (CDL) is a de ned list of chronic condi ons we cover according to thePrescribed Minimum Bene ts. You need to get your approved chronic medicinefrom one of our network pharmacies or from your chosen KeyCare GP (if heor she dispenses medicine). You have full cover for approved medicine on theSchemes medicine list (formulary). If you choose chronic medicine that is noton our medicine list, you wi ll have to pay for it.

Hospital coverWe cover you in hospital You have to get authorisais made up of your hospiis an account from your thealthcare services like pDay-to-day cover

Day-to-day cover includes your visits to doctors out of hospital, blood tests andmedicines purchased for everyday use. Members on KeyCare Plus and KeyCareAccess have cover for day-to-day medical care.


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NetworksSome plans, bene ts and network providers. If you

contribu ons as a ordabl

Medicine list (formulary)This is a list of approved chronic medicines that the Scheme covers in full.The list includes an extensive range of high-quality medicines for all coveredchronic condi ons to ensure you always have an op on of full cover.

Payment arrangementsThe Scheme has entered iprofessionals that have agThis ensures that you hav

LimitsMost in- and out-of-hospital healthcare bene ts are unlimited but there aresome healthcare services that are subject to annual limits. It is important for

you to familiarise yourself with these limits and to track your usage by loggingonto www.discovery.co.za or checking your statements.


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IMPORTANT CONCEPTS TO HELP YOUUNDERSTAND YOUR HEALTH PLAN

Claiming for healthcare a er a motor vehicle accident

Discovery Health Medical Scheme pays for your healthcare expenses when youreinvolved in a motor vehicle accident according to your selected health plan andrules of the Scheme. According to the rules of Discovery Health Medical Scheme,you need to lodge a claim with the Road Accident Fund. If your claim with the RoadAccident Fund is successful and both Discovery Health Medical Scheme and theRoad Accident Fund pay your medical expenses, youll need to pay back the medicalexpenses paid by the Road Accident Fund to Discovery Health Medical Scheme.

Claiming for healthcar

Discovery Health Medicalinjury on duty at your workplan type. According to the1993, the Compensa on Cinjury on duty. All accidentor absence from work for mseven days to the Compensany ques ons and free adm

If your claim with the CoDiscovery Health Medicaaccident-related medical eby the Compensa on Com

For any assistance with inThird Party Recovery Ser


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What Prescribed Minimum Bene t (PMB) condi ons areThese are condi ons which all medical schemes are required to cover as set by the Council for Medical Schemes according to clinical guidelines. YoService Provider (DSP). A DSP is a hospital or healthcare provider who has an agreement with Discovery Health Medical Scheme to provide treatm

without any co-payments by you.

Cover for Prescribed Minimum Bene tsIn most cases, Discovery Health Medical Scheme plans o er bene ts that are far richer than the Prescribed Minimum Bene ts. To access Prescribed Min

Your medical condi on must qualify for cover and be part of the list of de ned Prescribed Minimum Bene t condi ons The treatment needed must match the treatments in the de ned bene ts You must use Designated Service Providers in the Discovery Health network. This does not apply in life-threatening emergencies. However ev

according to the rules of the Scheme, you may be transferred to a healthcare provider in the Discovery Health network otherwise we will paYou will be responsible for the di erence between what we pay and the actual cost of your treatment.

More informa on on our approach to Prescribed Minimum Bene ts is available on www.discovery.co.za

PRESCRIBED MINIMUM BENEFITS


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Plus | Access | CoreKeyCare Series Plan range

KEY FEATURES


KeyFIT

Day-to-day medical care

Chronic Illness Bene t

Plannedhospital care

Cri calhospital care Unlimited hospital cover in our KeyCare network of

Guaranteed full cover in hospital for specialists on thDiscovery Health Rate for other healthcare professio

Essen al cover for chronic medicine on the KeyCarCDL chronic condi ons

Unlimited cover for medically appropriate GP consuKeyCare network on the KeyCare Plus and KeyCare

Discovery Vitality (Pty) Ltd is an authorised nancial services provider. Registra on number: 1999/007736/07.


