Cover for planned hospital admissions
Before you go to hospital for any planned procedure, you must:
- See your doctor
- Check whether your specialist participates in a payment arrangement
- Call us on 0860 99 88 77 to confirm your hospital admission at least 48 hours before you go to hospital. If you do not confirm your admission, we will only pay 70% of the costs that we would normally cover.
When you contact us, give us the following details:
- Your Discovery Health membership number
- When you will be admitted to hospital and how long you will stay
- The date of the procedure
- The name of the hospital or clinic
- Your treating doctor’s name, practice number and phone number
- Your diagnosis (ask your doctor for the ICD-10 diagnosis code)
- The procedure name (ask your doctor for the CPT or RPL procedure codes).
If one of your dependants is admitted, give us their details.
Read more about hospital benefits available on your Health Plan:
Executive Plan
There is no overall hospital limit on the Executive Plan. Limits apply to some healthcare services and procedures.
Find full details of your Health Plan
How we cover your healthcare professionals
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates. If they charge the Discovery Health Rate or participate in a payment arrangement, we will pay them directly. If they charge more than the Discovery Health Rate or choose not to participate in a payment arrangement, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists participating in our payment arrangement
We pay your procedures and consultations in full if you consult a specialist who charges the Premier Rate or Classic Direct Rate.
We pay all 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 any approved account for expenses you incur during your hospital stay, other than the hospital account itself, or accounts for internal medical devices and prostheses.
Other specialists
We pay up to 300% of the Discovery Health Rate. We pay all 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 any approved account for expenses you incur during your hospital stay, other than the hospital account itself, or accounts for internal medical devices and prostheses.
Cover in a private ward
If you choose to be admitted to a private ward, we will cover the costs of the private ward, up to a maximum of R1 000 a day.
Limits on related healthcare services
| Dentistry* | There is an overall limit of R26 000 for each person. We pay the hospital account from the Hospital Benefit. We pay all related accounts from the Medical Savings Account or Above Threshold Benefit. |
| Cochlear implants and 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 | R31 500 for each prosthesis for each event |
| 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 |
* 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 and any approved expense you incur during your hospital admission, other than the hospital admission. We pro-rate this benefit according to when you join the medical scheme.
Comprehensive Plans
There are four plans in the Comprehensive Series – Classic Comprehensive, Classic Delta Comprehensive, Essential Comprehensive and Essential Delta Comprehensive.
There is no overall hospital limit on Comprehensive Plans.
Limits apply to some healthcare services and procedures.
Find full details of your Health Plan
How we cover your healthcare professionals
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates. If they charge the Discovery Health Rate or participate in a payment arrangement, we will pay them directly.
If they charge more than the Discovery Health Rate or choose not to participate in a payment arrangement, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists participating in our payment arrangement
We pay your procedures and consultations in full if you consult a specialist who charges the Premier Rate.
If you are on a Classic Comprehensive or Classic Delta Comprehensive Plan we cover a wider range of specialists in full.
Other healthcare professionals
Classic Comprehensive and Classic Delta Comprehensive
We pay up to 200% of the Discovery Health Rate
Essential Comprehensive and Essential Delta Comprehensive
We pay up to 100% of the Discovery Health Rate
Network of hospitals
Delta Comprehensive
On the Classic Delta Comprehensive and Essential Delta Comprehensive plans 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. This does not apply in an emergency. If you are admitted to a hospital not in the Delta Hospital Network in an emergency, you may be transferred to a Delta Network Hospital once stabilised.
Limits on related healthcare services
| Dentistry | There is an overall limit of R18 500** for each person. We pay the first R1 975 of your hospital account from your day-to-day benefits. We pay the balance of the hospital account from your Hospital Benefit.* |
| Cochlear implants and 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 | R31 500 for each prosthesis for each event |
| 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 |
* We pay all 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 any approved account for expenses you incur during your hospital stay, other than the hospital account itself.
** We pro-rate this benefit according to when you join the medical scheme. Both your hospital and related accounts are paid up to this limit
Priority Plans
There are two plans in the Priority Series – Classic Priority and Essential Priority.
There is no overall hospital limit on Priority Plans.
Limits apply to some healthcare services and procedures.
You need to pay a deductible for a defined list of procedures.
