Executive Plan. Extensive cover for in-hospital and day-to-day benefits. Unlimited hospital cover in any private hospital and private ward cover

Transcription

1 Executive Plan Extensive cover for in-hospital and day-to-day benefits Unlimited hospital cover in any private hospital and private ward cover The most extensive cover for chronic medicine, including full cover for an exclusive list of medicines and access to specialised and advanced technology and medicine Certainty of cover for GP consultation fees, blood tests and day-to-day generic medicines The highest savings account and limits to cover your day-to-day healthcare needs Cover for medical emergencies when travelling in and outside South Africa We offer you the choice to be covered in full. Look out for the Full Cover Choice stamp in this brochure. It shows you when to use our range of online tools that guide you to full cover

2 Your cover in hospital We cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us. There is no overall hospital limit. Unlimited hospital cover Emergency cover when you need it most 911 offers fast, life-saving emergency care. In an emergency, go straight to hospital. If you need medically-equipped transport, call This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport to you. It is important that you, a loved one or the hospital let us know about your admission as soon as possible. Cover for planned hospital admissions Please call us 48 hours before you go to hospital to confirm your admission. Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital. To help make your admission to hospital convenient and seamless we offer an online tool that assists you to plan and authorise your hospital admission and confirms how you will be covered. Private ward cover You have exclusive access to private ward cover up to R1 300 a day. Use our online tools to plan, authorise and confirm how you are covered. Your cover for investigations Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) and MRI or CT scans If performed during an approved admission, we pay the hospital account from your Hospital Benefit and all related accounts from the Medical Savings Account or Above Threshold Benefit. Unlimited healthcare services Most of your in-hospital healthcare services have no overall limit. These are: GPs Pathology Specialists 300% Allied healthcare professionals, like physiotherapists Other healthcare services including radiology Specialists Radiology HIV cover

3 Your cover for healthcare professionals We pay your treating doctors and other related accounts from the Medical Savings Account. Once you reach your Annual Threshold, we pay these accounts from the Above Threshold Benefit. A related account is the account for any approved expense you incur during your hospital admission, other than the hospital account. Full cover for specialists who we have an agreement with You can benefit by using healthcare professionals who we have an agreement with because we will cover their approved procedures in full. You benefit from access to the broadest range of specialists, which represents over 90% of our members specialist interactions. These healthcare professionals are also the designated providers for Prescribed Minimum Benefits. Other specialists 300% All other healthcare professionals Limited healthcare services Only the following healthcare services have an annual limit in hospital: Private ward cover Cochlear implants, auditory brain implants and processors Internal nerve stimulators Hip, knee and shoulder joint prostheses Prosthetic devices used in spinal surgery Mental health Up to R1 300 for each day in a private ward R for each person for each benefit R for each person There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R applies to each prosthesis. R for the first level, R for two or more levels, limited to one procedure for each person 21 days for each person You may have a co-payment if your healthcare professional charges above these rates. Alcohol and drug rehabilitation Terminal care 21 days for each person R for each person in their lifetime Dentistry* There is an overall limit of R for each person. We pay the hospital account from your Hospital Benefit. We pay all related accounts from the Medical Savings Account or Above Threshold Benefit. Use our website to find a specialist who we cover in full. * This limit applies to the hospital account and all accounts related to your admission. A related account is the account from your admitting doctor, anaesthetist or any approved expense you incur during your hospital admission, other than the hospital account. If you join the medical scheme after January, you won t get the full limit because it is calculated by counting the remaining months in the year.

4 Care Care looks after you when you are living with a chronic condition that needs ongoing management and care. Our skilled consultants help guide you to ensure you always receive the most appropriate level of care, when you register for one of our care programmes. Your cover for chronic conditions You have extensive cover for a comprehensive list of chronic conditions. You have full cover for approved medicine on s medicine list. If you choose to use medicine that is not on the medicine list, you have a set monthly amount available that is higher than that of our other plans. We pay medicine up to the. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit. An exclusive list of medicines You also have access to a defined list of medicines that we cover in full. MedXpress convenient medicine delivery When you use MedXpress, s convenient medicine delivery service, you pay no delivery or administration fees. s service agents can also advise you on the most cost-effective alternatives and you will always be charged at the or less minimising co-payments. Call us on to make use of this free service. Savings on essential care items at Dis-Chem When you shop at Dis-Chem, ChroniCare brings you savings on a wide range of items appropriate to your needs, such as monitoring devices and diabetic footwear, that help manage your chronic condition. You can activate ChroniCare if you are registered on our Chronic Illness Benefit for one of the following chronic conditions: asthma, diabetes, high cholesterol or high blood pressure. Earn up to 25% cash back by activating ChroniCare at Your cover for medical technology and expensive medicine You have cover for a defined list of the latest treatments through the Specialised Medicine and Technology Benefit, up to R for each person each year. Please call us to see whether your treatment qualifies. You also have access to the Overseas Treatment Benefit, which covers you when you travel overseas to seek evidence-based healthcare treatment not available in South Africa. The treatment must be at a registered healthcare professional and is paid up to a limit of R for each person each year. You will need to pay and claim back from us when you return to South Africa. Specific rules and a co-payment of up to 20% applies to both benefits. Your cover for cancer treatment Our Oncology Programme covers the first R of approved cancer treatment over a 12-month cycle. Cover is unlimited once your cancer treatment costs go over this amount, but you will need to pay 20% of the cost of all further treatment. All cancer-related healthcare services You might have to make a co-payment if your healthcare professional charges above this rate. Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. Please call us to register on the Oncology Programme.

5 Your cover for day-to-day medical expenses We pay for day-to-day medical expenses like GP visits, radiology and pathology from your Medical Savings Account, at the rate the healthcare professional charges, as long as you have money available. If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay for your day-to-day medical expenses yourself. The Insured Network Benefit pays for certain day-to-day benefits before you reach the Annual Threshold. Once your claims add up to the Annual Threshold, we pay the rest of your claims from the Above Threshold Benefit. The Insured Network Benefit reduces gaps in cover Limits on some day-to-day healthcare services We extend your day-to-day cover through the Insured Network Benefit. When you have spent the annual funds in your Medical Savings Account and if you use a provider in our network, we cover: Medicine Prescribed medicine (over schedule 3)* Single member: R With one dependant: R With two dependants: R With three or more dependants: R Your GP consultation fees Day-to-day generic medicines (above schedule 3) Blood tests The Above Threshold Benefit offers extra day-to-day cover The Executive Plan has an unlimited Above Threshold Benefit. This gives you extra cover at the or a percentage of it when your claims add up to a set amount called the Annual Threshold. As an Executive Plan member, your cover for specialists is at 300% of the. Over-the-counter medicine (including prescribed medicine under schedule 3 and lifestyle-enhancing products) Appliances and equipment External medical items Hearing aids Optical (includes cover for lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye, like excimer laser)* We pay these claims from the available funds in your Medical Savings Account. R for your family R for your family R for each person * If you join the medical scheme after January, you won t get the full limit because it is calculated by counting the remaining months in the year. Unlimited key day-to-day healthcare services We pay these healthcare services from your Medical Savings Account or Above Threshold Benefit, with no annual limit: GPs, who we pay at a higher rate than on our other plans Radiology and pathology Specialists Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) MRI and CT scans (except for back and neck scans, where specific rules and limits apply) Extending your cover for allied healthcare services The Allied, Therapeutic and Psychology Extender Benefit gives you unlimited cover for a list of allied healthcare services, like physiotherapy. This unlimited cover is for a defined list of conditions. The unlimited cover depends on your condition and the criteria for it.

