1 reviews | Active since Aug 2015
Problem with Discovery Health plan
I was a member of the Discovery Medical Aid (Classic Comprehensive Plan) from 2002 until January 2011. In February 2011 i joined a company in Namibia and was employed by them until January 2014 (during this period i was a member of the Namibian Health Plan - NHP.)<br> During January 2014 i again app**** for membership of Discovery - the application was sent to their Head Office , which they claim was never received. Back in RSA in February 2014 i again app**** for membership of Discovery and was referred to their consultants in Delmas ie Johan and Carina Nel.After numerous consultations with the said consultants i was informed that Discovery would accept me back as a member with the following provisions -<br> 1. A waiting period of 3 months during which no claims would be considered<br> 2. A further 12 month waiting period during which limited claims would be considered<br> 3. A 25 % levy on my monthly premium because SA Medical Aids do not recognise any Aids outside the RSA borders (this as explained to me by the consultant.)<br> At no stage was i asked to provide proof that since 1975 until 2011 i was never without a Medical Aid.<br> Wife urgently needs knee replacement - Discovery refuses upgrade plan
Thank you for your comment.
I investigated your query and have sent you a detailed email with feedback on the concerns you raised.
I confirmed that based on your application form received, the waiting periods and late joiner penalty fee was correctly app**** on your membership. Unfortunately, medical schemes registered outside the borders of South Africa is not recognised as credible cover. The terms of your membership were noted on the acceptance letter sent to you prior to activating your membership so you are made aware of how you are covered.
Plan upgrades are only allowed during our Year End Revision (YER) which occurs during October to December each year and the plan change is made effective 1 January the following year. Where a member moves from a lower level of cover to a plan which offers more richer benefits, this is seen as an upgrade and not permitted during the year. This is in line with legislation.
Based on your chosen level of cover, knee replacement surgery is not covered and I have provided the options available to you.
I am sorry we could not provide you with a more positive outcome.
Kind regards
Bruce
Thank you for your comment.
I investigated your query and have sent you a detailed email with feedback on the concerns you raised.
I confirmed that based on your application form received, the waiting periods and late joiner penalty fee was correctly app**** on your membership. Unfortunately, medical schemes registered outside the borders of South Africa is not recognised as credible cover. The terms of your membership were noted on the acceptance letter sent to you prior to activating your membership so you are made aware of how you are covered.
Plan upgrades are only allowed during our Year End Revision (YER) which occurs during October to December each year and the plan change is made effective 1 January the following year. Where a member moves from a lower level of cover to a plan which offers more richer benefits, this is seen as an upgrade and not permitted during the year. This is in line with legislation.
Based on your chosen level of cover, knee replacement surgery is not covered and I have provided the options available to you.
I am sorry we could not provide you with a more positive outcome.
Kind regards
Bruce