Knowledge Assessment 3

All out-of-hospital day-to-day claims, including the Smart Risk Benefits, will accumulate towards the annual threshold at 100% of the Discovery Health Rate,

• Over-the-counter medication

• Prescribed Medication

• Existing benefits that are covered from Risk, such as the Screening and Prevention Benefit, claims related to the Chronic Illness Benefit

Miles is a single member on the Classic Smart Comprehensive Plan; he has not reached his Above Threshold Benefit as yet, and needs to consult with an ENT specialist. Miles contacts the call centre to confirm how specialists are covered on his plan type, he speaks to Janet. What would Janet confirm?

• In order for Miles to have access to the Specialist Benefit, his Smart Network GP would need to request for a specialist authorisation via HealthID

• Miles does not need an authorisation because he is on the Comprehensive Series.

• Miles specialist’s consultation will be covered up to the Specialist Benefit limit of R5,700

• In order for Miles to have access to the Specialist Benefit, his GP would need to request for a specialist authorisation via HealthID. Once he has an authorisation, he can consult with a specialist from any discipline

Mr Johnson also downloads the Discovery mobile app from the Google Playstore. Where can he find his plan information?

• Mobile App » Medical aid » Your plan » About your health plan

• Mobile App » Medical aid » About your health plan » Your plan

• Medical aid » Mobile App » About your health plan » Your plan

What tool would Keith use on the Discovery website and mobile app to find an optometrist in his area?

• View MSA balance

• Medadvisor

• Keith should use the ‘Find a healthcare provider’ tool on the Discovery website or mobile app.

What is the optometry Limit on Executive , Comprehensive plan respectively

• R8550 and R6550 per person

• R9550 + R6550 per person

• R9550 + R7320 per person

What is the email address Bruno should use to email any international claims to Discovery?

• [e-mail]

• [e-mail]

• [e-mail]

Johan and his family are on the Executive Plan and will be going to the Swiss Alps on Holiday. He contacts the call centre to find out how will they be covered in the event that they require medical attention whilst traveling abroad.

• The International Travel Benefit will cover him for a maximum of $1 million per person travelling

• The International Travel Benefit will cover the repatriation of mortal remains

• Hospital cover is limited to 90 days from the date of departure

• The member will be liable for the first US$150 or €100 for any out-of-hospital emergency medical claims

What does the Allied, Therapeutic and Psychology Extender Benefit offer members?

• Allows for extra benefits to see GP

• The Allied, Therapeutic and Psychology Extender Benefit offers members with severe, complex conditions, who need short-term or long-term care from allied, therapeutic and psychology healthcare professionals, access to clinically appropriate care.

• Nurse consultations

The Allied, Therapeutic and Psychology Extender Benefit offers members with severe, complex conditions, who need short-term or long-term care from allied, therapeutic and psychology healthcare professionals, access to clinically appropriate care.

• The antibiotic will be covered in full as Greg used a Smart GP

• Greg will need to pay cash for the medication, as he has exceeded his Annual Benefit Limit of R1,720 for acute medication

• Greg’s medication will be covered by the Scheme, however, he will need to pay a R10 co-payment

• Greg has only used R1,500 from the overall annual benefit limit for acute medication. The antibiotic will be covered up to R750

What is the definition of a Prescribed Minimum Benefit (PMB) as per the Medical Scheme Act?

• Conditions that Discovery Health has created to pay as an added benefit to members

• A benefit option that is offered by a Medical Scheme do not need to pay in full, without co-payment or the use of deductibles, the diagnosis, treatment and care costs of the Prescribed Minimum Benefit conditions.

• A benefit option that is offered by a Medical Scheme must pay in full, without co-payment or the use of deductibles, the diagnosis, treatment and care costs of the Prescribed Minimum Benefit conditions.

• A benefit option that is offered by a Medical Scheme must pay in full, with co-payment or the use of deductibles, the diagnosis, treatment and care costs of the Prescribed Minimum Benefit conditions.