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PLAN SPECIFIC INFORMATION

KeyCare Series Plan range

The KeyCare Series has three health plan types. These are:

KeyCare Plus KeyCare Access

KeyCare CoreThere are slight di erences in bene ts as highlighted on thenext page. The bene ts not men oned in the table are thesame across both plans.


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Hospitals Unlimited cover in the KeyCare HospitalNetwork. There is a list of proceduresthat are covered in the KeyCare daysurgery network.

Unlimited cover for emergencies, traumachildbirth and care for your newborn in thKeyCare Access network of private hospOther condi ons are covered in a contracnetwork of state facili es.

Day-to-day medical coverPrimary care cover through your chosen GP and day-to-day medicine from our medicine list.

Private specialist cover up to a limit of R2 750for each person.

Private specialist cover up to a limit foremergencies, trauma, childbirth and coveyour baby up to 12 months a er childbir

KeyCare plans o er you the best and most a ordable cover through the KeyCare network of hospitals and doctors. The KeyCare Series haare slight di erences in the bene t structure as highlighted below. The bene ts not men oned in the below table and on the next page are


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Casualty visits Cover in any casualty unit at one of the KeyCarenetwork hospitals.You have to pay the rst R225 of theconsulta on.

Other than for emergencies and trauma, yhave cover in any casualty unit at one of KeyCare Access Hospitals and KeyCare hospitals once a year. You have to pay theR225 of the consulta on.

Chronic medicines prescrip ons Your chosen KeyCare GP must prescribe your approved chronic medicine.

Cancer We cover treatment if it is a PrescribedMinimum Bene t and if you go to a cancerspecialist in our network.

We cover treatment if it is a PrescribedMinimum Bene t in a state facility.

Trauma Recovery Extender Bene t Out-of-hospital claims for recovery a er certain trauma c events are covered on this bene t for

the rest of the year in which the trauma took place, and a year a er the trauma.


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Always keep your membership card with you; it iden es you as a KeyCare member. Your membership card helps you get access to

Always use your chosen GP or a hospital in t he KeyCare network.

Check with your GP that your treatment or medicine is on our list of covered services.

If your GP decides you have to see a s pecialist, your GP will get approval from us so that you can go to the specialist. Make sure you you visit the specialist.

In an emergency, go straight to hospital. If you are going to hospital for a planned procedure, call us to con rm your bene ts before yknow what you are covered for.

WHAT TO DO TO GET THE MOSTOUT OF YOUR KEYCARE PLAN


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Medical emergencyA medical emergency is the sudden and, at the me, unexpected onset of a health condi onthat needs immediate medical or surgical treatment, where failure to provide medical

or surgical treatment would result in serious impairment to bodily func ons or seriousdysfunc on of a bodily organ or part, or would place the persons life in serious jeopardy inline with the Schemes rules and Medical Schemes Act.

What to do in a medical emergencyIn an emergency, go straight to hospital. If you need medically equipped transport, call0860 999 911. This line is managed by highly quali ed emergency personnel who willsend air or road emergency evacua on transport to you, depending on which is mostappropriate.

Your hospital cover is made up of:

Cover for the account of your hospital stay

Cover for the accounts from your admi ng doctor, anaesthe st or any other approvedhealthcare professional.

Cover for your hospital account oWe cover you in any hospital in the KKeyCare network hospital for planned

We cover these procedures in our day

Adenoidectomy

Arthrocentesis ( jointinjec on)

Cataract surgery

Cautery of vulva warts

Circumcision

Colonoscopy

Cystourethroscopy

Diagnos c D&C

Ga

Hy

M

Min

Pr

Pr

Re

Si

HOSPITAL COVERThere is no overall hospital limit. If you have to stay in hospital for a long me, or if your treatment is very expensive, your coverservices and procedures have a limit or we may have rules on how we pay for them.


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Cover for your hospital account on KeyCare AccessOn KeyCare Access, healthcare services for approved admissions for emergencies, trauma,childbirth and care for your baby up to 12 months a er childbirth are covered in our

network of private hospitals with no overall limit. We pay approved admissions for all otherhospital care in our network of state facili es.

