The key differences between Plan A and Plan B

Plan A

Plan B

Overall annual limit

R580 000 per family per year

R1 908 000 per family per year

Hospital cover
Cover of hospital costs and other accounts, like accounts from your admitting doctor, anaesthetist or any approved health care expenses, while you are in hospital

Up to overall annual limit e.g. In 2017, R580 000 per family

Up to overall annual limit e.g. In 2017, R1 907 000 per family

Chronic medicine
The scheme pays for an approved chronic medicine list of conditions, subject to an applicable Chronic Drug Amount at 100% of the Scheme Rate

Only covered for Prescribed Minimum Benefits (PMB) Clinical guidelines, protocols, pre-approval and authorisation required. An additional 4 consultations per beneficiary are available with a GP where a member is registered on the Chronic Illness Benefit (CIB) and the condition is PMB related.

Up to an amount of R23 800 per beneficiary with an overall limit of R65 650 per family per year, thereafter Prescribed Minimum Benefits only.
An additional 4 consultations per beneficiary are available with a GP where a member is registered on the Chronic Illness Benefit (CIB) and the condition is PMB related.

Primary care benefits
Consultations and visits to GP’s, specialists, registered private nurse practitioners and associated health services.

80% of Scheme Rate at non-network providers and 100% of network or negotiated rate at network providers e.g. In 2017, M+2 = R2 800 limit

100% of Scheme Rate at non-network providers and 100% of network negotiated rate at network providers e.g. In 2017, M+2 = R6 900 limit

Oncology cover
Cover to members diagnosed with cancer over a rolling 12 month period and provided to members from date of diagnosis and registration on the Oncology programme.

Limited amount per beneficiary per rolling 12 month period e.g. In 2017, R276 000. Benefit is paid at 100% of Scheme Rate until this benefit limit is reached. Thereafter it is paid at 80% of Scheme Rate up to R580 000 per family.

Limited amount per beneficiary per rolling 12 month period e.g. In 2017, R550 000. Benefit is paid at 100% of Scheme Rate until this benefit limit is reached. Thereafter it is paid at 80%

of Scheme Rate up to R1 908 000 per family.

Optical

A biennial benefit available every second benefit year depending on date of first claim received

100% of Scheme Rate for one comprehensive consultation, lens and frames per beneficiary, subject to limits e.g. 2017
Consultation R630
Single lens R390 OR
Bifocal lens R860 OR
Multifocal lens R1 610 OR
Frame R690
Contact lenses R2 630
(Alternative to glasses)

100% of Scheme Rate for one comprehensive consultation, lens and frames per beneficiary,
subject to limits e.g. 2017
Consultation R630
Single lens R390 OR
Bifocal lens R860 OR
Multifocal lens R1 610 OR
Frame R880
Contact lenses R2 630 (Alternative to glasses)

Pregnancy and maternity consultations

In addition to the Primary care benefit GP consultations, 2 consultations at a GP per pregnant beneficiary per pregnancy are provided

In addition to the Primary care benefit GP consultations, 4 consultations at a GP or gynaecologist per pregnant beneficiary per pregnancy are provided

Children’s Screening Benefit

Screening Benefits for children aged 2 to 18 will be made available from the Prevention & Screening Risk Benefit from the overall annual limit.

PrEP (Post Exposure Prophylaxis)

Funding of PrEP medication will be made available to members where authorised and pre-approved by Discovery Managed Care