The Core Series
The Core Plans offer you cover in hospital
You have access to additional benefits
- Emergency response services nationwide with Discovery 911
- Cover for up to 90 days for medical emergencies when you travel overseas, up to R5 million for each person
- Evacuation benefits for medical emergencies when travelling or working in Africa through the Africa Benefit
- Cover for specific preventive screening tests and flu vaccines
Your cover in hospital
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 a 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 48 hours before you go to hospital to confirm your admission.
You must use a network hospital on the Delta and Coastal options
Delta
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 R3 850.
The Delta Hospital Network
Gauteng
- Arwyp Medical Centre
- Life Bedford Gardens Hospital
- 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
- Pelonomi Private Hospital
- 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
- Midlands Medical Centre
- Life Mount Edgecombe Hospital
- 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.
Your cover for healthcare professionals
We have negotiated with the majority of specialists to guarantee that when you use a specialist in our direct payment arrangements we pay them directly at our agreed rate. This means that when consulting a specialist in our direct payment arrangements you are covered in full.
Full cover for specialists participating in our payment arrangements
You can benefit by using healthcare professionals participating in our direct 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.
Your cover for investigations
Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies)
You pay the first R2 200 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 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.
Unlimited healthcare services
Most of your in-hospital healthcare services have no overall limit. These include:
- GPs
- Specialists
- Allied healthcare professionals, for example physiotherapists
- Blood tests and x-rays
- HIV cover if you are registered on the HIVCare Programme.
Limited healthcare services
Only the following healthcare services have a limit:
| Dentistry* | There is an overall limit of R13 100 for each person. You pay the first R1 975 of your hospital account. We pay the balance of the hospital account from your Hospital Benefit. You need to pay all related accounts. The R1 975 co-payment does not apply when children 12 years old or younger are admitted to hospital. |
| Cochlear implants, auditory brain implants and processors | R126 000 for each person for each benefit |
| Internal nerve stimulators | R96 000 for each person |
| Hip and knee joint prostheses | There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R31 500 will apply to each prosthesis. |
| Prosthetic devices used in spinal surgery | R20 000 for each level, limited to two levels for each procedure, and one procedure for each person each year |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
| Terminal care benefit | R23 400 for each person |
| Chronic dialysis | We cover these expenses in full if we have approved your treatment plan and you use a provider in our network. If you go elsewhere, we will pay up to the Discovery Health Rate. |
* This limit applies to the hospital account only. 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. We pro-rate this benefit according to when you join the medical scheme.
DiscoveryCare looks after you in times of need
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.
Delta Range
You have cover with no co-payment for approved chronic medicine if you use a Delta Courier Pharmacy. If you don’t use a Delta Courier Pharmacy, a 25% co-payment applies.
Your cover for cancer treatment
DiscoveryCare’s Oncology Programme offers you cover for cancer treatment.
The DiscoveryCare Oncology Programme covers the first R200 000 of your approved cancer treatment over a 12-month cycle, in full, after which a 20% co-payment will apply, without any overall limits.
Radiology and pathology approved for your cancer treatment is also covered. Cancer treatment that falls within the Prescribed Minimum Benefit is always covered in full, with no co-payment. Please call us to register on the Oncology Programme.
Your cover for day-to-day medical expenses
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 fl u 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.
2010 Monthly contributions
| Family size | Classic Core | Classic Delta Core | Essential Core | Essential Delta Core | Coastal Core |
|---|---|---|---|---|---|
| Principal member | R1 045 | R837 | R898 | R718 | R759 |
| Spouse / adult dependant | R823 | R658 | R673 | R538 | R569 |
| Child | R418 | R334 | R359 | R288 | R303 |
General exclusions
Discovery Health does not cover certain healthcare services. You can find a full list of these exclusions here.
How to join Discovery Health
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.
