Does Discovery Medical Aid Cover Medication?
March 29, 2018
The short answer is: “Yes.” How much medication cover you receive, and what form it takes, depends on your plan. In this post we will go through the basic plans and what the cover.
On all plans, the Chronic Illness Benefit comes into play. This is subject to your condition being on the pre-defined list and is only available on application. The chronic conditions are under the Prescribed Minimum Benefits as laid down by the government.
The medicine covered does fall under a formulary that Discovery will provide. If your medication is not on that formulary, you will have cover only up to a set amount per month. With the KeyCare and Smart Plans, you must pay for any medications not on this formulary.
This is medication that you need as a once-off or for the short term. Claims for such medication will be payable from your day-to-day plan.
On the Smart Plan, the medications covered appear on the formulary. You will have to pay R10 as a co-payment for each item your doctor prescribes. You must see a network GP and must use a network pharmacy. Your scripts have a limit: 12 for each person on the plan per year.
On the Priority, Comprehensive and Executive plans, you are covered for a larger range of medications and cover is also restricted in terms of annual limits.
Whether or not Discovery pays for all medication depends on the schedule. It also depends on whether it is a brand or a generic medicine.
On the Classic Delta Comprehensive, Classic Comprehensive and Executive plans, you are able to enjoy a much more extensive range of medicines. On these plans, if you have depleted your medical savings account, Discovery will still allow you to get access to medication.
This will have to be generic medications through the network and annual limits apply as well.
Preferentially Priced Medication
This is medication that offers the best value for money. They are generally generic medications and are covered in full, in accordance with the Discovery Health Rate if a predefined set of circumstances comes into play.
Discovery does encourage people to use medications on this list in order to maximise their day to day benefits. Generic medication is just as good as the original but comes in at a better price.
Ensuring Your Medication is Covered in Full
If you are on a Delta or Core plan, you must use the MedXpress providers in order to avoid paying co-payment of 20%.
If you are on one of the Smart plans, you must use Dis-Chem, Clicks or MedXpress pharmacies or pay in full for your medication.
And if you are on one of the KeyCare plans, you will need to get the medication from a network provider or pay in full for it.
For Smart Series and KeyCare Plans you have to use these designated 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 for medications. Any amounts over and above this rate will be for your account.
Discovery provides extensive cover for medications and will cover most as long as they are within the formulary or if they are generic medications.
All info was correct at time of publishing