We cover the following traumas in our network of private hospitals

Injuries at work

Burns

Injuries from a crime

Sexual assault

Injuries from a car accident

Injuries from a fall

The loss of an arm, hand,leg or foot

Near drowning

Head injuries

Poisoning or a serious allergic reac on that may cause death

Care for your baby a er c hildbirth on KeyCare Access

This bene t covers babies that are registered on the Scheme from their date of birth whenborn to a parent registered on the Scheme. It covers approved hospital admissions in ournetwork of private hospitals for the baby for 12 months from the babys date of birth.

Babies not added to the Scheme fromnetwork of state facili es.

Cover for related accounts

We guarantee full cover when you useKeyCare network.

Other specialists and healthcare pIf you are treated by a specialist who whealthcare professionals, we pay up toprofessional charges more than the Di

HOSPITAL COVER


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Cover for going to casualtyIf you are admi ed to hospital from casualty, we will cover the costs of the casualty visitfrom your Hospital Bene t, as long as we con rm your hospital admission.

On KeyCare Plus, you can go to any casualty unit at one of the KeyCare network hospitals.You have to pay the rst R225 of the casualty account if you are not admi ed to hospital from casualty.

For emergencies and trauma on KeyCare Access, you can go to any casualty unit at oneof the KeyCare Access or KeyCare network hospitals. For visits, other than emergenciesand trauma on KeyCare Access, each person can go to casualty at one of the KeyCarenetwork hospitals once a year. You have to pay the rst R225 of the casualty account ifyou are not admi ed.

Your cover for MRI and CT scansMRI and CT scans are like x-rays, but show much more detail. They are used when an x-raydoesnt show enough. If your scan is related to an approved hospital stay in our network ofprivate hospitals, we pay for it from your Hospital Bene t. If it is not, we pay for it from yourSpecialist Bene t, up to R2 750 for each person. We do not pay for MRI or CT scans that arerelated to conserva ve back or neck treatment (this is treatment for your back or neck thatis not surgery).

Unlimited healthcare servicesMost of your in-hospital healthcare se

These are:

GPs Specialists Allied healthcare professionals, Pathology and radiology


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HOSPITAL COVER

Some healthcare services have an annual limit

KeyCare Core and KeyCare Plus KeyCare

Mental health 21 days for each person21 daystate f

Alcohol and drug rehabilita on 21 days for each person21 daystate f

Cataract surgeryWe cover cataract surgery as long as we have approvedyour treatment at a doctor and facility in our network forcataract surgery.

Cover

Chronic dialysisWe cover these expenses in full as long as we have approvedyour treatment at a doctor and facility in our network.

We cotreatm

Compassionate care R28 500 for each person in their life me


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HOSPITAL NETWORKSKEYCARE HOSPITAL NETWORKSYou must go to one of these hospitals for planned hospital admissions. If you do not use one of these hospitals for a planned admission, yo

KeyCare Core and KeyCare Plus Hospital NetworkKeyCare Access trauma and emergency network

Eastern CapeEast London Life Beacon Bay Hospital Life East London Private Hospital Life St James Opera ng Theatres Life St Dominics Private HospitalHumansdorp Life Isivivana Private HospitalPort Elizabeth Life New Mercan le HospitalQueenstown Life Queenstown Private HospitalUitenhage Netcare Cuyler ClinicUmtata Life St Marys Private Hospital

Free StateBethlehem Hoog land Medi-Clinic

Bloemfontein Bloemfontein Eye Centre Netcare Pelonomi Private Hospital Life Rosepark Clinic Life Pasteur Hospital Netcare Universitas Private HospitalWelkom Ernest Oppenheime r Hospital Welkom Medi-Clinic St Helena Hospital

GautengBenoni Life The Glynwood HospitalBoksburg Botshelong Empilweni Clinic

(Clinix Vosloorus) S unshine HospitalBrakpan Life Dalview Clinic

Germiston Life Roseacres ClinicHeidelberg Life Suikerbosrand ClinicJohannesburg Netcare Rand Clinic Johannesbur g Eye Clinic

Netcare Garden City Clinic Life Brenthurst ClinicKempton Park Arwyp Medical CentreLake eld Netcare Op klin Eye HospitalLenasia Lenmed ClinicMidrand

Life Carstenhof ClinicPretoria Netcare Bougainville Private Hospital Centurion Eye Hospital

