Available on the Executive, Comprehensive, Priority and Saver plans
We pay your day-to-day medical expenses such as GP and specialist consultations, medicine, except for registered and approved chronic medicine, radiology and pathology from the available funds allocated to your Medical Savings Account (MSA). Any unused funds will carry over to the next year.
On the Executive, Comprehensive and Priority plans, when you run out of MSA, you will have to pay for some healthcare expenses from your pocket before you reach your Annual Threshold. This is called the Self-payment Gap (SPG).
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 (10%, 15%, 20% or 25%, depending on your plan type) of your total and monthly contribution.
25%
Executive, Classic Comprehensive, Classic Priority plans
20%
Classic Saver and Classic Delta Saver plans
15%
Classic Smart Comprehensive, Coastal Saver and Essential Priority plans
10%
Essential Saver and Essential Delta Saver plans
Using your MSA
The available funds allocated to your 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. If you are on a plan with an Above Threshold Benefit (ATB), then 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 healthcare professional 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 Medical Scheme will refund you at the Discovery Health Rate, and you will be responsible to pay the difference.
When you make a claim that is eligible for payment, the Scheme will use the money available in your Medical Savings Account (MSA) to pay for it. Your MSA is a combination of your annual MSA allocation, which is the amount of money you receive at the start of each year, and your accumulated MSA, which is the money that you didn't spend in previous years and that carried over to the current year.
How we pay for your claims
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 or you choose a plan without a medical savings account, then 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.
Please note: The payment arrangement we have with healthcare professionals will make sure we pay them according to the agreed rate.