I’m considering moving away from Discovery and I’m looking to see what your experiences are with the other medical aids.
I used to be on Discovery Classic Priority, but the plan has become quite useless and I then downgraded to Classic Saver in the middle of the year (before the premium increases), which turns out to be a superior plan compared to Classic Priority.
Since we have an extra child going to kindergarten next year, I downgraded the plan again to Classic Smart for next year to free up some funds and that move turns out to be significantly cheaper than Classic Saver and it is even cheaper than Classic Core. Our preferred hospital is on the Smart Network so they still cover 200% for hospital and the savings is about R4500 per month, much more than the “savings pocket” I get from the Classic Saver.
So I’ll effectively have to pay for all doctors and medications out of pocket (since my doctors aren’t on the network), but I was wondering if there aren’t other medical aids that maybe cost similarly, but where I can get some extra day-to-day benefits like doctor visits or medication.
I realise that Discovery is the only medical aid that covers 200% for hospital, but I do have a decent gap cover, so moving to a medical aid with 100% coverage should be fine.
So for anyone willing to answer some questions, here are what I can think of thus far. The technical details of each plan I can obviously get from their website, so my questions are more with regards to the experience with dealing with them. My questions:
Which medical aid and which plan are you on?
How convenient is it to interact with them? i.e. Submitting claims, obtaining authorizations, etc.?
Any issues or complaints about them?
Any co-payments that you’ve had to cover for admissions or procedures?
Thus far I’ve briefly been looking into KeyHealth and MediHelp (although my hospital is not on Medihelp’s network) and I must still take a look at Bonitas (a couple of years ago they were the only other medical aid covering more than 100% for hospital).
I’m moving to Coastal Saver from Classic Priority from next year. Saving is about R3k per month with some decent out of hospital benefits. All our local hospitals are also on the network, so it suits us perfectly.
Of course, I’ve had no interactions with Bonitas as yet and switched to them purely due to cost and benefit reasons as we restructured our option to include the kids on the plan. Discovery was too pricey when offering similar benefits.
I’m not a sickly person and had little engagement with Discovery. I made claims for COVID tests which were covered no hassle, along with wellness day claims. I also claimed PMB when I was visiting a psychologist which required pre-approval but was covered for 100%.
All in all, I have no issue with Discovery and can only recommend them. That being said, I never in e had human interaction with any of my interaction or claims and did everything digitally.
I am with Fedhealth and have been for over 20 years. Plan is FlexiFed 1. (cheapest one I can find) basically just a hospital plan. We have had to downgrade over the years as we became less and less able to keep the higher plans going.
How convenient is it to interact with them? i.e. Submitting claims, obtaining authorizations, etc.?
Claims are done by doctors usually, claim shows up on their portal, gets turned down/co-payment etc. I have had to pay for all my specialist visits and GP visits myself as I cannot afford a proper medical aid, just the hospital plan.
Auth is either done by the specialists or via phone to a human
Pretty convenient
Any issues or complaints about them?
As all my operations and my wife’s have been life threatening, they should be covered by PMB but we have had to fight for it. I hate doing that but have gotten so used to the game that it is the new normal now.
Any co-payments that you’ve had to cover for admissions or procedures?
Co-payments on all procedures, even ones supposedly covered by PMB, luckily I have a good gap cover that has paid out every time.
Co-payments on admissions if the procedures are done in a hospital not on their stupid “networks” but in most cases a friendly word from the surgeon to the hospital management got those waived. You would be amazed at how much pull a renowned cardiologist has on the hospitals they operate in
In short, not an easy ride. Having to pay for my own very expensive blood thinning medication when the normal warfarin made me ill was painful, for 3 years. Just because it was not on their damned “formulary”.
I suspect this is true of all these medical aid sharks, you are a number and if you don’t fit nicely into their rules, you pay.
Oh how I hate them, with a passion. Just typing this makes me angry…
I moved from discovery to momentum incentive with gap cover from Turnberry.
Haven’t had major things done yet with them besides loads of dental work. That they took from my medical savings that is built into the plan. I normally have to submit my GP visit myself. Which I do via quick email and get paid back within 10 days.
I have to go for xrays on my hand soon, so will request authorisation on it and see how it goes.
I have had less issues with momentum than discovery who wouldn’t even cover a root canal. Momentum on this plan gives me even that.
I do wish medical aids would let us pick what we need. Aka no maternity and swop that with dental and eye care.