Life Eugene Marais Netcare Jakaranda H Le gae Medi-Clinic Louis Pasteur Hospi Med forum Medi-Cli M uelmed Hospital Pretoria Eye Ins tut Zuid -Afrikaans HosRandfontein Life Robinson Hosp Lenmed RandfonteiSasolburg Netcare Vaalpark HSoweto Clinix Private Hospita Clinix Private HospSprings Life Springs Parklan Life St Marys WomThembisa Zamokuhle Private

On KeyCare Access we pay approved admissions for hospital care other than emergencies, trauma, childbirth and care for your baby in a contracted state

HOSPITAL NETWORKS


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HOSPITAL NETWORKSKEYCARE HOSPITAL NETWORKS

Kokstad Kokstad Private HospitalLadysmith La Verna HospitalNewcastle Newcastle Private HospitalPhoenix Life Mount EdgecombePietermaritzburg Midlands Medical Centre Netcare St Annes HospitalPinetown Life Crompton HospitalPort Shepstone Hibiscus HospitalRichards Bay Netcare The Bay HospitalSydenham Nu Shifa HospitalTongaat

Victoria Private Hospital (Tongaat)

LimpopoBela-Bela St Vincents Hospital

Phalaborwa Clinix Phalaborwa Private HospitalPolokwane Limpopo Medi-ClinicThabazimbi Thabazimbi Medi-ClinicTzaneen Tzaneen Medi-Clinic

MpumalangaBarberton Barberton Medi-ClinicEmalahleni Life Cosmos Hospital Emalahleni Day HospitalErmelo Ermelo Private HospitalMiddelburg Life Middelburg Private HospitalNelspruit

Nelspruit Private HospitalTrichardt Hi ghveld Medi-Clinic

North WestCarletonville Leslie Williams Private Hospital Western Deep Clinic

Klerksdorp Life Anncron ClinicMa keng Victoria Private Hospital (Ma keng Hospital)

Orkney West Vaal ClinicPotchefstroom Potch efstroom Medi-ClinicRustenburg Life Peglerae HospitalNorthern CapeKathu Kathu Medi-ClinicKimberley Kimb erley Medi-ClinicUpington Upington Private HospitalVryburg Vryburg Private Hospital

Western CapeBellville Bellville Medical C Louis Leipoldt Me

Cape Town Netcare Chris aan Netcare UCT MedCeres Ceres Private HospGatesville Gatesville MedicalGeorge Geneva Clinic Ge orge Medi-CliniHermanus Herm anus Medi-CKuils River Netcare Kuils RiveMilnerton Miln erton Medi-Cl

Mitchells Plain Mitchells Plain MeMossel Bay Bayview Hospital


HOSPITAL NETWORKS


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HOSPITAL NETWORKSKEYCARE HOSPITAL NETWORKS

Eastern Cape

Kokstad Netcare Kokstad Hospital

Port Elizabeth

Life New Mercan le Hospital

Uitenhage

Netcare Uitenhage Hospital

Umtata

Life St Marys Private Hospital

Free State

Bloemfontein

Netcare Pelonomi Private Hospital

Gauteng

Alberton Netcare Clinton Hospital

Johannesburg

Netcare Rand ClinicKrugersdorp

Netcare Krugersdorp Hospital

Pretoria

Netcare Femina Hospital

Legae Medi-Clinic

Louis Pasteur Hospital

Sasolburg

Netcare Vaalpark Hospital

Soweto

Clinix Private Hospital Lesedi

Springs

Netcare N17 Hospital

Tembisa Zamokhule Private Hospital

Kwazulu-Natal

Amanzimto

Netcare Kingsway Hospital

Ladysmith La Verna Hospital

Pietermaritzburg Netcare St Annes Hospital

Richards Bay Netcare The Bay Hospital

Tongaat Victoria Private Hospital (Tongaat)

