What is the self-payment gap on Discovery Classic comprehensive?

What is the self-payment gap on Discovery Classic comprehensive?

The Self-payment Gap (SPG) only applies to the Executive, Comprehensive and Priority Plans. You are in a SPG when you’ve used the funds in your Medical Savings Account before your expenses add up to the Annual Threshold. During this time, you will need to pay for your day-to-day expenses from your own pocket.

How does Discovery payment gap work?

Available on the Executive, Comprehensive and Priority plans We call this a Self-payment Gap (SPG). Please note: We do not pay certain claims, for example over-the-counter medicine, from the Above Threshold Benefit.

What is my self-payment gap?

WHAT IS A SELF-PAYMENT GAP? The Self-payment Gap (SPG) is a temporary gap in cover when you run out of funds in your Medical Savings Account (MSA) but have not yet reached your Annual Threshold. You will have to pay for day-to-day claims from your own pocket during this period.

How do I claim my gap cover discovery?

If you experience a life-changing event that qualifies for a benefit payment, you can claim in one of the following ways:

1. Contact: You do not need to submit a separate Discovery Gap Cover claim to us.
2. Email: scan and email your claims to [email protected]
3. Call us on 0860 99 88 77.

What is Discovery comprehensive cover?

You get comprehensive benefits for maternity and early childhood that cover certain healthcare services before and after birth.. We pay your day-to-day medical expenses from the available funds allocated to your Medical Savings Account (MSA). This empowers you to manage your spend.

What does Discovery Classic priority cover?

Discovery Health Classic Priority bundles key benefits like 200% hospital cover, pathology tests at network providers and other out of hospital benefits into a package suitable for those who do not require comprehensive cover.

Is there a waiting period for discovery gap cover?

We apply waiting periods and exclusions to certain healthcare services from the start date of each person’s policy. There is an automatic three-month general waiting period for all healthcare services and treatment, except authorised emergency hospital admissions.

Is Gap cover only for hospital?

Gap cover is not a replacement for a medical aid. Gap cover serves to cover shortfalls where doctors charge above medical aid rate, and where medical aid pays up to their specified rate from the Risk or hospital benefit.

What is Discovery annual threshold?

We set the Annual Threshold amount at the beginning of each year. The number and type of dependants (spouse, adult or child) on your plan will determine the amount. The Annual Threshold is an amount that your claims need to add up to before we pay your day-to-day claims from the Above Threshold Benefit.

What does gap cover actually cover?

Gap cover works by covering the difference or shortfall between what your Doctor charges and what your medical aid pays from the Risk or hospital benefit. Depending on the option you select, you will also have cover for Medical aid Co-payments, Sub-limits and cancer treatment shortfalls.

What is the best gap cover in South Africa?

Sanlam and Absa emerged as the top-ranked gap cover providers in South Africa. Sanlam offers the best value for money to people under the age of 60 – their Comprehensive Gap Cover costs approximately R250* per month per individual or family.

What does gap cover mean?

Gap cover is short-term insurance policy which provides shortfall cover where doctors and specialists charge above medical aid rates of cover. Gap cover works in conjunction with your medical aid.

What is a self-payment gap (SPG)?

The Executive and Comprehensive plans have an unlimited ATB, and the Priority plans have a limited ATB. However, before we pay claims from the Above Threshold Benefit, you may have to pay some of your day-to-day medical expenses from your pocket. We call this a Self-payment Gap (SPG).

What is discovery’s smart comprehensive plan?

The Smart Comprehensive plan is a new plan for Discovery for 2020, and is meant to replace the old Comprehensive Zero MSA plan. The plan offers no savings account, but once you have paid a certain amount for out of hospital expenses from pocket, you will get a Limited Above Threshold benefit, where Discovery will cover the claims.

What are the benefits of a discovery plan?

You can view the network hospital here. The Executive and Comprehensive series are the top range Discovery plans. They have excellent benefits both in and out of hospital. There is a savings account for daily expenses. Once that runs out, you have a substantial self payment gap which you need to pay out of pocket.

Do you have a ‘self-payment gap’ in your medical savings?

This is the time of year when many medical scheme members have exhausted their day-to-day benefits, and move into the so-called ‘self-payment gap’. If for argument’s sake you have R3500 in your medical savings day-to-day account and you have used it all, many schemes have instituted what they call a ‘self-payment gap’.