Insured Network Benefit
The Insured Network Benefit provides significant extra cover to members for GP consultations and pathology in the Discovery Health GP Network and the pathology network.
Through the Insured Network Benefit:
- members on the Executive, Comprehensive and Priority Plans who use up their Medical Savings Account deposits for the year will have unlimited cover for GP consultations in the Discovery Health GP Network.
- members on the Executive, Comprehensive and Priority plans will have unlimited pathology cover as long as the doctor uses the Discovery Health pathology form to refer members for tests at a pathology provider in our network.
- members on Saver Plans who use up their Medical Savings Account deposits for the year will have cover for a specified number of GP consultations in the Discovery Health GP Network. Saver Plans do not have access to unlimited pathology cover.
- Core and KeyCare Plans do not have access to cover from the Insured Network Benefit.
Executive
The Insured Network Benefit ensures you have no gaps in cover for GPs and pathology in our network
We further 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 at our agreed rate. This GP benefit only covers the consultation fee (code 0190, 0191 or 0192). We pay for any other healthcare services from your available day-to-day benefits.
- we cover pathology at our network providers if your GP or specialist requests the appropriate tests using the Discovery Health pathology form.
Comprehensive series
The Insured Network Benefit ensures you have no gaps in cover for GPs and pathology in our network
We further 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 at our agreed rate. This GP benefit only covers the consultation fee (code 0190, 0191 or 0192). We pay for any other healthcare services from your available day-to-day benefits.
- We cover pathology at our network providers if your GP or specialist requests the appropriate tests using the Discovery Health pathology form.
Priority series
The Insured Network Benefit ensures you have no gaps in cover for GPs and pathology in our network
We further 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 at our agreed rate. This GP benefit only covers the consultation fee (code 0190, 0191 or 0192). We pay for any other healthcare services from your available day-to-day benefits.
- We cover pathology at our network providers if your GP or specialist requests the appropriate tests using the Discovery Health pathology form.
Saver
The Insured Network Benefit ensures you have no gaps in cover for GPs in our network
We further extend your day-to-day cover through the Insured Network Benefit by paying for GP consultation fees when you have spent your annual Medical Savings Account deposit. We cover the cost of your consultations if you go to a GP in our network. The maximum number of consultations that we cover for a single member and a family each year depends on your plan type:
| Health plan | Single member | Family |
|---|---|---|
| Classic and Coastal plans | 3 consultations | 6 consultations |
| Essential plan | 2 consultations | 4 consultations |
This GP benefit only covers the consultation fee (code 0190, 0191 or 0192). We pay for any other healthcare services from your available day-to-day benefits.
If your GP sees you in hospital, we will pay this from the Hospital Benefit as long as you have confirmed your hospital admission with us.
