Arthroplasty

To improve the level and consistency of quality, the Scheme is implementing the Major Joints Network. This network consists of teams working at hospitals collectively performing a minimum number of procedures and agreeing to partner in a quality of care program. Members using participating practices and hospitals in the Major Joints Network will enjoy full cover. Planned admissions performed outside the hospital network or by non-participating practices will be covered up to 80% of the Discovery Health Rate (DHR) for the hospital account and is subject to the limit per prosthesis if a preferred supplier is not used. Unless indicated otherwise the standard hospital network rules by plan apply (including for Coastal, Delta and Smart plan series). This network will not apply to emergency and trauma related surgeries as well as bilateral and revision replacements or those related to congenital malformation of the joint, septic joints or cancer. This network is not applicable to the KeyCare and Essential Smart plans, because major joint replacements are excluded on these plans.