Trauma
Trauma happens when a person is exposed to an extraordinary situation that causes physical and emotional after-effects. Someone doesn't have to be hurt to have experienced trauma. Witnessing any type of personal or environmental disaster or being threatened with an assault are also traumatic incidents. We offer cover after certain traumatic events as well as counselling support.
Cover for trauma after certain traumatic events
The Trauma Recovery Extender Benefit helps to preserve the funds in your Medical Savings Account after certain traumatic events by giving you access to additional cover for certain day-to-day treatment after you are discharged from hospital. The benefit pays the day-to-day medical care costs of the traumatic event in the year it happened and in the year after it happened, without using the funds in your Medical Savings Account. This applies if you are on a plan that offers the benefit. You will not qualify for the Trauma Recovery Extender Benefit if the traumatic event happened in a previous benefit year while you were on a plan type that did not offer this benefit or while you were a member of another medical scheme. You have to be a member of Discovery Health Medical Scheme at the time that the trauma happens to qualify for cover from the Trauma Recovery Extender Benefit. The benefit covers only the claims for the member who is registered for the benefit and claims that are related to the original diagnosis after the specific trauma.
The Trauma Recovery Extender Benefit is available on all plans, except the Classic Comprehensive Zero MSA Plan, the Essential Smart Plan, the Core Series and KeyCare Core Plan.
How does the Trauma Recovery Extender Benefit works?
The Trauma Recovery Extender Benefits covers you for certain day-to-day medical costs resulting from any of the following events:
Crime-related injury
The condition must require an ICU stay of five days or more
Conditions related to a near-drowning
The condition must require an ICU stay of five days or more
Poisoning
The condition must require an ICU stay of five days or more
Severe anaphylactic (allergic) reaction
The condition must require an ICU stay of five days or more
Paraplegia
(paralysis of the lower half of the body affecting both legs, due to blunt force injury to the spinal cord)
Severe lessening of the strength or effectiveness of the limbs, shown by loss of reflexes, numbness and loss of motion in the spine.
We use Beta or FIMS* score indications to measure the severity of the physical trauma.
Quadriplegia
(paralysis of both arms and legs due to blunt force injury to the spinal cord)
Severe lessening of the strength or effectiveness of the limbs, shown by loss of reflexes, numbness and loss of motion in the spine.
We use Beta or FIMS* score indications to measure the severity of the physical trauma.
Severe burns
15% of the surface area must have full thickness burns.
Loss of limb due to direct blunt force trauma
Trauma-related loss of limb
External and internal head injuries
The condition must require an ICU stay of five days or more. We use Beta or FIMS* score indications to measure the severity of the physical trauma.
*FIMS: Functional Independent Measure Scale – a universal measure of activities of daily living.
How do I qualify?
You will have automatic access to this benefit if you meet the entry criteria (refer to the table above). The benefit will be activated after you have been admitted for one of the specific traumas and the event has been appropriately reviewed and your benefits approved.
You will not qualify for the Trauma Recovery Extender Benefit if the traumatic event happened in a previous benefit year while you were on a plan type that did not offer this benefit or while you were a member of another medical scheme.
The day-to-day costs that are covered
Medicine
Schedule 3 and above prescribed medicine
Radiology and pathology
Includes x-rays, scans, blood tests and other tests done in a laboratory
Medical devices and limb prostheses
External devices including wheelchairs and hearing aids
Allied, therapeutic and psychology healthcare services
Acousticians, Biokineticists, Chiropractors, Counsellors, Dietitians, Homeopaths, Nurses, Occupational therapists, Physiotherapists, Podiatrists, Psychologists, Psychometrists, Social workers, Speech-language therapists and audiologists
The day-to-day limits that apply to claims paid from your day-to-day benefits also apply to the Trauma Recovery Extender Benefit
This includes, but is not limited to prescribed medicine and medical devices. It also means that if you join the Scheme after 1 January, you won’t get the full limit for prescribed medicine and allied, therapeutic and psychology healthcare services limits because these limits are calculated by counting the remaining months in the year.
The Saver and KeyCare Plus Plans do not ordinarily have limits on the available day-to-day cover, as the day-to-day care on these plans is either limited to funds in the Medical Savings Account, or members have to use specific healthcare providers and medicine lists. For this reason, we have created certain sub-limits on these plans specifically for the cover available through the Trauma Recovery Extender Benefit.
Refer to the Trauma recovery extender benefit guide for detailed information on the limits applicable to your health plan.
About how we pay accounts from the Trauma Recovery Extender Benefit
- The Trauma Recovery Extender Benefit provides cover up to the Discovery Health Rate, unless stated otherwise.
- The co-payment for MRI or CT scans that normally applies will not apply to scans that form part of treatment covered from the Trauma Recovery Extender Benefit.
- We will pay prescribed medicine (that is schedule 3 and above) from the benefit according to your plan. We pay medicine on the Preferred Medicine List up to 100% of the Discovery Health Rate for medicines. For medicine that is not on our Preferred Medicine List, we will pay up to 75% of the Discovery Health Rate for medicines on all plans except the Executive Plan, where we pay up to 90% of the Discovery Health Rate for medicines.
Trauma support
Discovery Trauma Support is available to assist you 24 hours a day, seven days a week. Mobile, face-to-face counselling (in Johannesburg, Pretoria, Durban and Cape Town) by trained counsellors is made possible by our fleet of dedicated Discovery Trauma Support vehicles.
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