The Core Series

Whether you need to be hospitalised for a planned hospital procedure or need emergency cover, the Core Series offers cover in a private hospital with no overall limit.

We cover you in any private hospital for emergency and planned hospital admissions that you have authorised with us.

Emergency cover when you need it most

In an emergency, go straight to hospital but call us or get someone to call us within 12 hours.

If you need medically-equipped transport in a medical emergency, call 0860 999 911. This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport.

Cover for planned hospital admissions

Please call us at least 48 hours before you go to hospital to confirm your admission.

You must use a network hospital on the Delta option

On the Classic and Essential Delta Core options, you are covered in full at hospitals in the Delta Hospital Network.

For planned admissions at any other private hospital, you must pay a deductible of R4 150.

The Delta Hospital Network

Gauteng

• Arwyp Medical Centre
• Life Bedford Gardens Hospital
• Netcare Bougainville Private Hospital
• Life Brenthurst Clinic
• Life Carstenhof Clinic
• Clinix Private Hospital – Lesedi
• Clinix Private Hospital – Sebokeng
• Clinton Clinic
• Emfuleni Medi-Clinic
• Life Fourways Hospital
• Legae Private Hospital
• Lenmed Clinic Limited
• Life Little Company of Mary
• Louis Pasteur Hospital
• Midvaal Private Hospital
• Morningside Medi-Clinic
• Life Robinson Private Hospital
• Life Roseacres Clinic
• Suikerbosrand Clinic
• The Donald Gordon Medical Centre
• Life Wilgeheuwel Hospital

Day Hospitals

• Birchmed Day Clinic
• Boksburg Medical & Dental Centre
• Brooklyn Surgical Centre
• Centurion Eye Hospital
• Clinton Clinic
• Constantia Park Medical & Dental Centre
• Cormed Clinic
• Fauchard Clinic
• Fordsburg Clinic
• Johannesburg Clinic
• Johannesburg Eye Hospital
• Karibu Day Clinic
• Kilnerpark Narko Clinic
• Mayo Clinic
• Medgate Day Clinic
• Medkin Clinic
• Mercidoc Day Clinic
• Ocumed
• Oprimed
• PJ Schutte Theatre Unit
• Silverton Medical & Dental Centre
• The Healthy Eye
• Visiomed Eye Laser Clinic
• Wilgeheuwel Day Clinic

Free State

• Life New Mercantile Hospital

Free State

• Life Rosepark Hospital
• Universitas Private Hospital

Day Hospitals

• Bethlehem Medical Centre
• CityMed Theatre
• Bloemfontein Eye Clinic

KwaZulu Natal

• Life Chatsmed Garden Hospital
• Life Entabeni Hospital
• Ethekwini Hospital
• Midlands Medical Centre
• Life Westville Hospital

Day Hospital

• Bluff Medical & Dental Centre

Western Cape

• Cape Town Medi-Clinic
• Life Claremont Hospital
• Life Kingsbury Hospital
• Mitchells Plain Medical Centre
• Panorama Medi-Clinic
• Vergelegen Medi-Clinic

Day Hospitals

• Khangella Eye Theatre
• Panorama Laser Clinic
• Parow Medical & Dental Centre
• Wesfleur Private Clinic

Coastal

On the Coastal Core Plan you must go to a hospital in one of the four coastal provinces for a planned hospital admission. If you don’t use these hospitals, Discovery Health will pay up to a maximum of 70% of the hospital account and you will need to pay the difference. This does not apply in an emergency.

No overall limit

There is no overall hospital limit on the Core Series. Limits, clinical guidelines and policies apply to some healthcare services and procedures.

We have negotiated with the majority of specialists to guarantee that when you use a specialist in our payment arrangements we pay them directly at our agreed rate. This means that when consulting a specialist in our payment arrangements you will be covered in full.

Full cover for specialists participating in our payment arrangements

You can benefit by using healthcare professionals participating in our payment arrangements because we will cover their approved procedures in full. If you are a Classic Core Plan member, you benefit from access to the broadest range of specialists whom we pay in full, which represents over 87% of specialist interactions.

You may have a co-payment if you use other specialists

If you are treated in hospital by a specialist who does not participate in one of our payment arrangements, we cover you up to a maximum of 200% of the Discovery Health Rate on Classic Core and at 100% of the Discovery Health Rate on Essential Core and Coastal Core.