Limpopo

Phalaborwa

Clinix Phalaborwa Private Hospital

Polokwane Limpopo Medi-Clinic

Tzaneen

Tzaneen Medi-Clin

Mpumulanga

Nelspruit

Nelspruit Medi-Cli

North West

Rustenburg

Netcare Ferncrest H

Western Cape

Gatesville

Gatesville Medical

Kuils River

Netcare Kuils River

Milnerton

Milnerton Medi-Cl

KeyCare Access Hospital Network for childbirth and care for your baby



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CHRONIC ILLNESS, CANCER AND HIV COVER

Your cover for chronic condi onsYou have cover for a list of chronic condi ons, as long as your chronic medicine is on theKeyCare medicine list. We need to approve your applica on before we cover your condi on

from the Chronic Illness Bene t.On the KeyCare Plus and KeyCare Access Plans, your chosen KeyCare GP must prescribeyour approved chronic medicine. On the KeyCare Core Plan, any GP can prescribe yourapproved medicine.

How we pay for medicineYou need to get your approved chronic medicine that is on the KeyCare medicine list fromone of our network pharmacies or from your chosen KeyCare GP (if he or she dispensesmedicine). If you get your medicine from anywhere else, you will have to pay 20% of theDiscovery Health Rate for medicines. If you use chronic medicine that is not on our medicinelist, you will have to pay for it yourself.

Cover for cancerWe cover you for cancer treatment ondiagnosed with cancer you need to re

On the KeyCare Core and KeyCare PMinimum Bene t and if you go to a

On KeyCare Access, we cover cancestate facility.

Cover for HIV and AIDSWhen you register for our HIV Carthat you need. You get access to clinibe assured of con den ality at all mblood tests, scans and x-rays at a netwlist are covered in full. You need to geavoid a 20% co-payment.


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DAY TO DAY COVER

Cover for GP visitsWhen joining, you must choose a GP from the KeyCare GP network. You must consulta ons and some minor procedures.

Blood, urine and other uid andssue tests

We pay for a list of blood, urine and other uid and ssue tests. Your chosen GPpathology form.

Day-to-day medicine We pay for medicines from our medicine list if they are prescribed by your chos

You get one out-of-network GPvisit

If you need to see a doctor and your chosen GP from our network is not availablmembership can go to any other GP once a year. We will cover the GP visit, withon our medicine list.

Cover for den stry We cover consulta ons, llings and tooth removals at a den st in our den st net

Cover for eye careWe cover one eye test for each person, but you must go to an eye doctor in our nrange of glasses that you can choose from. You can get a set of contact lenses insnew glasses or contact lenses every 24 months.

Applicable to KeyCare Plus and KeyCare Access Plans


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Basic x-rays We pay for a list of basic x-rays at a network provider. Your chosen GP must ask

Casualty visits

On KeyCare Plus you can go to any casualty unit at one of the KeyCare networkconsulta on.

On KeyCare Access, other than for emergencies and trauma, each person can go hospitals once a year. You have to pay the rst R225 of the consulta on. You don

Trauma Recovery ExtenderBene t

We will cover speci c out-of-hospital claims for your recovery a er certain trauyear in which the trauma took place, and in the year a er your trauma. You may apply to KeyCare Core.

Medical equipmentWe cover wheelchairs, wheelchair ba eries and cushions, transfer boards and mocrutches and walkers on the medical equipment list, if you get them from a netwfor each family.

Other types of healthcareprofessionals

We do not cover other types of healthcare professionals, such as physiotherapistshomeopaths or chiropractors from your day-to-day bene ts.

DAY TO DAY COVER


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Specialist Bene t

Each person is covered up to R2 750. Your GP must get a reference number befoneed to see a dental specialist, eye specialist (opthalmologist) or a specialist for your GP or a reference number from us.

The KeyCare Access Plan covers specialist visits in our network for maternityemergencies up to the limit. You have to register your baby as soon as it is bornspecialists employed by a state facility.

Preven ve screening

The Screening and Preven on Bene t covers certain tests like blood glucose, blwhen done at any one of the Discovery Wellness Network providers. We also coscreening) and HIV screening tests. Members 65 years or older and members recovered for a seasonal u vaccine.