6 Limits on some day-to-day healthcare services Some of your day-to-day benefits have limits. These are not separate benefits. These limits apply to claims paid from your Medical Savings Account or Above Threshold Benefit. Professional services Allied, therapeutic and psychology healthcare services (acousticians, biokineticists, chiropractors, counsellors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists and audiologists) * Antenatal classes Dentistry* Single member: R With one dependant: R With two dependants: R With three or more dependants: R R1 100 for your family Overall limit of R for each person * If you join the medical scheme after January, you won t get the full limit because it is calculated by counting the remaining months in the year. How we extend your benefits and make your Medical Savings Account last longer We pay claims for these day-to-day expenses without using your Medical Savings Account: The Screening and Prevention Benefit covers certain tests at a Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate screening test) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine. We will cover out-of-hospital claims for recovery after certain traumatic events from the Trauma Recovery Extender Benefit. The cover applies to the rest of the year in which the trauma took place, and to the year after your trauma. Save on self-medication at Clicks With MedSaver, you can earn up to 25% cash back on self-medication at any Clicks Pharmacy, whether you pay for it or claim for it. Activate MedSaver by going to Your Contributions cover day-to-day medical expenses Total contributions (including Medical Savings Account amounts) Annual Medical Savings Account amounts** Annual Threshold amounts** Main member Adult Child* Main member Adult Child* Main member Adult Child* R3 764 R3 764 R714 R R R2 136 R R R2 125 * We count a maximum of three children when we work out the monthly contributions, annual Medical Savings Account and Annual Threshold. ** If you join the medical scheme after January, you won t get the full amounts because it is calculated by counting the remaining months in the year. General exclusions: We do not cover certain healthcare services. You can find a full list of exclusions at This brochure is intended for intermediary use. It is only a summary of the key benefits and features of the Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. Full details can be found in the Medical Scheme Rules. It also summarises other products and value-added services. For compliance questions, compliance@discovery.co.za. Medical Scheme, registration number 1125, is administered by (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Vitality is not part of the Medical Scheme. Vitality is a separate product sold and administered by Vitality style (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider. GM_17535DHL_EXECUTIVE_27/09/2012 HPBE 09/12 (13)

7 Comprehensive Series Classic Classic Delta Classic Zero MSA Essential Essential Delta Extensive in-hospital and out-of-hospital cover Unlimited private hospital cover Comprehensive cover for chronic medicine Access to specialised and advanced technology and medicine A high savings account to cover your day-to-day healthcare needs Certainty of cover for GP consultation fees, blood tests and day-to-day generic medicines Cover for medical emergencies when travelling in and outside South Africa We offer you the choice to be covered in full. Look out for the Full Cover Choice stamp in this brochure. It shows you when to use our range of online tools that help guide you to full cover

8 Your cover in hospital We cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us. There is no overall limit. Unlimited hospital cover Emergency cover when you need it most 911 offers fast, life-saving emergency care. In an emergency, go straight to hospital. If you need medically-equipped transport, call This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport to you. It is important that you, a loved one or the hospital let us know about your admission as soon as possible. Limited healthcare services Only the following healthcare services have an annual limit in hospital: Cochlear implants, auditory brain implants and processors Internal nerve stimulators R for each person for each benefit R for each person Cover for planned hospital admissions We cover you in a private hospital for approved admissions. You have no overall limit on your hospital cover. Please call us 48 hours before you go to hospital to confirm your admission. Use a network hospital on Delta On Classic Delta and Essential Delta, you are covered in full at private hospitals in the Delta Hospital Network. For planned admissions at any other private hospitals, you must pay an amount of R5 000 upfront to the hospital. To help make your admission to hospital convenient and seamless we offer an online tool that assists you to plan and authorise your hospital admission and confirms how you will be covered. Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital. Hip, knee and shoulder joint prostheses Prosthetic devices used in spinal surgery Mental health Alcohol and drug rehabilitation There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R applies to each prosthesis. R for the first level, R for two or more levels, limited to one procedure for each person 21 days for each person 21 days for each person Unlimited healthcare services Most of your in-hospital healthcare services have no overall limit. These are: GPs Specialists Pathology Radiology Allied healthcare professionals, HIV cover like physiotherapists Terminal care R for each person in their lifetime

9 Your cover for healthcare professionals Full cover for specialists who we have an agreement with You can benefit by using healthcare professionals who we have an agreement with because we will cover their approved procedures in full. These healthcare professionals are also the designated providers for Prescribed Minimum Benefits. If you are a Classic member, you benefit from access to the broadest range of specialists who we pay in full, which represents over 90% of our members specialist interactions. Use our website to find a specialist who we cover in full. Your cover for dental treatment Severe dental and oral surgery The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. This benefit is subject to authorisation and the Scheme s clinical rules. Dental treatment in hospital You need to pay a portion of your hospital or day-clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment: Other specialists and healthcare professionals Radiology and pathology Hospital Younger than 13 R1 450 Day-clinic Younger than 13 R % 13 and older R and older R2 400 Classic Essential You may have a co-payment if your specialist charges above these rates. Your cover for investigations All plans Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) We pay the first R2 300 of your hospital account from your day-to-day benefits. We pay the balance of the hospital account and your related accounts from your Hospital Benefit. A related account is the account from your treating healthcare professional or any approved expense you incur during your hospital admission, other than the hospital account. We pay the balance of the hospital account from your Hospital Benefit, up to of the. We pay the related accounts, which include the dental surgeon s account, from your Hospital Benefit, up to of the. On Classic Plans, we pay anaesthetists up to 200% of the. We cover routine, conservative dentistry, such as preventative treatments, simple fillings and root canal treatments from your available day-to-day benefits. No overall dental limit There is no overall limit for dental treatment. However, all dental appliances, their placement, and orthodontic treatment (including related accounts for orthognathic surgery) are paid at of the from your day-to-day benefits, up to an annual limit of R a person. If you join the medical scheme after January, you won t get the full limit because it is calculated by counting the remaining months in the year. MRI and CT scans If your MRI or CT scan is done as part of an approved admission, we pay it from your Hospital Benefit at of the. If you are admitted for conservative back or neck treatment, or if the scan is not related to your admission, we pay the first R2 450 of the scan code from your day-to-day benefits. We pay the balance of the scan code from your Hospital Benefit, up to of the. Specific rules and limits apply to conservative back and neck scans. On Classic Zero MSA, MRI and CT scans are covered once you reach your Annual Threshold.

10 Care Care looks after you when you are living with a chronic condition that needs ongoing management and care. Our skilled consultants help guide you to ensure you always receive the most appropriate level of care when your condition is registered on one of our care programmes. Your cover for chronic conditions You have the most extensive cover for a comprehensive list of chronic conditions. You have full cover for approved medicine on s medicine list. If you choose to use medicine that is not on our list, you have a set monthly amount available that is higher than that of our other plans. We pay medicine up to the. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit. MedXpress convenient medicine delivery When you use MedXpress, s convenient medicine delivery service, you pay no delivery or administration fees. s qualified service agents can also advise you on the most cost-effective alternatives and you will always be charged at the or less minimising co-payments. Call us on to make use of this free service. Savings on essential care items at Dis-Chem When you shop at Dis-Chem, ChroniCare brings you savings on a wide range of items appropriate to your needs, such as monitoring devices and diabetic footwear, that help manage your chronic condition. You can activate ChroniCare if you are registered on our Chronic Illness Benefit for one of the following chronic conditions: asthma, diabetes, high cholesterol or high blood pressure. Your cover for medical technology and expensive medicine You have cover for a defined list of the latest treatments through the Specialised Medicine and Technology Benefit, up to R for each person each year. Please call us to see whether your treatment qualifies. You also have access to the Overseas Treatment Benefit, which covers you when you travel to seek evidence-based healthcare treatment not available in South Africa. The treatment must be at a registered healthcare professional and is paid up to a limit of R for each person each year. You will need to pay and claim back from us when you return to South Africa. Specific rules and a co-payment of up to 20% applies to both benefits. Your cover for cancer treatment Our Oncology Programme covers the first R of approved cancer treatment over a 12-month cycle. Cover is unlimited once cancer treatment costs go over this amount, but you will need to pay 20% of the cost of all further treatment. All cancer-related healthcare services You might have to make a co-payment if your healthcare professional charges above this rate. Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. Please call us to register on the Oncology Programme. Earn up to 25% cash back by activating ChroniCare at