As for my experience with Discovery, I can’t really complain and this potential move is purely a cost consideration. They covered the twins birth in full (R500k), the youngest’s birth in full and I went for a sinus operation in September that cost R100k and that was also paid in full.
The Priority plan has degraded somewhat lately with lots of co-payments for procedures and lots of exclusions with regards to the self-pay gap when you’ve depleted your savings, making it harder to reach the above-threshold benefits. (i.e. even prescribed medicine is now excluded). Ironically the Classic Saver plan, which is a cheaper plan than Classic Priority, has no co-payments for hospitals. Even the person at Discovery that I talked to for authorization (to remove my one daughter’s tonsils), said that Classic Saver is better for when you have kids due to the lack of co-payments. I had a co-payment of R4600 on Classic Priority when I removed my other daughter’s tonsils beginning of the year, nothing this time on Classic Saver and it is the exact same doctor and day clinic.
My only real issue with Discovery was with their Vitality and them constantly moving the goalposts. However, I resolved that issue by cancelling Vitality and moving my life insurance to another company that isn’t further subject to premium increases.
The new Classic Smart plan has unlimited doctor visits (co-payment of R60 per visit), but only to doctors in the Smart Network (which is a no-go for us). We also get R800 OTC medication and R3000 worth of prescribed medication per year (S3 and up) if prescribed by a network doctor so we’ll maybe do a virtual consultation and get a prescription for the chronic stuff to deplete that benefit.
Looking at the KeyHealth Equilibrium plan which costs about the same as Classic Smart, they’ll provide some additional benefits which Discovery doesn’t. Here is a rough comparison:
Hospital benefit
KeyHealth: 100% and R180k oncology benefit
Discovery: 200% and R250k oncology benefit
Hospital discharge medication
KeyHealth: R610 per admission
Discovery usually pays that from savings.
MRI & CT scans
KeyHealth: R20k worth of MRI and CT scans with only a R1500 co-payment
Discovery: Co-payment of R3500 but doesn’t look like there are limits other than 100% the DHR rate. However, I had a CT scan and decided to pay/process it privately (it was after hours and Discovery was already closed for authorizations). It worked out a couple of hundred rands cheaper than R3500, but if I did it with Discovery, I would have had to pay the full R3500.
Day to day benefits
KeyHealth: Savings Account: R5,592 + Additional Day to Day benefits: R8,570 = R14,162 per year
Discovery C-Smart: Unlimited doctors in network with R60 payment per visit, R3000 prescribed meds, R700 OTC meds. (Our doctors are not on their network though)
Discovery C-Saver: R35,736 savings
Other benefits from KeyHealth
Child Immunisations for children 6 and under, contraceptive medications, malaria medication and a bunch of other screenings plus the same ones as Discovery… none of these benefits really apply to us though since our kids are all up to date with their injections and the others just doesn’t apply. Maybe their weight-loss benefit will
Total contributions for our family (2 adults, 3 kids)
KeyHealth: R7,056 (R6,430 was 2023’s rates)
Discovery Classic Smart: R7,204
Discovery Classic Saver: R12,140.
So on paper, Classic Smart seems like a no-brainer over Classic Saver (in our case since our hospital is on the Smart Network) because the hospital benefits are the same and the difference in premiums amounts to R4900 per month which equates to almost R59k per year (vs the R36k savings account offered in Classic Saver).
KeyHealth seems to provide even more benefits for even less per month, but I’ll need input from people’s experience with this medical aid. Will also have to ask our doctors’ input on them.
Other medical aids looked at thus far:
MediHelp: They don’t have our hospital on their network
Bonitas: Our hospital not on their network
FedHealth & Momentum: Not really competitive with the others looked at thus far.
** Edit: Seems that our hospital is on MediHelp (they just listed it under a different area). Their competing network plan is about R200 more than KeyHealth with some less day-to-day benefits, but still more than Discovery Classic Smart.
Ok, so KeyHealth and Medihelp have some shocking reviews, so I think I’ll steer clear. Issues ranging from short payments for approved procedures to rejecting critical hospital authorizations. Covering approved hospital stays at 100% doesn’t mean much if they don’t approve your admission in the first place. This essentially renders the comparisons between medical aids on paper, pretty much useless.
My broker only deals with Discovery, Momentum and Bestmed. I think I’ll limit my options to those 3 then and if my broker doesn’t come with a better option from Bestmed, I’ll take my savings from the downgrade and stay put on Classic Smart. (Bestmed seems to have a better option, but maybe with some Ts and Cs)