Antenatal Bene t

If you are pregnant, the Antenatal Bene t covers you at 100% of the Discovery

Four visits to a midwife or gy naecologist/obstetrician

One rou ne scan (between 10 and 20 weeks)

Selected blood tests requested by your gynaecologist/obstetrician

BENEFITS THAT ENHANCE YOUR COVER

GENERAL


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GENERALEXCLUSIONS

Discovery Health Medical Scheme has certain exclusions. We do not pay for healthcare services related to the following, except where sunder the Prescribed Minimum Bene ts.

General exclusion list Cosme c procedures and treatments Otoplasty for bat ears, port-wine stains and blepharoplasty (eyelid surgery) Breast reduc ons or enlargements and gynaecomas a Obesity Frail care Infer lity Wilfully self-in icted illness or injury Alcohol, drug or solvent abuse Wilful and material viola on of the law Wilful par cipa on in war, terrorist ac vity, riot, civil commo on, rebellion or uprising Injuries sustained or healthcare services arising during travel to or in a country at war Experimental, unproven or unregistered treatments or prac ces Search and rescue Any costs for which a third party is legally responsible

We also do not cover the complica oany of the exclusions listed above, ex

under the Prescribed Minimum Bene

Wai ng periodsIf we apply wai ng periods becauseor have had a break in membership oMedical Scheme, they will not have wai ng periods. This includes cover

KEYCARE SERIES


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KEYCARE SERIESEXCLUSIONS

In addi on to the general exclusions that apply to all plans, the KeyCare Series does not cover the following, except if the Prescribed Minimum Ben

1. Hospital admissions related to: Den stry Nail disorders Skin disorders Inves ga ons and diagnos c work-up Func onal nasal surgery Elec ve caesarean sec on, except if medically necessary Surgery for oesophageal re ux and hiatus hernia Back and neck treatment or surgery Joint replacements, including but not limited to hips, knees, shoulders

and elbows Cochlear implants, auditory brain implants and internal nerve s mulators this

includes procedures, devices and processors Healthcare services that should be done out of hospital and for which an

admission to hospital is not necessary2. Correc on of Hallux Valgus/Bunion and Tailors Bunion/Bunione e

3. Arthroscopy

4. Removal of varicose veins

5. Refrac ve eye surgery6. Non-cancerous breast condi

7. Healthcare services outside S

We also do not cover the cost of treatmexpenses related to any of these exclu

The bene ts outlined in this guide are a summary of the plans registered in the medical scheme rules. These bene ts are reviewed annually and amendeMedical Schemes Act and also take into account the requirements of the Consumer Protec on Act where it relates to the business of a medical scheme.


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CONTRIBUTIONS

Total contribu ons

Main member AdultKeyCare Plus (8 801+) R1 448 R1 448

KeyCare Plus (6 651-8 800) R973 R973

KeyCare Plus (0-6 650) R695 R695

KeyCare Access (8 801+) R1 416 R1 416

KeyCare Access (6 651- 8 800) R942 R942

KeyCare Access (4 151-6 650) R653 R653

KeyCare Access (0-4 150) R490 R490

KeyCare Core (8 801+) R1 070 R1 070

KeyCare Core (6 651-8 800) R693 R693

KeyCare Core (0-6 650) R556 R556

* We count a maximum of three children when we work out the monthly contribu ons.

CLAIMING


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CLAIMING

Submi ng proof of claims paymentDiscovery Health Medical Scheme strives to pay your claims as quickly and as accuratelyas possible. If you have paid a claim up front, you need to provide proof of payment to berefunded. We will only accept the following as proof of payment:

A receipt An internet bank transac on A Paid stamp on your claim Wording in your claim indica ng that you, the member or pa ent have paid Credit column on the claim with an amount showing

This will ensure mely and correct payment of your claim.

What to remember when claiming Claims must be submi ed within four months from the end of the month in which the

service was rendered. Older claims will be considered expired and will not be paid.

Make sure that your membership number, the healthcare professionals detailsincluding the prac ce number are clear on the claim. Send a detailed claim and not just a receipt as we need the details of what you are

claiming for to process your claim quickly and correctly.

How to submit your claims Smartphone App Submit a

on your iPhone or Android smasubmit claims and follow theGoogle Play store.

Upload On your laptop, smamenu, hover over Health and cnow and follow the steps.