11 Your cover for day-to-day medical expenses We pay for day-to-day medical expenses like GP visits, radiology and pathology from your Medical Savings Account, as long as you have money available. If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay for your day-to-day medical expenses yourself. The Insured Network Benefit pays for certain day-to-day benefits before you reach the Annual Threshold. Once your claims add up to the Annual Threshold, we pay the rest of your claims from the Above Threshold Benefit, at the. The Insured Network Benefit reduces gaps in cover We extend your day-to-day cover through the Insured Network Benefit. When you have spent the annual funds in your Medical Savings Account and if you use a provider in our network, we cover: Your GP consultation fees* Day-to-day generic medicines (above schedule 3)** Blood tests** * Available on Classic, Classic Delta, Essential and Essential Delta ** Available on Classic and Classic Delta The Above Threshold Benefit offers extra day-to-day cover The Comprehensive Series has an unlimited Above Threshold Benefit. This gives you extra cover at the or at a percentage of it when your day-to-day claims add up to a set amount called the Annual Threshold. Unlimited cover on key day-to-day healthcare services We pay these healthcare services from your Medical Savings Account or Above Threshold Benefit, with no annual limit: GPs Pathology Radiology Basic dental check-ups Specialists MRI and CT scans: We pay the first R2 450 of your MRI or CT scan code from your day-to-day benefits. We cover the balance of the scan code from your Hospital Benefit, up to the (except for conservative back and neck scans, where specific rules and limits apply). On Classic Zero MSA, MRI and CT scans are covered once you reach your Annual Threshold. Limits on some day-to-day healthcare services Some of your day-to-day benefits have limits. These are not separate benefits. These limits apply to claims paid from your Medical Savings Account or Above Threshold Benefit. Classic Essential Professional services Allied, therapeutic and psychology healthcare services (acousticians, biokineticists, chiropractors, counsellors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists and audiologists)* Single member: With one dependant: With two dependants: With three or more dependants: R R R R Antenatal classes R for your family Dental appliances and orthodontic treatment* R for each person Medicine Prescribed medicine (over schedule 3)* Over-the-counter medicine (including prescribed medicine under schedule 3 and lifestyleenhancing products) Appliances and equipment Single member: With one dependant: With two dependants: With three or more dependants: R R R R We pay these claims from the available funds in your Medical Savings Account. R R R R R R R R External medical items For your family: R R Hearing aids For your family: R R Optical (includes cover for lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye, like excimer laser)* R3 250 for each person * If you join the medical scheme after January, you won t get the full limit because it is calculated by counting the remaining months in the year.

12 How we make your Medical Savings Account last longer We pay claims for these day-to-day expenses without using your Medical Savings Account: The Screening and Prevention Benefit covers certain tests at a Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate screening test) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine. We will cover out-of-hospital claims for recovery after certain traumatic events from the Trauma Recovery Extender Benefit. The cover applies to the rest of the year in which the trauma took place, and to the year after your trauma. (not available on Classic Zero MSA). We pay for scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) from your Hospital Benefit if it s done in your doctor s rooms. Save on self-medication at Clicks With MedSaver, you can earn up to 25% cash back on self-medication at any Clicks Pharmacy, whether you pay for it or claim for it. Activate MedSaver by going to Extending your cover for allied healthcare services 200% Classic Essential The Allied, Therapeutic and Psychology Extender Benefit gives you unlimited cover for a list of allied healthcare services, like physiotherapy. This unlimited cover is for a defined list of conditions, for example quadriplegia and cerebral palsy. The unlimited cover depends on your condition and the criteria for it. Please call us before you have a scope done in your doctor s rooms, to confirm your benefits. Contributions Total contributions (including Medical Savings Account amounts) Annual Medical Savings Account amounts** Annual Threshold amounts** All plans Main member Adult Child* Main member Adult Child* Main member Adult Child* Classic Comprehensive R3 086 R2 918 R616 R9 252 R8 748 R1 848 Classic Delta Comprehensive R2 780 R2 629 R553 R8 340 R7 884 R1 656 Classic Zero MSA R2 315 R2 189 R462 No Medical Savings Account R R R1 950 Essential Comprehensive R2 594 R2 451 R520 R4 668 R4 404 R936 Essential Delta Comprehensive R2 335 R2 207 R467 R4 200 R3 972 R840 * We count a maximum of three children when we work out the monthly contributions, annual Medical Savings Account and Annual Threshold. ** If you join the medical scheme after January, you won t get the full amount because it is calculated by counting the remaining months in the year. General exclusions: We do not cover certain healthcare services. You will find a full list of exclusions at This brochure is intended for intermediary use. It is only a summary of the key benefits and features of the Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. Full details can be found in the Medical Scheme Rules. It also summarises other products and value-added services. For compliance questions, compliance@discovery.co.za. Medical Scheme, registration number 1125, is administered by (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Vitality is not part of the Medical Scheme. Vitality is a separate product sold and administered by Vitality style (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider. GM_17535DHL_COMPREHENSIVE_27/09/12 HPBE 09/12(13)

13 Priority Series Classic Essential Cost-effective in-hospital and out-of-hospital cover Unlimited private hospital cover Essential cover for chronic medicine A high savings account to cover your day-to-day healthcare needs Efficient day-to-day limits and extended day-to-day cover Cover for medical emergencies when travelling in and outside South Africa We offer you the choice to be covered in full. Look out for the Full Cover Choice stamp in this brochure. It shows you when to use our range of online tools that guide you to full cover

14 Your cover in hospital We cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us. There is no overall limit. Unlimited hospital cover Emergency cover when you need it most 911 offers fast, life-saving emergency care. In an emergency, go straight to hospital. If you need medically-equipped transport, call This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport to you. It is important that you, a loved one or the hospital let us know about your admission as soon as possible. Cover for planned hospital admissions Please call us 48 hours before you go to hospital to confirm your admission. Upfront payments for in-hospital procedures You need to pay an amount upfront to the hospital when you are admitted for one of the following procedures: Unlimited healthcare services Most of your in-hospital healthcare services have no overall limit. These are: GPs Pathology Allied healthcare professionals, like physiotherapists Limited healthcare services Specialists Radiology HIV cover Only the following healthcare services have an annual limit in hospital: Cochlear implants, auditory brain implants and processors R for each person for each benefit Conservative back and neck treatment, myringotomy (grommets), tonsillectomy, adenoidectomy R1 950 Colonoscopy, sigmoidoscopy, proctoscopy, gastroscopy, cystoscopy R2 600 Arthroscopy, functional nasal procedures, hysterectomy (except for pre-operatively diagnosed cancer), laparoscopy, hysteroscopy, endometrial ablation R4 700 Internal nerve stimulators Hip, knee and shoulder joint prostheses Prosthetic devices used in spinal surgery Mental health R for each person There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R applies to each prosthesis. R for the first level, R for two or more levels, limited to one procedure for each person 21 days for each person Nissen fundoplication (reflux surgery), spinal surgery (back and neck), joint replacements R9 500 Alcohol and drug rehabilitation 21 days for each person If the procedure can be done out of hospital, for example in the doctor s rooms, you won t have to pay an amount upfront to the hospital. Please call us beforehand to confirm your benefits. To help make your admission to hospital convenient and seamless we offer an online tool that assists you to plan and authorise your hospital admission and confirms how you will be covered. Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital. Terminal care Chronic dialysis R for each person in their lifetime We cover these expenses in full if we have approved your treatment plan and you use a provider and facility in our network. If you choose not to, you have to make a co-payment.

