Medical Aid and MTB

[RuanJvR89]

Hi there,

 

I'm on Discovery Keycare Plus. It is the lowest plan they have. I don't really need anything more. I need to know if the medical aid will pay for injuries that occurs while I'm mountain biking or should I get additional cover?

 

I'm new to this.

 

Thanks

[madbradd]

I'm on Classic Core which is the hospital plan. They won't cover you for anything unless admitted to hospital by the Doc. So check up on your plan details... should help you out.

[worriesnot]

I'm on Classic Core which is the hospital plan. They won't cover you for anything unless admitted to hospital by the Doc. So check up on your plan details... should help you out.

 

+1 the admission to hospital bit.

I'm on Classic Comprehensive and they covered everything (ICU, hospital, Neuro etc...) including helicopter ride to Milpark after I fell off a bike.

[Captain Fastbastard Mayhem]

Hi there,

 

I'm on Discovery Keycare Plus. It is the lowest plan they have. I don't really need anything more. I need to know if the medical aid will pay for injuries that occurs while I'm mountain biking or should I get additional cover?

 

I'm new to this.

 

Thanks

 

Yes they will. Depending on the severity of the injury, they will either take you to the nearest network hospital or admit you and work on you until you are stable, then take you to a network hospital. If it's just a broken arm or something, you will need to go to the casualty department of one of the network hospitals or day clinics to have X Rays done and the injury assessed.

 

The referral process on the Keycare plans is only if you need to see a specialist for a planned procedure, and doesn't apply in cases of emergency.

 

More to this, but it can only really be discussed with a broker - give yours a call and he will be able to help you... Has to do with earnings and so on, as well as determining whether the Keycare option is right for you. Unfortunately if it's not, you can't upgrade except at the end of the year so it's either wait it out or go to another provider to find a plan that works for you.

Edited January 22, 2014 by cpt armpies mayhem

[TheKaiser]

A buddy of mine took a spill over the weekend, and was sorted out in casualty (wasn't admitted or anything). Did X-rays and all kinds of scans, and ended up having to clear his MSA.... The rest of the costs (substantial) he has to carry on his own.

 

Fine print is a bugger, know what you are covered for to avoid (or lessen) the shock and disappointment.

[kandui]

Check out www.sweatsafe.co.za as a top-up option.

[Captain Fastbastard Mayhem]

A buddy of mine took a spill over the weekend, and was sorted out in casualty (wasn't admitted or anything). Did X-rays and all kinds of scans, and ended up having to clear his MSA.... The rest of the costs (substantial) he has to carry on his own.

 

Fine print is a bugger, know what you are covered for to avoid (or lessen) the shock and disappointment.

 

Keycare Plus has no MSA. It has its own rules and regs, which are entirely different to any other of Discovery's med aids...

[Ratty]

Just make sure you fall bad enough to get admitted to hospital.

 

I took a spill end of November and its been expensive. My only serious injury was my thumb.

 

+- R700 for visit to casualty

+- R500 X-Rays

+- R400 Splint for Thumb

+- R670 OT - Custom Splint for Thumb (first one too big once swelling went down)

+- R1100 Physio Visits so far

 

Total so far R3370 and I still can't ride my bike :-( This was without going to see a specialist, they are +- R500 per visit minimum.

Edited January 22, 2014 by Ratty

[fanievb]

I have additional (limited) cover through my short term insurance, but only if it happens during an event.

[Ratty]

Hi there,

 

I'm on Discovery Keycare Plus. It is the lowest plan they have. I don't really need anything more. I need to know if the medical aid will pay for injuries that occurs while I'm mountain biking or should I get additional cover?

 

I'm new to this.

 

Thanks

 

Have a look here. It shows what is covered and what isn't. Keycare Plus is actually not their lowest plan, the Keycare core is the lowest. Interestingly, I pay less for my Coastal saver than I would on KeyCare plus.

https://www.discovery.co.za/portal/individual/tools-compare-health-plans

 

One thing you need to watch out for is where they say they pay 100% of the Discovery Rate. Some specialists charge 300%.

[stringbean]

Biggest misconception is that a thing called medical aid rate exists.

 

[Uni]

I wish medical aids would allow you to select things to be covered for. For example why do men and women have the same options when a man (and some women) will never make use of any pregnancy benefits (other halfs excluded) - I should be able to exclude that and add something else.

 

My classic saver pays for casualty from medical savings i.e. my own money - so if i get injured and land up in casualty i need to roll out of bed and fall badly and hit my head to get admitted - then they'll pay. Madness.

[ibruegge]

Medical aid in this country is a pain in the rear (basically a savings account...) - until hit it badly and spend weeks in hospital.

Am on a cheap Discovery plan - and I am still not sure where we would have been R400K hospital bills later..

[Captain Fastbastard Mayhem]

Biggest misconception is that a thing called medical aid rate exists.

 

LOL. It's a misconception that is useful, in that there used to be one, and docs still mostly base their fees on the old "med aid rate"

 

The council, together with professionals, are still trying to hash out the ideal base rates for induvidual procedures, appliances, items and so on. Until that has happened, the term shall remain.

 

All med aids have their own payment rate for services. Though they are different, they are mostly around the same net rand amount. Again, loosely based on the old NHRPL price list (the list used to determine Med Aid Rates)

 

When the NHRPL list was rendered unconstitutional, there was nothing to base payments on. SO they used it as a guideline, as many specialists still do. They then determine their payment rates as a factor of that NHRPL rate.

 

The 100% / 200% / 300% is expressed as a factor of each company's med aid payment rate (the Discovery Health Rate or DHR for one)

 

But yeah - it doesn't "exist" per se, but it is still used as a term to make it easier to understand.

[Cruz Addict]

i am on a classic saver, hit a tree square in the hip about 6 or so months ago at 50 odd km and hour, was completely trashed, went to sandton mediclinnic and was seen in the casualty, everything came out of my MSA till there was nothing left and then the bills started coming, total for the visit was R7300 and some change. MSA covered about half of that. i had to pay the rest.

[stringbean]

 

 

LOL. It's a misconception that is useful, in that there used to be one, and docs still mostly base their fees on the old "med aid rate"

 

The council, together with professionals, are still trying to hash out the ideal base rates for induvidual procedures, appliances, items and so on. Until that has happened, the term shall remain.

 

All med aids have their own payment rate for services. Though they are different, they are mostly around the same net rand amount. Again, loosely based on the old NHRPL price list (the list used to determine Med Aid Rates)

 

When the NHRPL list was rendered unconstitutional, there was nothing to base payments on. SO they used it as a guideline, as many specialists still do. They then determine their payment rates as a factor of that NHRPL rate.

 

The 100% / 200% / 300% is expressed as a factor of each company's med aid payment rate (the Discovery Health Rate or DHR for one)

 

But yeah - it doesn't "exist" per se, but it is still used as a term to make it easier to understand.

Sometimes price Fixing can be a Good thing.