Other healthcare professionals

We cover GPs and other healthcare services up to 200% of the Discovery Health Rate on Classic Core and up to 100% of the Discovery Health Rate on Essential Core and Coastal Core.

We cover radiology and pathology up to 100% of the Discovery Health Rate on all plans.

Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy)

You pay the first R2 375 of your hospital account. We pay the balance of the hospital account and your related accounts from your Hospital Benefit. A related account is the account for your admitting doctor, anaesthetist and any approved expense you incur during your hospital admission, other than the hospital account.

MRI and CT scans

If your MRI or CT scan is done as part of an approved hospital admission, we pay it from your Hospital Benefit. If you are admitted for conservative back or neck treatment or the scan is unrelated to your admission, we do not pay for it. You are limited to one MRI or CT scan a year for conservative back and neck treatment.

You need to pay a portion (deductible) of your hospital or day clinic account upfront for dental admissions. This amount varies depending on the member’s age and the place of treatment.

We pay the balance of the hospital account from the Hospital Benefit up to 100% of the Discovery Health Rate.

We pay the related accounts, which include the dental surgeon and anaesthetist’s account, from the Hospital Benefit up to 100% of the Discovery Health Rate.

Dental devices, appliances and orthodontic treatment

You are responsible for paying the costs of all dental appliances and orthodontic treatment (including the related accounts for orthognathic surgery).

Severe dental and oral surgery

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures with no deductibles and no overall limits. This benefit is subject to authorization and the Scheme’s clinical entry criteria.

Most of your in-hospital healthcare services have no overall limit. These include:

• GPs
• Specialists
• Allied healthcare professionals, for example physiotherapists
• Pathology and radiology
• HIV cover if you are registered on the HIVCare Programme

Only the following healthcare services have a limit:

Your cover for chronic conditions

The Chronic Illness Benefit offers you flexible cover for chronic conditions – you always have the option of full cover through our medicine list or the choice of using any medicine up to a set monthly amount.

You have flexible cover for a list of chronic conditions. You have full cover for approved medicine on Discovery Health’s medicine list or up to a set amount for medicine not on our list.

We pay medicine up to a maximum of the Discovery Health Medication Rate. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit.

The Delta Range

You have cover with no co-payment for approved chronic medicine if you use a Delta network pharmacy. If you don’t use a Delta network pharmacy, a 25% co-payment applies.

Your cover for cancer treatment

DiscoveryCare’s Oncology Programme covers you for cancer treatment.

DiscoveryCare’s Oncology Programme covers the first R200 000 of your approved cancer treatment over a 12-month cycle, in full. Cover is unlimited once your cancer treatment costs go over this amount but you need to pay 20% of the costs of all further treatment from your pocket.

Radiology and pathology approved for your cancer treatment is also covered. Cancer treatment that falls within the Prescribed Minimum Benefits is always covered in full, with no co-payment. Please call us to register on the Oncology Programme.

We cover chemotherapy and any oncology-related medicines up to the Discovery Health Medication Rate. Consultations, radiotherapy, radiology, pathology and scans are paid up to the Discovery Health Rate. You may be responsible for a co-payment if your healthcare provider charges more than the applicable Discovery Health Rate.

Early detection and prevention of diseases is vital to your wellbeing. The Screening and Prevention Benefit pays for a range of healthcare services that help to prevent and screen for diseases that would otherwise go unnoticed.

You have access to the following day-to-day benefits:

• The Screening and Prevention Benefit covers a range of healthcare services, including the following tests at a Discovery Wellness Network provider: blood glucose, blood pressure, cholesterol and body mass index. The benefit also covers a mammogram, Pap smear, PSA and HIV screening tests. Members from the age of 65 and members registered for certain chronic conditions are also covered for a seasonal flu vaccine from this benefit.
• We also cover endoscopies (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) if done in your doctor’s rooms. Please call us before you go for your scope to confirm your benefits.

Discovery Health does not cover certain healthcare services. You can find a full list of these exclusions here.

We market our Discovery Health Plans through independent and accredited financial advisers. If you want a financial adviser to help you choose a Health Plan to suit the needs of your family, please send us your contact details and we will contact you.