15 Your cover for healthcare professionals Full cover for specialists who we have an agreement with You can benefit by using healthcare professionals who we have an agreement with because we will cover their approved procedures in full. These healthcare professionals are also the designated providers for Prescribed Minimum Benefits. If you are a Classic Plan member, you benefit from access to the broadest range of specialists who we pay in full, which represents over 90% of our members specialist interactions. Use our website to find a specialist who we cover in full. Your cover for dental treatment Severe dental and oral surgery The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. This benefit is subject to authorisation and the Scheme s specific clinical rules. Dental treatment in hospital You need to pay a portion of your hospital or day-clinic account upfront for dental admissions. Other healthcare professionals Radiology and pathology This amount varies, depending on your age and the place of treatment: Hospital Day-clinic 200% Classic Essential Your cover for MRI and CT scans All plans You may have a co-payment if your healthcare professional charges above these rates. If your MRI or CT scan is done as part of an approved hospital admission, we cover your scan up to of the from your Hospital Benefit. If the scan is not related to your admission, we pay the first R2 450 of the scan code from your day-to-day benefits. We pay the balance of the scan code from your Hospital Benefit, up to of the. If you are admitted for conservative back or neck treatment, you have to pay the first R1 950 of the hospital account, and we ll pay the first R2 450 of the scan code from your day-to-day benefits. We pay the balance of the scan code from your Hospital Benefit, up to of the. Specific rules and limits apply to conservative back and neck scans. Younger than 13 R1 450 Younger than 13 R and older R and older R2 400 We pay the balance of the hospital account from your Hospital Benefit, up to of the. We pay the related accounts, which includes the dental surgeon s account, from your Hospital Benefit, up to of the. On the Classic Plan, we pay anaesthetists up to 200% of the. We cover routine, conservative dentistry such as preventative treatments, simple fillings and root canal treatments from your day-to-day benefits. No overall dental limit There is no overall limit for dental treatment. However, all dental appliances, their placement, and orthodontic treatment (including related accounts for orthognathic surgery) are paid up to of the from your day-to-day benefits, up to an annual limit of R a person. If you join the medical scheme after January, you won t get the full limit because it is calculated by counting the remaining months in the year. The overall Above Threshold Benefit limit applies to this benefit.

16 Care Care looks after you when you are living with a chronic condition that needs ongoing management and care. Our skilled consultants help guide you to ensure you always receive the most appropriate level of care when your condition is registered on one of our care programmes. Your cover for chronic conditions You have cover for a list of chronic conditions. You have full cover for approved medicine on s medicine list or up to a set monthly amount for medicine not on our list. We pay medicine up to the. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit. MedXpress convenient medicine delivery When you use MedXpress, s convenient medicine delivery service, you pay no delivery or administration fees. s qualified service agents can also advise you on the most cost-effective alternatives and you will always be charged at the or less minimising co-payments. Call us on to make use of this free service. Your cover for cancer treatment Our Oncology Programme covers the first R of approved cancer treatment over a 12-month cycle. Cover is unlimited once your cancer treatment costs go over this amount, but you will need to pay 20% of the cost of all further treatment. All cancer-related healthcare services You may have a co-payment if your healthcare professional charges above this rate. Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. Please call us to register on the Oncology Programme. Savings on essential care items at Dis-Chem When you shop at Dis-Chem, ChroniCare brings you savings on a wide range of items appropriate to your needs, such as monitoring devices and diabetic footwear products, that help manage your chronic condition. You can activate ChroniCare if you are registered on our Chronic Illness Benefit for one of the following chronic conditions: asthma, diabetes, high cholesterol or high blood pressure. Earn up to 25% cash back by activating ChroniCare at

17 Your cover for day-to-day medical expenses We pay for day-to-day medical expenses like GP visits, radiology and pathology from your Medical Savings Account, as long as you have money available. If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay your day-to-day medical expenses yourself. The Insured Network Benefit pays for certain day-to-day benefits before you reach the Annual Threshold. Once your claims add up to the Annual Threshold, we pay the rest of your claims from the Above Threshold Benefit, at the. Your Above Threshold Benefit has an overall limit. The Insured Network Benefit reduces gaps in cover We extend your day-to-day cover through the Insured Network Benefit. When you have spent the annual funds in your Medical Savings Account, and if you use a provider in our network, we cover: Your GP consultation fees Blood tests (available on Classic) The Above Threshold Benefit offers extra day-to-day cover The Priority Series has a limited Above Threshold Benefit. This gives you extra cover at the or at a percentage of it when your day-to-day claims add up to a set amount called the Annual Threshold. Limits on some day-to-day healthcare services We pay all day-to-day benefits up to the Above Threshold Benefit limit or up to the limit that applies below, whichever you reach first. These limits apply to claims paid from your Medical Savings Account or your limited Above Threshold Benefit. Classic Essential Professional services Allied, therapeutic and psychology healthcare services (acousticians, biokineticists, chiropractors, counsellors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists and audiologists)* Single member: With one dependant: With two dependants: With three or more dependants: R R R R R4 400 R6 600 R8 250 R9 900 Limits on some day-to-day healthcare services Antenatal classes Dental appliances and orthodontic treatment* Medicine Prescribed medicine (over schedule 3)* Over-the-counter medicine (including prescribed medicine under schedule 3 and lifestyle-enhancing products) Appliances and equipment Single member: With one dependant: With two dependants: With three or more dependants: R1 100 for your family R for each person R R R R We pay these claims from the available funds in your Medical Savings Account R R R R External medical items For your family: R R Hearing aids For your family: R R Optical (includes cover for lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye, like excimer laser)* R for each person * If you join the medical scheme after January, you won t get the full limit because it is calculated by counting the remaining months in the year.

18 How we make your Medical Savings Account last longer We pay claims for these day-to-day expenses without using your Medical Savings Account: The Screening and Prevention Benefit covers certain tests at a Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate screening test) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine. We will cover out-of-hospital claims for recovery after certain traumatic events from the Trauma Recovery Extender Benefit. The cover applies to the rest of the year in which the trauma took place, and to the year after your trauma. We pay for scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) from your Hospital Benefit if it s done in your doctor s rooms. 200% Classic Essential Please call us before you have a scope done in your doctor s rooms, to confirm your benefits. Only the overall Above Threshold Benefit limit applies to these day-to-day healthcare services We pay these healthcare services from your Medical Savings Account or limited Above Threshold Benefit: GPs Specialists Pathology Radiology Basic dental check-ups Save on self-medication at Clicks MRI and CT scans: We pay the first R2 450 of your MRI or CT scan code from your day-to-day benefits. We cover the balance of the scan code from your Hospital Benefit, up to the. For conservative back and neck scans, specific rules and limits apply. With MedSaver, you can earn up to 25% cash back on self-medication at any Clicks Pharmacy, whether you pay for it or claim for it. Activate MedSaver by going to Contributions Total contributions (including Medical Savings Account amounts) Annual Medical Savings Account amounts** Annual Threshold amounts** Above Threshold Benefit limits** Main member Adult Child* Main member Adult Child* Main member Adult Child* Main member Adult Child* Classic R2 069 R1 629 R828 R6 204 R4 884 R2 484 Essential R1 778 R1 397 R710 R3 192 R2 508 R1 272 R9 170 R6 890 R3 000 R7 800 R5 550 R2 680 * We count a maximum of three children when we work out the monthly contribution, Annual Medical Savings Account, Annual Threshold and Above Threshold Benefit Limit. ** If you join the medical scheme after January, you wont get the full amount because it is calculated by counting the remaining months in the year. General exclusions: We do not cover certain healthcare services. You will find a full list of exclusions at This brochure is intended for intermediary use. It is only a summary of the key benefits and features of the Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. Full details can be found in the Medical Scheme Rules. It also summarises other products and value-added services. For compliance questions, compliance@discovery.co.za. Medical Scheme, registration number 1125, is administered by (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Vitality is not part of the Medical Scheme. Vitality is a separate product sold and administered by Vitality style (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider. GM_17535DHM_COMPRIORITY_REPRINT_27/09/2012 HPBE 09/12(13)

