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WorksheetsYE 2020 - Afternoon
Total questions: 10
Worksheet time: 5mins
The Day-to-day Extender Benefit includes face-to-face consultations with a network GP and requires a referral by a Network Pharmacy Clinic virtual GP or DrConnect?
True
False
Adam, a 45 year old male, on the Executive Plan has a colonoscopy and CT Abdomen in-hospital on 25 March 2020. How would the hospital claim be covered?
Adam would be liable for an upfront deductible of R2 000 on the hospital claim. The balance will be covered from available funds in the Medical Savings Account.
Adam’s hospital claim will be paid in full from the Hospital Benefit
The first R4 100 of the hospital claim is paid from available day-to-day benefits and the balance is covered from the Hospital Benefit at 100% of the Scheme Rate
The hospital claim will be paid in full from the Medical Savings Account
When can Discovery Primary Care Advanced members with nurse referral visit their network GP without being referred by a nurse?
Discovery Primary Care Advanced members with nurse referral are allowed two network GP visits per year without being referred by a nurse
Discovery Primary Care Advanced members with nurse referral are allowed one network GP visits per year without being referred by a nurse
Discovery Primary Care Advanced members with nurse referral do not have the option to visit their network GP without being referred by a nurse
Discovery Primary Care Advanced members with nurse referral are allowed three network GP visits per year without being referred by a nurse
Private household employers only have one Discovery Primary Care option to select for their household employees, however, they do have the option to add a Trauma Benefit?
True
False
Tanya is a 35 year old female on the Classic Smart Plan. She is having a colonoscopy and gastroscopy done in hospital on 28 January 2020 at a non-network facility. How would she be covered?
The first R5 500 of the hospital claim will be paid from the Medical Savings Account and the balance is paid from the Hospital Benefit. Related claims are paid from the Hospital Benefit at 100% of the Scheme Rate.
An upfront deductible of R6 250 is payable on the hospital claim and the balance is paid from the Hospital Benefit. Related claims are paid from the Hospital Benefit at 100% of the Scheme Rate.
An upfront deductible of R9 650 is payable on the hospital claim and the balance is paid from the Hospital Benefit. Related claims are paid from the Hospital Benefit at 200% of the Scheme Rate.
The hospital claim and related claims are paid from the Hospital Benefit at 300% of the Discovery Health Rate
The Day Surgery Network Benefit was introduced by Discovery Health Medical Scheme (DHMS) in 2019. What are the changes to the Day Surgery Procedure list in 2020?
Due to the skillset, complexities and specialised equipment used for these procedures, a decision was made to remove and add certain procedures to the list
There will be no changes to the Day Surgery Procedure list in 2020
We will be removing all scopes from the Day Surgery Procedure list
DHMS will be adding new hospitals to the Day Surgery Network Benefit
How will non-preferentially priced generic medication, that falls in Tier 7, accumulate to the Annual Threshold for a member on a Classic Comprehensive Plan?
It will accumulate to the Annual Threshold at 50% of the DHR
It will accumulate to the Annual Threshold at 75% of the DHR
It will accumulate to the Annual Threshold at 100% of the DHR
It will accumulate to the Annual Threshold at 90% of the DHR
If a member is admitted into a hospital on the New Hospital Network in 2020 for an approved involuntary emergency PMB condition, how will the admission be covered?
Admissions related to involuntary PMB conditions will be covered in full at the agreed rate, the member must be moved once stable
Admissions related to involuntary PMB conditions at a hospital on the New Hospital Network,will be covered at 80% of the Discovery Health Rate
Admissions related to involuntary PMB conditions at a hospital on the New Hospital Network ,will not be covered
Admissions related to involuntary PMB conditions at a hospital on the New Hospital Network, will not be covered by Discovery Gap Cover
Joan Smart is on a Essential Priority Plan and she has a Discovery Bank account. Her GP refers her for blood tests and an x-ray of her hand, to be done as an out patient. Joan’s MSA is almost depleted, she can cover any co-payments for x-rays and blood tests from her Discovery Bank account, provided she has signed a mandate.
True
False
How are GP consultations covered on the Classic Smart Comprehensive Plan from the Smart Risk Benefit?
GP consultations are paid from the Smart Risk Benefits; this is subject to a R55 co-payment
GP consultations are paid from the Smart Risk Benefits; this is subject to a R50 co-payment. Members need to use a Smart Network GP
Consultations are not covered from the Smart Risk Benefit
GP consultations are paid from the Smart Risk Benefits; this is subject to a R55 co-payment. Members need to use a Smart Network GP
