The Medical Savings Account
The Medical Savings Account (MSA) is only applicable to the Executive, Comprehensive, Priority and Saver Plans. It is a fixed amount that the Scheme gives you at the beginning of the year. You can use it for day-to-day medical expenses like GP and dentist visits, and your medicine. You pay the MSA amount back to us in equal monthly payments.
How you pay for your allocated MSA
The monthly payments form part of your monthly contribution to the Scheme. If you leave the Scheme part-way through the year or downgrade your health plan, we calculate how much of the MSA you have used and how much you have contributed to it. If you have used more than what you have paid, you will need to pay the difference to us.
Your total allocated MSA amount and contribution is calculated as a fixed portion (15%, 20% or 25%, depending on your plan type) of your total and monthly contribution.
Executive and Classic Plans: 25%
Essential Plans: 15%
Coastal Saver Plan: 20%
Using your MSA
The money in your allocated Medical Savings Account is yours to use for your non-hospital expenses (day-to-day expenses). Claims are paid from this account subject to the availability of funds. We pay your non-hospital claims at one of two rates:
- Cost: we pay your claims in full at the claimed amount. We pay medicine claims up to a maximum of the Discovery Health Rate for medicines. We add up claims to the Annual Threshold up to the Discovery Health Rate and not Cost. This can increase your Self-payment Gap. If the provider charges more than the Discovery Health Rate and is not part of a direct payment arrangement, we will pay you.
- Discovery Health Rate: we pay your claims up to the Discovery Health Rate. If your healthcare professional charges a rate higher than the Discovery Health Rate, Discovery Health will refund you at the Discovery Health Rate, and you will be responsible to pay the difference.
The Medical Savings Account works like a bank account. What you do not spend, you carry over to the next year. If you leave Discovery Health Medical Scheme, we are legally required to pay the balance to the new medical scheme you join. If that information is not available we pay you whatever you have contributed that is more than you have claimed, after four months.
However, if you have spent more than what you have contributed, you will owe us the extra amount. If you join another medical scheme with a savings account, we will transfer the money you have left to the new scheme.
Please note: The payment arrangement we have with healthcare professionals will make sure we pay them according to the agreed rate.