19 Saver Series Classic Classic Delta Essential Essential Delta Coastal The most cost-effective in-hospital and out-of-hospital cover Unlimited private hospital cover Essential cover for chronic medicine A Medical Savings Account to cover your day-to-day healthcare needs Cover for medical emergencies when travelling in and outside South Africa We offer you the choice to be covered in full. Look out for the Full Cover Choice stamp in this brochure. It shows you when to use our range of online tools that help guide you to full cover

20 Your cover in hospital We cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us. There is no overall hospital limit. Unlimited hospital cover Emergency cover when you need it most 911 offers fast, life-saving emergency care. In an emergency, go straight to hospital. If you need medically-equipped transport, call This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport to you. It is important that you, a loved one or the hospital let us know about your admission as soon as possible. Unlimited healthcare services Most of your in-hospital healthcare services have no overall limit. These are: GPs Pathology Allied healthcare professionals, like physiotherapists Specialists Radiology HIV cover Cover for planned hospital admissions We cover you in a private hospital for approved admissions. You have no overall limit on your hospital cover. Please call us 48 hours before you go to hospital to confirm your admission. Use a network hospital on Delta and Coastal Delta On Classic Delta and Essential Delta, you are covered in full at hospitals in the Delta Hospital Network. For planned admissions at any other private hospital, you must pay an amount of R5 000 upfront to the hospital. Coastal On the Coastal Plan, you must go to a hospital in one of the four coastal provinces for a planned hospital admission. If you don t use a coastal hospital, we pay a maximum of 70% of the hospital account and you have to pay the difference. To help make your admission to hospital convenient and seamless we offer an online tool that assists you to plan and authorise your hospital admission and confirms how you will be covered. Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital. Limited healthcare services Only the following healthcare services have an annual limit in hospital: Cochlear implants, auditory brain implants and processors Internal nerve stimulators Hip, knee and shoulder joint prostheses Prosthetic devices used in spinal surgery Mental health Alcohol and drug rehabilitation Terminal care R for each person for each benefit R for each person There is no overall limit if you get your prosthesis from a preferred supplier. If you choose not to, a limit of R applies to each prosthesis. R for the first level, R for two or more levels, limited to one procedure for each person 21 days for each person 21 days for each person R for each person in their lifetime Chronic dialysis We cover these expenses in full if we have approved your treatment plan and you use a provider in our network. If you choose not to, you have to make a co-payment.

21 Your cover for healthcare professionals Full cover for specialists who we have an agreement with You can benefit by using healthcare professionals who we have an agreement with because we will cover their approved procedures in full. These healthcare professionals are also the designated providers for Prescribed Minimum Benefits. If you are a Classic member, you benefit from access to the broadest range of specialists who we pay in full, which represents over 90% of our members specialist interactions. Use our website and smartphone tools to find a specialist who we cover in full. Specialists and healthcare professionals 200% Classic Essential and Coastal Radiology and pathology All plans You may have a co-payment if your healthcare professional charges above these rates. Your cover for investigations Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) We pay the first R2 850 of your hospital account from your Medical Savings Account. We pay the balance of the hospital account and your related accounts from your Hospital Benefit. A related account is the account from your admitting doctor, anaesthetist or any approved expense you incur during your hospital admission, other than the hospital account. Your cover for dental treatment Severe dental and oral surgery The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payments and no overall limit. This benefit is subject to authorisation and the Scheme s clinical rules. Dental treatment in hospital You need to pay a portion of your hospital or day-clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment: Hospital Younger than 13 R1 450 Day-clinic Younger than 13 R and older R and older R2 400 We pay the balance of the hospital account from your Hospital Benefit, up to of the. We pay the related accounts, which include the dental surgeon s account, from the Hospital Benefit, up to of the. On Classic Plans, we pay anaesthetists up to 200% of the. We cover routine, conservative dentistry, such as preventative treatments, simple fillings and root canal treatments from your available day-to-day benefits. No overall dental limit There is no overall limit for dental treatment. We pay for all dental appliances, their placement and orthodontic treatment (including related accounts for orthognathic surgery) at of the from your Medical Savings Account, as long as you have money available. MRI and CT scans If your MRI or CT Scan is done as part of an approved admission, we pay up to of the from your Hospital Benefit. If you are admitted for conservative back or neck scans, or if the scan is unrelated to your admission, we pay the first R2 450 of the scan code from your Medical Savings Account. We pay the balance of the scan code from your Hospital Benefit, up to of the. Specific rules and limits apply to conservative back and neck scans.

22 Care Care looks after you when you are living with a chronic condition that needs ongoing management and care. Our skilled consultants help guide you to ensure you always receive the most appropriate level of care when you register for one of our care programmes. Your cover for chronic conditions You have cover for a list of chronic conditions. You have full cover for approved medicine on s medicine list or up to a set monthly amount for medicine not on our list. We pay medicine up to the. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit. Delta You have cover for your approved chronic medicine, with no additional co-payment, if you use a Delta network pharmacy. If you don t use a Delta network pharmacy, a 20% co-payment applies. MedXpress convenient medicine delivery When you use MedXpress, s convenient medicine delivery service, you pay no delivery or administration fees. s service agents can also advise you on the most cost-effective alternatives and you will always be charged at the or less minimising co-payments. Call us on to make use of this free service. Your cover for cancer treatment Our Oncology Programme covers the first R of approved cancer treatment over a 12-month cycle. Cover is unlimited once your cancer treatment costs go over this amount, but you will need to pay 20% of the cost of all further treatment. All cancer-related healthcare services You might have to make a co-payment if your healthcare professional charges above this rate. Cancer treatment that is a Prescribed Minimum Benefit is always covered in full, with no co-payment. Please call us to register on the Oncology Programme. Savings on essential care items at Dis-Chem When you shop at Dis-Chem, ChroniCare brings you savings on a wide range of items appropriate to your needs, such as monitoring devices and diabetic footwear, that help manage your chronic condition. You can activate ChroniCare if you are registered on our Chronic Illness Benefit for one of the following chronic conditions: asthma, diabetes, high cholesterol or high blood pressure. Earn up to 25% cash back by activating ChroniCare at

23 Your cover for day-to-day medical expenses We pay day-to-day medical expenses like GP visits, radiology and pathology from your Medical Savings Account, as long as you have money available. If you run out of money in your Medical Savings Account, you need to pay for your day-to-day expenses yourself. The Insured Network Benefit reduces gaps in cover We extend your day-to-day cover through the Insured Network Benefit by paying GP consultation fees when you have spent your Medical Savings Account given to you for the year. We cover your consultations if you go to a GP in our network. The maximum number of consultations that we cover for a single member and a family each year depends on your plan type: care services paid from your Medical Savings Account We pay for these day-to-day healthcare services from your available Medical Savings Account: GPs Specialists Allied healthcare professionals, like physiotherapists Radiology Pathology Plan Single member Family Classic and Coastal Plans 3 consultations 6 consultations Essential Plan 2 consultations 4 consultations Dentistry Private nursing Prescribed and over-the-counter medicine External medical items Hearing aids Optical care MRI and CT scans: We pay the first R2 450 of your MRI or CT scan code from your Medical Savings Account. We cover the balance of the scan code from your Hospital Benefit up to the. For conservative back and neck scans, specific rules and limits may apply.

