With healthcare costs growing at an average of 8-10% each year, beyond inflation, which leaves medical aid clients with little choice but to downgrade their scheme benefit options to manage their cost of living. The downgrade of scheme option results in less benefits covered. This is often met with an unexpected and unaffordable bill after consultation or procedures. This has given Gap cover insurance critical spotlight to ensure medical aid clients are not faced with exorbitant amount of out-of-pocket expenses. Gap cover pays the client back policy which provides shortfall cover where doctors and specialists charge above medical aid rates of cover. Gap cover works in conjunction with your medical aid. Gap cover cannot provide cover where medical aid does not pay towards a procedure or covers the full amount for a procedure. For example, if your medical scheme option only pays out at 100% of scheme rate, you will then be liable to pay the shortfall of the other 200% to 400% charged by your healthcare provider as an “out of pocket” expense. Here is a testimonial of one of our clients Mrs K I gave birth in a private hospital in Johannesburg. The hospital bill was R15,000, Doctor’s bill was R14,500 and the anaesthesiologist R4000. Medical Aid made the following payments:
I had to pay the shortfall of R9,000 and luckily, I was able to claim from my Sirago gap cover and got my R9,000 back. *Please note we changed the name to keep identity private Gap cover may cover the following instances:
At Daberistic, our preferred provider is Sirago. Why Choose Sirago?
2021 Sirago Gap Cover Premium To apply for Gap cover contact Tammy in our Health department, email service@daberistic.com, Tel 011-6581333, Option 2 for Medical Aid.
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The world has really gone digital for anything and everything. Discovery has their app available for any person who has at least one active Discovery product. To start using the app you must be registered on Discovery website. If you have not registered you can click this link to take you through the steps Click here. You will use the same username and password for the app as for the Discovery website. To assist with downloading the Discovery App, please click link: How to download the Discovery App If you have a Discovery Medical aid you may do the following on the app;
See below for listed details: Digital cards
Please click here for list of screening and benefit covers Track Vitality status and goals
If you have any questions on Discovery health mobile app, please contact Tammy or Jo in our Health department, tel: 011 658-1333, email: service@daberistic.com Prevention is always better than cure and that is the main objective of the screening benefit. Medical Aids strive to help their members in detecting medical conditions early. The Screening and Prevention Benefit covers preventive tests, screenings, and a seasonal flu vaccination (for members registered for certain chronic conditions and members over the age of 65) on all Discovery Health Medical Scheme Plans. Having these specific tests conducted (up to the specified number) will not impact your day to day benefits. 1. Tests covered by the benefit:
2. The Vitality Check, a group test done at network pharmacies include:
3. Seasonal flu vaccination – you qualify each year if you’re over age of 65 or registered for one of the below chronic conditions:
4. Screening for kids
You may have certain co-payments
Please be reminded that Medical aid upgrades for 2021 will end soon, please make sure you have submitted your change by 30 November. For clients on Discovery KeyCare plan, Momentum Ingwe plan, Bonitas Boncap plan and have been selected to do income verification, please make sure all required documents are submitted to prevent your service provider resulting to default to the highest income band and therefore the highest contribution will apply.
