MRI and CT Scans
Only specialists and certain GPs may refer you for a MRI or CT scan
All MRI and CT scans must be requested by a specialist or by a trauma unit GP that has joined our network. We will only cover MRI or CT scans if you are referred by an appropriate specialist or a trauma unit GP in our network. Approved MRI or CT scans will be covered from the Hospital Benefit. You have to phone us to confirm your benefits and cover.
How we pay MRI and CT scans needed before planned surgery
If an MRI or CT scan is done as part of a pre-operative work-up for a planned surgical procedure, in other words the scan could have been performed before the admission. We will pay the MRI or CT scan as an out-of-hospital scan.
How we pay MRI and CT scans needed for conservative back and neck treatment
If a MRI or CT scan is needed during an approved admission for a chronic back or neck condition, we will pay the MRI or CT scan as an out-of-hospital scan. We do not cover MRI or CT scans for conservative back and neck treatment on the Core Plans.
Payment for this healthcare service is based on your health plan
Executive Plan
In-hospital-We pay approved MRI and CT scans done during an approved hospital admission from the Medical Savings Account or Above Threshold Benefit. Specific rules and limits apply to conservative back and neck scans.
Out-of-hospital- We pay MRI and CT scans done out-of-hospital from the Medical Savings Account or Above Threshold Benefit (except for conservative back and neck treatment, where specific rules and limits apply).
Comprehensive Series
In-hospital We pay approved MRI and CT scans performed during an approved hospital admission from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for the admission. If the MRI or CT scan is performed during an approved hospital admission, but the scan is not related to the reason for admission, we pay the MRI or CT scan as an out of hospital scan.
Out-of-hospital We pay the first R2 300 of each scan from your available funds in the Medical Savings Account or Above Threshold Benefit. We pay the balance of the MRI or CT scan cost from the Hospital Benefit, up to the Discovery Health Rate (except for conservative back and neck treatment, where specific rules and limits apply).
If you are admitted for conservative back or neck treatment
We pay the first R2 300 of the scan from your available funds in your Medical Savings Account and Above Threshold Benefit. We pay the balance from the Hospital Benefit. Specific rules and limits apply to conservative back and neck scans.
Priority Series
In-hospital We pay approved MRI and CT scans performed during an approved hospital admission from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for the admission. If the MRI or CT scan is performed during an approved hospital admission, but the scan is not related to the reason for admission, we pay the MRI or CT scan as an out of hospital scan.
Out-of-hospital We pay the first R2 300 of scan from available funds in the Medical Savings Account or Above Threshold Benefit. We pay the balance of the MRI or CT scan cost from the Hospital Benefit, up to the Discovery Health Rate (except for conservative back and neck treatment, where specific rules and limits apply).
If you are admitted for conservative back or neck treatment
You have to pay the first R1 750 of the hospital account, and we'll pay the first R2 100 of the scan from your available funds in your Medical Savings Account and limited Above Threshold Benefit. We pay the balance from the Hospital Benefit, up to the Discovery Health Rate (except for conservative back and neck treatment, where specific rules and limits apply).
Saver Series
In-hospital We pay approved MRI and CT scans performed during an approved hospital admission from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for the admission. If the MRI or CT scan is performed during an approved hospital admission, but the scan is not related to the reason for admission, we pay the MRI or CT scan as an out of hospital scan.
Out-of-hospital We pay the first R2 300 of the scan from your available funds in the Medical Savings Account. We pay the balance of the MRI or CT scan cost from the Hospital Benefit, up to the Discovery Health Rate (except for conservative back and neck treatment, where specific rules and limits apply).
If you are admitted for conservative back or neck treatment
You pay the first R2 300 of the scan from your available funds in your Medical Savings Account. We pay the balance from the Hospital Benefit. Specific rules and limits apply to conservative back and neck scans.
Core Series
In-hospital We pay approved MRI and CT scans performed during an approved hospital admission from the Hospital Benefit at 100% the Discovery Health Rate, as long as the scan is related to the reason for the admission. If the MRI or CT scan is performed during an approved hospital admission, but the scan is not related to the reason for admission, you willl be responsible for payment of the cost of the scan.
Out-of-hospital You do not have cover for out-of-hospital MRI or CT scans.
If you are admitted for conservative back or neck treatment
You are responsible to pay these costs from your pocket.
KeyCare Series
In-hospital We pay MRI or CT scans performed during an approved hospital admission from the Hospital Benefit, as long as it is related to the reason for the admission. If it is not related to an approved hospital admission, we pay it from your Specialist Benefit up to R2 300 for each person a year.
Out-of-hospital We pay approved MRI or CT scans from the Specialist Benefit up to R2 300 for each person a year. A specialist or accredited trauma GP must refer you and you need to get a valid reference number from Discovery Health