24 How we make your Medical Savings Account last longer We pay these day-to-day expenses without using your Medical Savings Account: The Screening and Prevention Benefit covers certain tests at a Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (prostate screening) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine. We cover out-of-hospital claims for recovery after certain traumatic events from the Trauma Recovery Extender Benefit. The cover applies to the rest of the year in which the trauma took place, and to the year after your trauma. Save on self-medication at Clicks With MedSaver, you can earn up to 25% cash back on self-medication at any Clicks Pharmacy, whether you pay for it or claim for it. Activate MedSaver by going to We pay for scopes (gastroscopies, colonoscopies, sigmoidoscopies, and proctoscopies) from your Hospital Benefit if it s done in your doctor s rooms. 200% Classic Essential and Coastal Please call us before having a scope done in your doctor s rooms, to confirm your benefits. Contributions Total contributions (including Medical Savings Account amounts) Annual Medical Savings Account amounts** Main member Adult Child* Main member Adult Child* Classic R1 814 R1 428 R725 R5 436 R4 284 R2 172 Classic Delta R1 449 R1 141 R581 R4 344 R3 420 R1 740 Essential R1 442 R1 078 R576 R2 592 R1 932 R1 032 Essential Delta R1 152 R 864 R460 R2 064 R1 548 R 828 Coastal R1 428 R1 070 R574 R4 284 R3 204 R1 716 * We count a maximum of three children when we work out the monthly contributions and annual Medical Savings Account. ** If you join the medical scheme after January, you won t get the full amount because it is calculated by counting the remaining months in the year. General exclusions: We do not cover certain healthcare services. You will find a full list of exclusions at This brochure is intended for intermediary use. It is only a summary of the key benefits and features of the Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. Full details can be found in the Medical Scheme Rules. It also summarises other products and value-added services. For compliance questions, compliance@discovery.co.za. Medical Scheme, registration number 1125, is administered by (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Vitality is not part of the Medical Scheme. Vitality is a separate product sold and administered by Vitality style (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider. GM_17535DHL_SAVER_27/09/2012 HPBE 9/12 (13)

25 Core Series Classic Classic Delta Essential Essential Delta Coastal Cost-effective in-hospital cover Unlimited private hospital cover Essential cover for chronic medicine Cover for medical emergencies when travelling in and outside South Africa We offer you the choice to be covered in full. Look out for the Full Cover Choice stamp in this brochure. It shows you when to use our range of online tools that guide you to full cover

26 Your cover in hospital We cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us. There is no overall hospital limit. Unlimited hospital cover Emergency cover when you need it most 911 offers fast, life-saving emergency care. In an emergency, go straight to hospital. If you need medically-equipped transport, call This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport to you. It is important that you, a loved one or the hospital let us know about your admission as soon as possible. Cover for planned hospital admissions Please call us 48 hours before you go to hospital to confirm your admission. Use a network hospital on Delta and Coastal Delta On Classic Delta and Essential Delta, you are covered in full at hospitals in the Delta Hospital Network. For planned admissions at any other private hospital, you must pay an amount of R5 000 upfront to the hospital. Coastal On the Coastal Plan, you must go to a hospital in one of the four coastal provinces for a planned hospital admission. If you don t use a coastal hospital, we pay up to a maximum of 70% of the hospital account and you have to pay the difference. To help make your admission to hospital convenient and seamless we offer an online tool that assists you to plan and authorise your hospital admission and confirms how you will be covered. Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital. Your cover for healthcare professionals Full cover for specialists who we have an agreement with You can benefit by using healthcare professionals who we have an agreement with because we will cover their approved procedures in full. These healthcare professionals are also the designated providers for Prescribed Minimum Benefits. If you are a Classic member, you benefit from access to the broadest range of specialists who we pay in full, which represents over 90% of our members specialist interactions. Specialists and healthcare professionals Radiology and pathology 200% Classic Use our website to find a specialist who we cover in full. Essential and Coastal All plans You may have a co-payment if your healthcare professional charges above these rates.

27 Your cover for investigations Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) You pay the first R2 850 of your hospital account. We pay the balance of the hospital account and your related accounts from your Hospital Benefit. A related account is the account from your admitting doctor, anaesthetist or any approved expense you incur during your hospital admission, other than the hospital account. MRI and CT scans If your MRI or CT scan is done as part of an approved admission, we pay for it from your Hospital Benefit at of the. If you are admitted for a conservative back or neck scan or if the scan is unrelated to your admission, we do not pay for it. Your cover for dental treatment Severe dental and oral surgery The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. This benefit is subject to authorisation and the Scheme s clinical rules. Dental treatment in hospital You need to pay a portion of your hospital or day-clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment. Hospital Day-clinic Unlimited healthcare services Most of your in-hospital healthcare services have no overall limit. These are: GPs Pathology Allied healthcare professionals, like physiotherapists Limited healthcare services Specialists Radiology HIV cover Only the following healthcare services have an annual limit in hospital: Cochlear implants, auditory brain implants and processors Internal nerve stimulators Hip, knee and shoulder joint prostheses Prosthetic devices used in spinal surgery R for each person for each benefit R for each person There is no overall limit if you get your prosthesis from a preferred supplier. If you choose not to, a limit of R applies to each prosthesis. R for the first level, R for two or more levels, limited to one procedure for each person a year Younger than 13 R1 450 Younger than 13 R700 Mental health 21 days for each person 13 and older R and older R2 400 We pay the balance of the hospital account and related accounts, which includes the dental surgeon s account, from the Hospital Benefit, up to of the. On Classic Plans, we pay anaesthetists up to 200% of the. You need to pay for routine, conservative dentistry such as preventative treatments, simple fillings and route canal treatments. Dental appliances and orthodontic treatment You are responsible for paying the cost of all dental appliances, their placement and orthodontic treatment (including the related accounts for orthognathic surgery). Alcohol and drug rehabilitation Terminal care Chronic dialysis 21 days for each person R for each person in their lifetime We cover these expenses in full if we have approved your treatment plan and you use a provider and facility in our network. If you choose not to, you have to make a co-payment.

28 Care Care looks after you when you are living with a chronic condition that needs ongoing management and care. Our skilled consultants help guide you to ensure you always receive the most appropriate level of care when you register for one of our care programmes. Your cover for chronic conditions You have cover for a list of chronic conditions. You have full cover for approved medicine on s medicine list or up to a set monthly amount for medicine not on our list. We pay medicine up to the. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit. Delta You have cover for approved chronic medicine, with no additional co-payment, if you use a Delta network pharmacy. If you don t use a Delta network pharmacy, a 20% co-payment applies. MedXpress convenient medicine delivery When you use MedXpress, s convenient medicine delivery service, you pay no delivery or administration fees. s qualified service agents can also advise you on the most cost-effective alternatives and you will always be charged at the or less minimising co-payments. Call us on to make use of this free service. Savings on essential care items at Dis-Chem When you shop at Dis-Chem, ChroniCare brings you savings on a wide range of items appropriate to your needs, such as monitoring devices and diabetic footwear, that help manage your chronic condition. You can activate ChroniCare if you are registered on our Chronic Illness Benefit for one of the following chronic conditions: asthma, diabetes, high cholesterol or high blood pressure. Earn up to 25% cash back by activating ChroniCare at Your cover for cancer treatment Our Oncology Programme covers the first R of approved cancer treatment over a 12-month cycle. Cover is unlimited once cancer treatment costs go over this amount, but you will need to pay 20% of the cost of all further treatment. All cancer-related healthcare services You might have to make a co-payment if your healthcare professional charges above this rate. Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. Please call us to register on the Oncology Programme.

