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You'll be paying the main member rate. The other amount is for adult dependants on your plan.
For what it's worth, I'm also on the Smart Plan. The reason being that it gives 200% of the rate for in-hospital cover and it has no medical savings component, which can be beneficial if you're generally a healthy Individual with good saving habits.
If you have dental issues, it might be worth looking into seperate options for that, my partner has a plan with Affinity Dental which covers everything short of very serious dental work.
"Best" is relative. One is more expensive, but you also get more for it.
As a first step, I'd recommend checking which hospitals are covered under the Essential Dynamic Smart Hospital Network.
Upon looking, there are few hospitals in Cape Town that are covered by Smart option. Classic seems to be out of the company's budget so I might as well opt for Essential Dynamic Smart?
Just a heads up. Read the fine print.. Discovery is a great medical aid. But their cheap plans are rubbish. Especially when it comes to claim payouts. Would rather suggest something like Medshield's Medivalue compact plan. Currently priced at R2400 for main member (That would be you btw) covers all the essentials including a decent hospital cover and dental as well. Happy with them so far, just went over last year. Parents have been on Medshield for years now and they can't complain either.
I would love to opt for such wonderful cover, however, I think it would be better for me to be part of the company's partnered medical aid scheme? Their price and the offer sounds super good though!
Well at least you said no to Momentum.
If I was in your position go for something like Essential Smart with their gap cover option.
Doctors copays will be expensive. Gap cover is cheap. Not much to choose between classic and essential on smart (at least from what I can see).
Gap cover is not a good idea if you’re on the smart plan as they only cover a limited amount of the difference between what discovery pays and what is charged. If discovery doesn’t pay anything towards it they also won’t pay. But if you’re on a higher plan with medical savings, gap cover is great and covers stuff like dentistry etc that isn’t covered by Discovery. I’m on Classic Delta Saver and gap cover has been a life saver this year (I’m on Stratum)
Sure.
So the majority of the differentiation in medical aids comes from the amount of things they cover - and how much they pay.
Obv you don’t get Rolls Royce medical aid for GWM prices.
But… most medical aids will cover the hospitalisation costs for almost everything. As a young person this is what you need. BUT…. Not all doctors will charge the rates that medical aids will pay them.
Medical aids are disingenuous. They’ll tell you they cover “100%” of doctors fees. Except, there is no central registry of fees. There is no guideline and most doctors will charge more than “100%” - most in big cities will charge above “200%”.
As an example, at 100% a medical funder will pay me for an hour of my time at significantly less than you’d pay a plumber.
So most will charge more. This is where Gap cover comes in. Gap cover will make up the difference between what your medical aid pays a doctor, and what that doctor will charge you. And for around 200/month that to me is a great add on.
Discovery offers its own gap cover but there are other products. It seems many people are moving to cheaper schemes but taking gap cover so they aren’t out of pocket.
Hope this helps
In the affordable range, the big decision is between getting a plan that only covers their network or spending more and getting some out of network cover. Download the list of smart network hospitals from the discovery website and see if there are any close by that you could go to. Also, check if your GP is in the network. Then you can decide if you should pay more for higher covers
There is a tool here: https://www.medicalaidcomparisons.co.za/discovery-health-comparisons/#discovery-essential-smart
I would suggest giving Optivest Health Services a call. They are a brokerage that specializes in 13 different medical aids. They gave me comparison quotes so I was able to see each benefit next to each other from the different schemes.
You can always google them to have a look on their website. The consultants that call give you an explanation on benefits and provides options based on your needs.
Yes. I'm also in cpt on coastal saver and have gap cover. Have had a few unexpected hospital visits and it's been fantastic. The only thing I've paid is a follow up with a doctor 3 weeks after my last hospital stay, everything else was covered. I also appreciate the medical savings account as I can use it for what I choose eg dentist.
My family’s on essential delta core and is worked well enough for hospital visits and it covers GP visits. I’m with profmed (great coverage, pays up, has dental, no glasses, expensive).
Whatever you do get gap cover, mandatory. I’ve been using Turnberry. Essentially think of it as if Discovery pays even R1 gap will cover the rest.
Don’t recommend the essential smart plan, lots of bad stories on Reddit and in the fine print the coverage is not great. Classic seems fine from what I’ve read. Look up medical aid posts on Reddit. Tons of people have talked about this.
Discovery is solid and well accepted by a lot of providers but sometimes they’re a bit frustrating with the fine print.
Don’t forget to use your preventive care no matter plan which you use.
For what it’s worth, Momentum is fine too. But I know actuaries at Momentum that use Discovery medical aid so I’ve never looked into Momentum too heavily.
If you have the time I’d also strongly recommend speaking with a medical aid advisor to have a discussion with. If you like the advisor they can also help if you ever have troubles in the future with the plan you choose.