Please note: Members joining Momentum health Ingwe option with effect 01 October 2020 onwards will not be required to submit information for income verification (declaration and proof of income). They will remain on their current income bracket moving into 2021 and the new premium will automatically be applicable from 01 January 2021. For more information on medical aid plans, please see below videos, brochures and links to assist you with change of option decision. Discovery Plan series and videos
Below are Discovery Health Plan Guides Brochures for 2021
To help you stay healthy and informed on the COVID-19 situation, Discovery will continue to provide the most up-to-date information and guidance through COVID-19 Information Hub Below are Momentum Health Plan Guides Brochures for 2021 Below are Bonitas Plan Guides Brochures for 2021 I have used up my Medical Savings Account, can I still see a doctor? I am a loyal customer of Discovery and have been a member of Discovery Health since I entered the workplace in 1996. During my start-up years from 2006 to 2009, I moved to my wife's company medical aid Sasolmed, then later changed to Medicover. In 2009, I returned to Discovery Health. My medical aid option has been Classic Delta Saver for the last few years. I think this plan is value for money, suitable for our family of five. However, towards the end of the year, I often run out of Medical Savings Account, then I have to pay out of my own pocket to see a doctor or to buy medicine. This plan provides Day-to-Day Extender Benefits: even when the savings account is used up, you can still visit a designated GP and be covered by Discovery. Discovery Health covers up to 6 network GP visits, which is helpful. The protocol to access this extender benefit has changed since the end of last year, however. Although I am a healthcare broker, I forgot to keep up with the change. I still wanted to use the same procedure as I have used in the past. I then ran into a wall and the Discovery Health refused to pay. What is going on here? There were like R30 left in my MSA. In order to use the extender benefits, I went to Dis-chem pharmacy to buy over-the-counter medicine. The intention was to reduce the savings account to zero. I asked the pharmacist to deduct from my savings account first, and I would pay the balance in cash. I also asked the pharmacist to confirm that there was no money in my savings account. After that, I made an appointment for my son with a designated family doctor, to assess his spinal injury. After the consultation, the front desk staff said that the claim had been submitted to Discovery Health, so I didn't have to pay for it. I thought that this extender benefit was really good, only to receive a claim statement from Discovery a few days later that they did not pay. I thought there was some misunderstanding. Upon further investigation, it turned out that I didn't apply the knowledge acquired. At the end of last year, Discovery announced a new process to use extender benefits. The first is to go to a network pharmacy such as Dis-chem to see a nurse. Or download the Dr Connect app on your mobile phone to consult with a doctor online. The infographic below illustrates: Below are the steps of how DrConnect works 1. Download DrConnect on the smart phone 2. Open the APP and log in 3. Log in with your Discovery Username and Password 4. You will see 4 categories: Assess your symptoms, Talk to a doctor, Ask doctors your questions, Enrol in a care guide. 5. If the GP you have visited before is also a DrConnect network doctor, he/she will appear here. Click the doctor for more options. 6. You can choose to book an appointment, send them a message about your queries, or connect for a video consultation (when they are online). 7. Or, on the main page (home), choose to ask a question. 8. Type in the question you would like to ask. 9. Answer a quick health survey or click Skip to skip it. 10. There may be other people have asked a similar question, which already has an answer to, see if you can find your answer here, if not, click to send your question.
Momentum Medical Scheme focuses more than ever on keeping benefit design stable and ensuring that their members continue to enjoy comprehensive and affordable benefits. The 3rd largest open medical aid scheme in South Africa, Momentum Medical Scheme has announced an average annual contribution increase of 3.9% for 2021. This is substantially lower that the weighted average annual contribution increase of 8.2% for 2020.
If you have any queries or are interested in joining Momentum Medical Scheme, please contact us on 011-658-1333, 076-200-5488 or email service@daberistic.com. Did you Know! That when you leave a medical aid as a member on Medical aid savings plan, as a member you have the following options • To request the refund which normally gets refunded back in 4 to 5 month • Members can request early payment on their Medical Aid Savings if they have financial problems, but they need to guarantee the scheme that should any claims arise after that they will be held accountable. • To request a transfer of Medical aid savings if they will be joining another medical aid that has the same component, Medical aid savings The other thing that members should know about their Medical aid savings - is that it works like a bank account, What you do not spend you carry over to the next year. But members needs to make sure they are on the New Generation scheme , options that offer Medical Aid savings not the Traditional scheme. Member can refer to their scheme website as the is different terms and conditions. If you have any queries regarding your medical aid, please contact Namhla in our Health Department, email health@daberistic.com , tel (011)658-1333 |
AuthorKevin Yeh Archives
January 2025
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