Email Scan and email your c Post Post your claims to Dis Fax Fax your claims to 0860

rst making a photocopy and th


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UNIQUE SAVINGS


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Q VONLY WITH DISCOVERY HEALTH

If you are registered on the Chronic Illness Be

specialised products at Dis-Chem Pharmaciesmonitoring devices, speciality food, health edand wellbeing items. Go to www.discoveryof products and for more information.

You get up to 25% cash back with MedSaver on Clicks Pharmacies. Go to www.discovery.co.z

start earning your cash back.

Discovery Health has partnered with Clicks, Dis-Chem and Netcells to help you save up to 25% on healthcare-related spend.


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You get an exclusive discount of 25% when yocell banking with Netcells Biosciences. When yof 20%. Go to www.discovery.co.za for m

MEDXPRESS


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DOOR TO DOOR MEDICINE DELIVERY

Have your monthlymedicines delivered

to your door.

Delivering wherever you are

MedXpress, Discovery Healths convenient medicine delivery serviceNow you can take standing in a long queue at the pharmacy o your already-over owing to-do lists. MedXpress lets you order medicine online or odirectly to your door. MedXpress is also the convenient way to order repeatable medicine prescrip ons. You have full cover for medicines on the Di

This means that you wont have to make any co-payments and you wont be charged above the Discovery Health Rate for medicines.


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What Discovery MedXpress o ers you

Convenience

Delivery to your door Theres no need to wait in queues or leave hometo get your medicine.

A simple process there are no complicated forms to complete. All we need isa valid script and a phone call.

Regular updates well keep you up to date on any changes that may a ect yourcover for chronic medicine when you call us to order your medicine.

Advice to help you save

When using MedXpress, Discovery Healths quali ed service agents can also advise youon the most cost-e ec ve alterna ves. And you will always be charged at the DiscoveryHealth Rate for medicines or less in e ect ge ng rid of all those small co-payments thatadd up over me.

Important points to remember

Delivery

Chronic or repeatable prescrip on manywhere in South Africa.

Once-o prescrip on medicine deliJohannesburg, Pretoria and Cape To

How you can order medicine

If youre placing your order for the with the words MedXpress and yonumber. You can email your prescrip011 539 1020 and you will receive aplaced your rst order for chronic m(downloadable in the App Store or Gcall us to have your monthly repeat m

There is no addi onal administra oin the pharmacy by placing your ord

THE DIGITAL WORLD OF DISCOVERY


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THE DIGITAL WORLD OF DISCOVERY

www.discovery.co.zaand the Discovery appOur website has been designed todisplay op mally, whether you are

accessing it from a desktop, laptop,tablet or smartphone.

The Discovery app available on theApp Store and Google Play puts yourhealth plan in your pocket.

Together they provide a wealth of self-service tools and informa on to helpyou manage your health plan and yourhealth. Any me, Anywhere.

Find a healthcareprofessional

Track your bene ts andmedical spend

Plan and authorisehospital admission*

Order medicine forhome delivery

Access importantdocuments

Submit and trackyour claims

*Only available on www.discovery.co.za

HEALTHID PUTTING YOUR MEDICAL


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INFORMATION IN YOUR DOCTORS HANDSHealthID puts your health records in your doctors hands. This is the rst electronic health record applica on of its k ind in South Afr

With Discovery Healths HealthID tablet app doctors can:

To bene t from HealthID, your doctor will need your permission to access your health records. You will nethat doctor can access your health records on HealthID. You can log onto www.discovery.co.za to give yourNo unauthorised person will have access to your personal medical informa on.

Access medical histories and electronic health recordsA doctor can go into your electronic health records and access

your health informa on to see your medical history. So, if you arehaving trouble remembering par cular medicines youve taken, thisinforma on is available to your doctor immediately. You can save meand money by not having to repeat tests and inves ga ons, becausethe results of your previous tests are available for your doctor to see.

Write electronic scriptsYour doctor can prescribe medicine during a consulta on with you usingelectronic scrip ng. Your doctor can also see medicines on the approvedmedicine list, as well as the cost of those medicines. You can nd waysto reduce or even avoid co-payments on your medicines before you evenreach the pharmacy.

NOTES


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NOTES


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meical aid (keycare series)

Documents