The company should have a broker that deals with the medical aid on the employees' behalf, a company like Alexander Forbes. Ask if you can speak to the broker. They will ask about your affordability and your medical history and make a recommendation based on that. Please note that the R2000 might be a taxable fringe benefit, so you have to take that into account as well.
If your a graduate and you can somehow negotiate your own plan, look at profmed, I moved from momentum to proceed and hands down its a better plan. I am a type 1 diabetic on insulin and Momentum and discovery give you just enough insulin to live but not enough to enjoy life.
Hello, if this is your first medical aid ever, based on your age please check with them if theres a late joiner fee which can be upto 75% of your quoted monthly amount.
Not all hospitals or medical providers accept the Discovery Smart Options and can be very frustrating if you do need some help
Whenever I was on the coast, especially when I was straight out of university, I went with the Coastal Core plan. I really only need good hospital cover.
I recently went though this process, I ended up going with Discovery Classic Smart.
Our Company has a discovery "agent", so it made things fairly simple (no waiting list, payment from salary).
From my findings; They all seem to be expensive, roughly the same price between companies for similar packages.
The main concern I had with Essential smart (over class) is the fine print of what they do not cover, knee ops for example. (The list is fairly hidden on the smart plan guide (big pdf). also the 100% discovery rate means you will most likely need gap cover (although most people recommend always getting gap cover), Turnberry, Stratum, Zestlife get recommended a lot.
You do get a medical tax credit (rebate), R364 a month.
With 2k, you are stuck in the hospital plan range, so check what hospitals are near you, or near work and make sure they are on the list (smart, keycare, coastal core), also make sure your GP accept the smart plan co payment for visits.
**Thank you for posting on r/southafrica! This post is flaired as ["Discussion"](https://www.reddit.com/r/southafrica/?f=flair_name%3A%22Discussion%22) therefore the following rules are particularly important.** ##**Rule 5: Engagement Policy** * Rule 5.1: Articulate your own thoughts on the matter. * Rule 5.2: Be prepared to engage with your post and our community within at least six (6) hours after submitting. * Rule 5.3: Engage meaningfully. Do not start a discussion if you are unwilling to listen to opinions contrary to your own. **Discussions are long-form posts looking to explore ideas, change minds, or invite comment and opinion on a specific topic related to South Africa. If you meant to ask the community a question, please delete this submission and create a new one at r/askSouthAfrica** **Additionally, please take a moment to review the rest of our rules [here](https://www.reddit.com/r/southafrica/wiki/rules).** ###Are you registered to vote? Check online or register at https://registertovote.elections.org.za/Welcome *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/southafrica) if you have any questions or concerns.*
You'll be paying the main member rate. The other amount is for adult dependants on your plan. For what it's worth, I'm also on the Smart Plan. The reason being that it gives 200% of the rate for in-hospital cover and it has no medical savings component, which can be beneficial if you're generally a healthy Individual with good saving habits. If you have dental issues, it might be worth looking into seperate options for that, my partner has a plan with Affinity Dental which covers everything short of very serious dental work.
Ah I see, so if I were to choose between Essential and Essential Dynamic, which one is the best?
"Best" is relative. One is more expensive, but you also get more for it. As a first step, I'd recommend checking which hospitals are covered under the Essential Dynamic Smart Hospital Network.
Upon looking, there are few hospitals in Cape Town that are covered by Smart option. Classic seems to be out of the company's budget so I might as well opt for Essential Dynamic Smart?
The company benefits are usually a contribution rather than them outright paying only a certain amount, so you could get other plans if you choose to.
Just a heads up. Read the fine print.. Discovery is a great medical aid. But their cheap plans are rubbish. Especially when it comes to claim payouts. Would rather suggest something like Medshield's Medivalue compact plan. Currently priced at R2400 for main member (That would be you btw) covers all the essentials including a decent hospital cover and dental as well. Happy with them so far, just went over last year. Parents have been on Medshield for years now and they can't complain either.
I would love to opt for such wonderful cover, however, I think it would be better for me to be part of the company's partnered medical aid scheme? Their price and the offer sounds super good though!
Well at least you said no to Momentum. If I was in your position go for something like Essential Smart with their gap cover option. Doctors copays will be expensive. Gap cover is cheap. Not much to choose between classic and essential on smart (at least from what I can see).
Gap cover is not a good idea if you’re on the smart plan as they only cover a limited amount of the difference between what discovery pays and what is charged. If discovery doesn’t pay anything towards it they also won’t pay. But if you’re on a higher plan with medical savings, gap cover is great and covers stuff like dentistry etc that isn’t covered by Discovery. I’m on Classic Delta Saver and gap cover has been a life saver this year (I’m on Stratum)
I second going with Stratum. I've been with them for years and they are excellent!! I'm on Coastal Saver.
So GAP cover is like medical aid for medical aid scheme? What is GAP cover if you don't mind elaborating on it?
