What types of medication does Discovery medical Aid cover?
March 26, 2018
Does Discovery medical aid cover medication? The short answer is “Yes.” How much you receive, and what form that cover takes depends on your plan. In this post we will go through the basic plans and what they cover.
Does Discovery medical Aid cover Medication – Chronic
All plans include the Chronic Illness Benefit. This is subject to your illness being on the list and is only available on application. The chronic state, noted under the PMB’s as laid down by the law.
The medicine covered falls under the official list that Discovery provides. If it’s not on the list, you get cover up to a set amount per month. With KeyCare and Smart Plans, you pay for any medicine not on the list.
Does Discovery medical Aid cover Medication – Acute
This is once-off medicine for the short term. Claims payable from your day-to-day plan.
Smart Plan lists the medicine covered. You pay R10 as a co-payment for each item your doctor prescribes but must use a network GP and pharmacy. Scripts limited to 12 for each person on the plan per year.
Priority, Comprehensive and Executive plans cover you for a larger range of medication, restricted in terms of annual limits. Payment for all medicine depends on scheduling and whether branded or generic.
On the Classic Delta Comprehensive, Classic Comprehensive and Executive plans, you enjoy a much more extensive range of medicine. If you have finished your savings account, Discovery still allows you access to medication. However, this must be generic as prescribed through the network and subject to annual limits as well.
Does Discovery medical Aid cover Medication – Generic value for Money
This is the best value for money. They are generic medications and covered in full with the Discovery Health Rate if a listed issue comes into play. Discovery encourages people to use the medicine on this list in order to get the most of their day to day benefits.
Generic medicine is just as good as the original but comes in at a better price.
How to Ensure your Medicine is Covered in Full
On a Delta or Core plan, you must use the MedXpress providers in order to avoid paying co-payment of 20%. With Smart plan, use Dis-Chem, Clicks or MedXpress. Or pay in full for your medication.
With the KeyCare plans get the medication from a network provider or pay in full for it. For Smart Series and KeyCare Plans, use these service providers for cover. If you don’t, you will have to pay the full account.
For all other plans, you can use any pharmacy as long as they have agreed to charge the Discovery Health Rate. Any amount over and above this rate is for your account.
Discovery provides extensive cover for medication and will cover most as long as they are listed or generic.
All info was correct at time of publishing