29 Your cover for day-to-day medical expenses You have access to the following day-to-day benefits The Screening and Prevention Benefit covers certain tests at a Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate screening) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine. We pay for scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies) from your Hospital Benefit if they are done in your doctor s rooms. Save on self-medication at Clicks With MedSaver, you can earn up to 25% cash back on self-medication at any Clicks Pharmacy, whether you pay for it or claim for it. Activate MedSaver by going to 200% Classic Essential and Coastal Please call us before having a scope done in your doctor s rooms, to confirm your benefits. Contributions Total contributions Main member Adult Child* Classic R1 350 R1 062 R0 539 Classic Delta R1 081 R0 849 R0 432 Essential R1 160 R0 869 R0 464 Essential Delta R1 927 R0 695 R0 372 Coastal R1 998 R0 748 R0 398 * We count a maximum of three children when we work out the monthly contribution. General exclusions: We do not cover certain healthcare services. You will find a full list of exclusions at

30 155 West Street Sandton This brochure is intended for intermediary use. It is only a summary of the key benefits and features of the Medical Scheme Plans, awaiting formal approval from the Council for Medical Schemes. Full details can be found in the Medical Scheme Rules. It also summarises other products and value-added services. For compliance questions, compliance@discovery.co.za. Medical Scheme, registration number 1125, is administered by (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Vitality is not part of the Medical Scheme. Vitality is a separate product sold and administered by Vitality style (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider. GM_17535DHL_CORE_27z/09/12 HPBE 09/12(13)

31 KeyCare Series Plus Access Core The KeyCare Plans offer you affordable cover at KeyCare s networks of hospitals and doctors Unlimited emergency and trauma cover in our KeyCare network of hospitals and planned hospital cover on KeyCare Core and KeyCare Plus An ambulance or helicopter sent to you in a critical emergency Cover in our network for essential antenatal care when you are pregnant Cover in our network when you need to see a specialist Unlimited cover for GP consultations when you are sick or need blood tests, x-rays or medicine in our network on the KeyCare Plus and KeyCare Access Plans We offer you the choice to be covered in full in our networks. Look out for the Full Cover Choice stamp in this brochure. It shows you when to use the range of online tools that guide you to full cover

32 The KeyCare Series Your cover KeyCare Plus KeyCare Access KeyCare Core Approved hospital admissions for: Emergencies Trauma Childbirth Cover for your baby up to 12 months after childbirth Unlimited cover in the KeyCare Hospital Network Unlimited cover in the KeyCare Access Hospital Network Unlimited cover in the KeyCare Hospital Network Other approved hospital admissions Unlimited cover in the KeyCare Hospital Network Unlimited cover in our contracted network of state facilities Unlimited cover in the KeyCare Hospital Network Chronic medicine You have cover for a list of chronic conditions and medicine on the KeyCare medicine list Primary care cover through your chosen GP and day-to-day medicine from our medicine list Day-to-day medical expenses Private specialist cover up to a limit Private specialist cover up to a limit for emergencies, trauma, childbirth and cover for your baby up to 12 months after childbirth This plan does not offer day-to-day medical cover Screening and prevention and antenatal services Access to certain screening tests to check your health and a list of healthcare services when you are pregnant Your cover in hospital The KeyCare Core and KeyCare Plus Plans cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us in the KeyCare network of hospitals. KeyCare Access covers you in any private hospital for emergencies, trauma, childbirth and care for your baby up to 12-months after childbirth, and in our contracted network of state facilities for all other hospital care. The cover you need, when you need it Emergency cover when you need it most In an emergency, go straight to hospital. If you need an ambulance or helicopter, call We will send the help you need. It is important that you, a loved one or the hospital let us know of your admission as soon as possible. No overall hospital limit on any of our KeyCare Plans There is no overall hospital limit. This means that even if you have to stay in hospital for a long time, or if your treatment is very expensive, your cover won t run out. Some healthcare services and procedures have a limit or we may have rules on how we pay for them. Unlimited healthcare services On the KeyCare Core and KeyCare Plus plans, most in-hospital healthcare services have no overall limit. These are: GPs Specialists Pathology Radiology Allied healthcare professionals, like physiotherapists HIV cover On the KeyCare Access Plan, healthcare services for approved admissions for emergencies, trauma, childbirth and care for your baby up to 12 months after childbirth are covered in our network of private hospitals with no overall limit. We pay approved admissions for all other hospital care in our contracted network of state facilities.

33 The cover you need, when you need it (continued from previous page) Cover for planned hospital admissions (KeyCare Core and KeyCare Plus) You have cover in a private hospital in the KeyCare Hospital Network. Call us at least two days before you go to hospital. You will not have cover if you do not call us. We cover these procedures in our day surgery network only: Adenoidectomy Arthrocentesis (joint injection) Cautery of vulva warts Circumcision Colonoscopy Cystourethroscopy Diagnostic D&C Gastroscopy Hysteroscopy Myringotomy Myringotomy with intubation (grommets) Prostate biopsy Proctoscopy Removal of pins and plates Sigmoidoscopy Simple abdominal hernia repair Simple nasal procedure for nose bleeding (that is, nasal plugging and nasal cautery) Tonsillectomy Treatment of Bartholin s cyst/abscess Vasectomy Vulva/cone biopsy Limited healthcare services in hospital These services have a limit in hospital: Mental health Alcohol and drug rehabilitation Cataract surgery Chronic dialysis KeyCare Core and KeyCare Plus 21 days for each person 21 days for each person We cover cataract surgery as long as we have approved your treatment at a doctor and facility in our network for cataract surgery We cover these expenses in full as long as we have approved your treatment at a doctor and facility in our network KeyCare Access 21 days for each person covered in our contracted network of state facilities 21 days for each person covered in our contracted network of state facilities Covered in our contracted network of state facilities We cover these expenses in full as long as we have approved your treatment at a doctor and facility in the KeyCare Access Network Essential care in a network of private hospitals on KeyCare Access The KeyCare Access Plan covers you in our network of private hospitals for emergencies, trauma, childbirth and care for your baby up to 12 months after childbirth. We pay for approved admissions for other hospital care in our contracted network of state facilities. A trauma is a serious injury from violence or an accident. We cover the following traumas in our network of private hospitals: Injuries at work Burns Injuries from a crime Sexual assault Injuries from a car accident Injuries from a fall The loss of an arm, hand, leg or foot Near drowning Your cover for MRI and CT scans Head injuries Poisoning or a serious allergic reaction that may cause death Care for your baby after childbirth This benefit covers babies that are registered on the medical scheme from their date of birth when born to a parent registered on the medical scheme. It covers approved hospital admissions in our network of private hospitals for the baby for 12 months from the baby s date of birth. Babies not added to the medical scheme from their date of birth will be covered in our contracted network of state facilities. MRI and CT scans are like x-rays, but show much more detail. They are used when an x-ray doesn t show enough. If your scan is related to an approved hospital stay in our network of private hospitals, we pay for it from your Hospital Benefit. If it is not, we pay for it from your Specialist Benefit, up to R2 550 for each person. We do not pay for MRI or CT scans that are related to conservative back or neck treatment (this is treatment for your back or neck that is not surgery). Terminal care R for each person in their lifetime Your cover for healthcare professionals Full cover for specialists who we have an agreement with We will cover approved treatment at healthcare professionals who we have an agreement with in full. These healthcare professionals are also the designated providers for Prescribed Minimum Benefits. Other specialists and healthcare professionals If you are treated by a specialist who we don t have an agreement with and other healthcare professionals, we pay up to: If the healthcare professional charges more than the, you must pay the rest. Your cover for healthcare professionals on KeyCare Access On KeyCare Access, for approved admissions in our network of private hospitals, your cover for healthcare professionals is the same as for KeyCare Core and KeyCare Plus. For all other healthcare services, we cover specialists employed in our contracted network of state facilities.