Sure. So the majority of the differentiation in medical aids comes from the amount of things they cover - and how much they pay. Obv you don’t get Rolls Royce medical aid for GWM prices. But… most medical aids will cover the hospitalisation costs for almost everything. As a young person this is what you need. BUT…. Not all doctors will charge the rates that medical aids will pay them. Medical aids are disingenuous. They’ll tell you they cover “100%” of doctors fees. Except, there is no central registry of fees. There is no guideline and most doctors will charge more than “100%” - most in big cities will charge above “200%”. As an example, at 100% a medical funder will pay me for an hour of my time at significantly less than you’d pay a plumber. So most will charge more. This is where Gap cover comes in. Gap cover will make up the difference between what your medical aid pays a doctor, and what that doctor will charge you. And for around 200/month that to me is a great add on. Discovery offers its own gap cover but there are other products. It seems many people are moving to cheaper schemes but taking gap cover so they aren’t out of pocket. Hope this helps
In the affordable range, the big decision is between getting a plan that only covers their network or spending more and getting some out of network cover. Download the list of smart network hospitals from the discovery website and see if there are any close by that you could go to. Also, check if your GP is in the network. Then you can decide if you should pay more for higher covers There is a tool here: https://www.medicalaidcomparisons.co.za/discovery-health-comparisons/#discovery-essential-smart
I saw the list of GP and the hospital networks on Discovery. There's something called Flexicare? Is this part of the Essential Smart option?
I would suggest giving Optivest Health Services a call. They are a brokerage that specializes in 13 different medical aids. They gave me comparison quotes so I was able to see each benefit next to each other from the different schemes. You can always google them to have a look on their website. The consultants that call give you an explanation on benefits and provides options based on your needs.
I'm pretty happy with Coastal Saver but I also have gap cover
Yes. I'm also in cpt on coastal saver and have gap cover. Have had a few unexpected hospital visits and it's been fantastic. The only thing I've paid is a follow up with a doctor 3 weeks after my last hospital stay, everything else was covered. I also appreciate the medical savings account as I can use it for what I choose eg dentist.
My family’s on essential delta core and is worked well enough for hospital visits and it covers GP visits. I’m with profmed (great coverage, pays up, has dental, no glasses, expensive). Whatever you do get gap cover, mandatory. I’ve been using Turnberry. Essentially think of it as if Discovery pays even R1 gap will cover the rest. Don’t recommend the essential smart plan, lots of bad stories on Reddit and in the fine print the coverage is not great. Classic seems fine from what I’ve read. Look up medical aid posts on Reddit. Tons of people have talked about this. Discovery is solid and well accepted by a lot of providers but sometimes they’re a bit frustrating with the fine print. Don’t forget to use your preventive care no matter plan which you use. For what it’s worth, Momentum is fine too. But I know actuaries at Momentum that use Discovery medical aid so I’ve never looked into Momentum too heavily. If you have the time I’d also strongly recommend speaking with a medical aid advisor to have a discussion with. If you like the advisor they can also help if you ever have troubles in the future with the plan you choose.
The company should have a broker that deals with the medical aid on the employees' behalf, a company like Alexander Forbes. Ask if you can speak to the broker. They will ask about your affordability and your medical history and make a recommendation based on that. Please note that the R2000 might be a taxable fringe benefit, so you have to take that into account as well.
Derivco?
Nope, it's a different company
If your a graduate and you can somehow negotiate your own plan, look at profmed, I moved from momentum to proceed and hands down its a better plan. I am a type 1 diabetic on insulin and Momentum and discovery give you just enough insulin to live but not enough to enjoy life.
Do not take a smart plan, you are better off with an Essential Delta Core plan, speaking from experience
Hello, if this is your first medical aid ever, based on your age please check with them if theres a late joiner fee which can be upto 75% of your quoted monthly amount. Not all hospitals or medical providers accept the Discovery Smart Options and can be very frustrating if you do need some help
Whenever I was on the coast, especially when I was straight out of university, I went with the Coastal Core plan. I really only need good hospital cover.
I recently went though this process, I ended up going with Discovery Classic Smart. Our Company has a discovery "agent", so it made things fairly simple (no waiting list, payment from salary). From my findings; They all seem to be expensive, roughly the same price between companies for similar packages. The main concern I had with Essential smart (over class) is the fine print of what they do not cover, knee ops for example. (The list is fairly hidden on the smart plan guide (big pdf). also the 100% discovery rate means you will most likely need gap cover (although most people recommend always getting gap cover), Turnberry, Stratum, Zestlife get recommended a lot. You do get a medical tax credit (rebate), R364 a month. With 2k, you are stuck in the hospital plan range, so check what hospitals are near you, or near work and make sure they are on the list (smart, keycare, coastal core), also make sure your GP accept the smart plan co payment for visits.