Comprehensive hospital cover

We cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us. There is no overall hospital limit.

Emergency cover when you need it most

In an emergency, go straight to hospital. 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. It is important that you, a loved one or the hospital let us know about your admission as soon as possible.

Cover for planned hospital admissions

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

Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital.

Going to hospital can be a stressful experience. Discovery’s HospitalXpress makes your admission to hospital convenient and seamless. This service offers you express pre-admissions and online tools to authorise your admission and confirm your cover. HospitalXpress also connects you to select partners, bringing you a range of value-added services at the reduced prices you’re accustomed to as a Discovery member.

We pay your admitting doctor, anaesthetist and other related accounts from the Medical Savings Account. Once you reach your Annual Threshold, we pay these accounts from the Above Threshold 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.

Full cover for specialists who we have an agreement with

You can benefit by using healthcare professionals who we have an agreement with because we will cover their approved procedures in full. These healthcare professionals are also the designated providers for Prescribed Minimum Benefits.

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

If you are treated in hospital by a specialist who we do not have an agreement with, we cover you up to 300% of the Discovery Health Rate. You may have a co-payment if your specialist charges above these rates.

Other healthcare professionals

We cover GPs, radiology, pathology and other healthcare services up to 100% of the Discovery Health Rate.

Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) and MRI or CT scans

If performed during an approved admission, we pay the hospital account from your Hospital Benefit and all related accounts from the Medical Savings Account or Above Threshold Benefit. We pay up to 300% of the Discovery Health Rate for specialists and up to 100% of the Discovery Health Rate for other healthcare services, including radiology.Specific rules and limits apply to conservative back and neck scans.

Most in-hospital healthcare services have no overall limit. These are:

• GPs
• Specialists
• Allied healthcare professionals, like physiotherapists
• Pathology
• Radiology
• HIV cover

Only the following healthcare services have a limit:

* This limit applies to the hospital account and all accounts related to the admission to hospital. A related account is the account for your admitting doctor, anaesthetist or any approved expense you incur during your hospital admission, other than the hospital account. If you join the medical scheme after January, you won’t get the full limit because it is calculated by counting the remaining months in the year.

Your cover for chronic conditions

You have extensive and flexible cover for a comprehensive list of chronic conditions. You have full cover for approved medicine on Discovery Health’s medicine list, which is our most extensive. If you choose to use medicine that is not on the medicine list, you have a set monthly amount available that is higher than that of our other plans.

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

When you use MedXpress, Discovery’s convenient medicine delivery service, you pay no delivery or administration fees. Discovery’s service agents can also advise you on the most cost-effective alternatives and you will always be charged at the Discovery Health Medicine Rate or less – minimising co-payments. Call us on 0860 99 88 77 to make use of this free service.

Your cover for medical technology and expensive medicine

You have cover for a defined list of the latest treatments through the Specialised Medicine and Technology Benefit, up to R200 000 for each person. Please call us to see whether your treatment qualifies.

You also have access to the Overseas Treatment Benefit, which covers you when you travel overseas to seek evidence-based healthcare treatment not available in South Africa. The treatment must be at a registered healthcare professional and is paid up to a limit of R500 000 for each person each year. You will need to pay and claim back from us when you return to South Africa.

Specific rules apply and a co-payment of up to 20% applies to both benefits.

Your cover for cancer treatment

Our Oncology Programme covers the first R400 000 of approved cancer treatment over a 12-month cycle. Cover is unlimited once your cancer treatment costs go over this amount, but you will need to pay 20% of the costs of all further treatment.

We cover chemotherapy and oncology-related medicines up to 100% of the Discovery Health Medicine Rate.

We pay consultations, radiotherapy, radiology, pathology, scopes and scans up to 100% of the Discovery Health Rate.You may be responsible for a co-payment if your healthcare provider charges more than the applicable Discovery Health Rate.

Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. Please call us to register on the Oncology Programme.

We pay for your day-to-day medical expenses like GP visits, radiology and pathology from your Medical Savings Account, at the rate the healthcare professional charges, as long as you have money available.  If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay for your day-to-day medical expenses yourself..

Once your claims add up to the Annual Threshold, we pay the rest of your claims from the Above Threshold Benefit.

The Insured Network Benefit ensures you have no gaps in cover for GPs and pathology in our network

We extend your day-to-day cover through the Insured Network Benefit.

 When you have spent your annual Medical Savings Account deposit:

• We cover the full cost of your consultation fees if you go to a GP in our network. We pay the claim directly to the GP.
• We cover pathology at our network providers if your GP or specialist requests the tests by filling in the Discovery Health pathology form.

How we extend your benefits and make your Medical Savings Account last longer

We pay claims for these day-to-day expenses without using your Medical Savings Account:

• The Screening and Prevention Benefit covers certain tests at a Discovery Wellness Network provider like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (prostate screening) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine.
• We cover out-of-hospital claims for recovery after certain traumatic events from the Trauma Recovery Extender Benefit. This cover applies to the rest of the year in which the trauma took place, and to the year after your trauma.

Extend your cover for allied healthcare services

The Allied and Therapeutic Extender Benefit gives you unlimited cover for a list of allied healthcare services, like physiotherapy. This unlimited cover is for a defined list of conditions. The unlimited cover depends on your condition and the criteria for it.

The Above Threshold Benefit offers extra day-to-day cover

The Executive Plan has an unlimited Above Threshold Benefit. It gives you extra day-to-day cover after your Medical Savings Account has run out and your day-to-day claims add up to a set amount called the Annual Threshold.When you claim, we add up the following amounts for you to get to the Annual Threshold:

• For Premier Rate specialists, we add up the Premier Rate. For specialists who we don’t have an agreement with, we add up to 300% of the Discovery Health Rate.
• For GPs, and all other healthcare services, we add up 100% of the Discovery Health Rate.
• For generic medicine, we add up 100% of the Discovery Health Medicine Rate. For non-generic medicines, we add up 90% of the Discovery Health Medicine Rate. Over-the-counter medicines do not add up to your Annual Threshold.

We add up the amount to the benefit limit available or pay from your Above Threshold Benefit.

No annual limit on certain day-to-day healthcare services

We pay for these healthcare services from your Medical Savings Account or Above Threshold Benefit, with no annual limit:

• GPs, who we pay at a higher rate than on our other plans
• Specialists
• Basic dental check-ups
• Radioloy
• Pathology
• Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy)
• MRI and CT scans (except for back and neck treatment, where specific rules and limits apply)

Annual benefit Limits on some day-to-day healthcare services

Some of your day-to-day benefits have limits. These limits apply to claims paid from your Medical Savings Account or Above Threshold Benefit. These are not separate benefits; you need to have funds in your Medical Savings Account or have reached your Above Threshold Benefit before we pay up to these limits.

* If you join the medical scheme after January, you won’t get the full limit because it is calculated by counting the remaining months in the year.

Annual Threshold amounts

* We count a maximum of three children when we work out the monthly contribution.

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.