34 Your cover for day-to-day medical expenses (KeyCare Plus and KeyCare Access) Cover for GP visits When joining, you must choose a GP from the KeyCare GP network. You must go to your chosen GP for us to cover your consultations and some minor procedures. Basic x-rays We pay for a list of basic x-rays at a network provider. Your chosen GP must ask for the x-rays to be done. Casualty visits On KeyCare Plus you can go to any casualty unit at one of the KeyCare network hospitals. You have to pay the first R205 of the consultation. On KeyCare Access, other than for emergencies and trauma, each person can go to casualty at one of the KeyCare network hospitals once a year. You have to pay the first R205 of the consultation. You don t need to call us if you go to casualty. Blood, urine and other fluid and tissue tests We pay for a list of blood, urine and other fluid and tissue tests. Your chosen GP must ask for these tests by filling in a KeyCare pathology form. Day-to-day medicine We pay for medicines from our medicine list if they are prescribed by your chosen KeyCare network GP. You get one out-of-network GP visit If you need to see a doctor and your chosen GP from our network is not available for you to see, each person on your membership can go to any other GP once a year. We will cover the GP visit, with selected blood tests and x-rays and medicines on our medicine list. Cover for dentistry We cover consultations, fillings and tooth removals at a dentist in our dentist network. Trauma Recovery Extender Benefit We will cover specific out-of-hospital claims for your recovery after certain traumatic events. We ll cover you for the rest of the year in which the trauma took place, and in the year after your trauma. How we cover medical equipment We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 200 for each family. Cover for other types of healthcare professionals We do not cover other types of healthcare professionals, such as physiotherapists, psychologists, speech therapists, audiologists, homeopaths or chiropractors. Cover for eye care We cover one eye test for each person, but you must go to an eye doctor in our network. The eye doctor will have a specific range of glasses that you can choose from. You can get a set of contact lenses instead of glasses if you choose to. You can get new glasses or contact lenses every 24 months. GM_17535DHL_KEYCARE_27/09/12 HPBE 09/12(13)

35 Care Your cover for chronic conditions You have cover for a list of chronic conditions if your medicine is on the KeyCare medicine list. You must get your approved medicine from one of our network pharmacies or from your chosen GP. If you get your medicine anywhere else, you have to pay a 20% co-payment. We need to approve your chronic condition before we can pay for it from the Chronic Illness Benefit. On the KeyCare Plus and KeyCare Access Plans, your chosen GP must prescribe the chronic medicine. MedXpress convenient medicine delivery When you use MedXpress, s convenient medicine delivery service, you pay no delivery or administration fees. s service agents can also advise you on the most cost-effective alternatives and you will always be charged at the or less minimising co-payments. Call us on to make use of this free service. Your cover for cancer treatment On KeyCare Core and KeyCare Plus we cover cancer treatment if it is a Prescribed Minimum Benefit and if you go to a cancer specialist in our network. On KeyCare Access, we cover cancer treatment, if it is a Prescribed Minimum Benefit in a state facility. Please call us to register on the Oncology Programme. Savings on essential care items at Dis-Chem When you shop at Dis-Chem, ChroniCare brings you savings on a wide range of items appropriate to your needs, such as monitoring devices and diabetic footwear, that help manage your chronic condition. You can activate ChroniCare if you are registered on our Chronic Illness Benefit for one of the following chronic conditions: asthma, diabetes, high cholesterol or high blood pressure. Earn up to 25% cash back by activating ChroniCare at Your cover for additional benefits Specialist Benefit Each person is covered up to R Your GP must get a reference number before your consultation with the specialist. If you need to see a tooth specialist or a specialist for maternity care, you do not need a referral from your GP or a reference number from us. The KeyCare Access Plan covers specialist visits in our network for maternity, care for your baby up to 12 months after it is born, trauma and emergencies up to the limit. For all other healthcare services we cover specialists employed by a state facility. Antenatal Benefit If you are pregnant, the Antenatal Benefit covers you at of the for the following healthcare services: Four visits to a GP or gynaecologist at a network hospital One routine scan (between 10 and 20 weeks) Selected blood tests requested by your gynaecologist or GP Screening and Prevention Benefit If you go for certain tests to check your health, we will cover them. These screening tests include blood glucose, blood pressure, cholesterol and body mass index at a Wellness Network provider. We also cover a mammogram, Pap smear, PSA (a prostate screening) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal injection to prevent flu.

36 Save on self-medication at Clicks Exclusions on the KeyCare Plans With MedSaver, you can earn up to 25% cash back on self-medication at any Clicks Pharmacy, whether you pay for it or claim for it. Activate MedSaver by going to We do not cover certain healthcare services. You can find a full list of exclusions at In addition to the general exclusions that apply to all plans, KeyCare Plans do not cover the following, except if the Prescribed Minimum Benefits say they must: 1. Hospital admissions related to: Dentistry Skin disorders Nail disorders Investigations and diagnostic work-up Functional nasal surgery Elective caesarean section, except if medically necessary Surgery for oesophageal reflux and hiatus hernia Back and neck treatment or surgery Joint replacements, including but not limited to hips, knees, shoulders and elbows Cochlear implants, auditory brain implants and internal nerve stimulators this includes procedures, devices and processors care services that should be done out of hospital and for which an admission to hospital is not necessary 2. Bunionectomy 3. Arthroscopy 4. Removal of varicose veins 5. Brachytherapy for prostate cancer 6. Refractive eye surgery 7. Non-cancerous breast conditions 8. care services outside South Africa We also do not cover the cost of treatment for any complications or the direct or indirect expenses related to any of these excluded conditions and treatments. Contributions Main member Adult Child* KeyCare Plus (8 301+) R1 330 R1 330 R 356 KeyCare Plus ( ) R 893 R 893 R 250 KeyCare Plus ( ) R 638 R 638 R 230 KeyCare Access (8 301+) R1 300 R1 300 R 350 KeyCare Access ( ) R 865 R 865 R 245 KeyCare Access ( ) R 600 R 600 R 215 KeyCare Access ( ) R 450 R 450 R 195 KeyCare Core (8 301+) R 982 R 982 R 222 KeyCare Core ( ) R 636 R 636 R 158 KeyCare Core ( ) R 511 R 511 R 129 * We count a maximum of three children when we work out the monthly contributions. General exclusions: We do not cover certain healthcare services. You will find a full list of exclusions at This brochure is intended for intermediary use. It is only a summary of the key benefits and features of the Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. Full details can be found in the Medical Scheme Rules. It also summarises other products and value-added services. For compliance questions, compliance@discovery.co.za. Medical Scheme, registration number 1125, is administered by (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. Vitality is not part of the Medical Scheme. Vitality is a separate product sold and administered by Vitality style (Pty) Ltd, registration number 1999/007736/07, an authorised financial services provider.