Find full details of your Health Plan
How we cover your healthcare professionals
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates. If they charge the Discovery Health Rate or participate in a payment arrangement, we will pay them directly. If they charge more than the Discovery Health Rate or choose not to participate in a payment arrangement, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists participating in payment arrangements
We pay your procedures and consultations in full if you consult a specialist who charges the Premier Rate.
If you are on a Classic Plan we cover a wider range of specialists in full.
Other healthcare professionals
Classic Priority
We pay up to 200% of the Discovery Health Rate
Essential Priority
We pay up to 100% of the Discovery Health Rate
Deductibles for in-hospital procedures
You need to pay an amount upfront (a deductible) to the hospital when you are admitted for one of the following procedures:
| Procedure | Deductible amount |
|---|---|
| Conservative back and neck treatment, myringotomy (grommets), tonsillectomy, adenoidectomy | R1 500 |
| Cystourethroscopy, colonoscopy, sigmoidoscopy, proctoscopy, gastroscopy | R2 000 |
| Arthroscopy, functional nasal procedures, hysterectomy (except for pre-operatively diagnosed cancer), laparoscopy, hysteroscopy, endometrial ablation | R3 600 |
| Nissen fundoplication (reflux surgery), spinal (back and neck) surgery, joint replacements | R7 300 |
Limits on related healthcare services
| Dentistry | There is an overall limit of R13 100** per person. We pay the first R1 975 of your hospital account from your day-to-day benefits. We pay the balance of the hospital account from your Hospital Benefit.* |
| Cochlear implants and 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 | R31 500 for each prosthesis for each event |
| 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 | 23 400 for each person |
* We pay all 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 any approved account for expenses you incur during your hospital stay, other than the hospital account itself.
** We pro-rate this benefit according to when you join the medical scheme. Both your hospital and related accounts are paid up to this limit
Saver Plans
There is no overall hospital limit on the Saver Series.
Limits apply to some healthcare services and procedures.
A hospital network applies to Coastal Saver and Delta Saver.
Find full details your Health Plan
How we cover your healthcare professionals
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates. If they charge the Discovery Health Rate or participate in a payment arrangement, we will pay them directly. If they charge more than the Discovery Health Rate or choose not to participate in a payment arrangement, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists participating in our payments arrangements
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates. If they charge the Discovery Health Rate or participate in a payment arrangement, we will pay them directly. If they charge more than the Discovery Health Rate or choose not to participate in a payment arrangement, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Other healthcare professionals
We pay your procedures and consultations in full if you consult a specialist who charges the Premier Rate.
If you are on a Classic Saver or Classic Delta Saver Plan we cover a wider range of specialists in full.
Network of hospitals
Coastal Saver
The Coastal Saver Plan covers you in any private hospital in the coastal provinces. On the Coastal 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.
Delta Saver
On the Classic Delta Saver and Essential Delta Saver plans 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. This does not apply in an emergency. If you are admitted to a hospital not in the Delta Hospital Network in an emergency, you may be transferred to a Delta Network Hospital once stabilised.
Limits on related healthcare services
| Dentistry | There is an overall limit of R13 100** per person. We pay the first R1 975 of your hospital account from your day-to-day benefits. We pay the balance of the hospital account from your Hospital Benefit.* |
| Cochlear implants and 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 | R31 500 for each prosthesis for each event |
| 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 |
| Dialysis | We cover these expenses in full as long as we have approved your treatment plan and you use a provider in our network |
* We pay all related accounts from the available funds in the Medical Savings Account. A related account is any approved account for expenses you incur during your hospital stay, other than the hospital account itself.
** We pro-rate this benefit according to when you join the medical scheme. Your hospital account is paid up to this limit.
Core Series
There is no overall hospital limit on most plans in the Core Series. The Foundation Core Plan has an overall limit of R320 000 for each person for hospitalisation.
Limits apply to some healthcare services and procedures.
A hospital network applies to Coastal Core and Delta Core.
Find full details of your Health Plan
How we cover your healthcare professionals
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates. If they charge the Discovery Health Rate or participate in a payment arrangement, we will pay them directly. If they charge more than the Discovery Health Rate or choose not to participate in a payment arrangement, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists participating in our payments arrangements
Your healthcare professionals’ accounts are separate from the hospital account. Healthcare professional accounts may include specialist accounts and other related accounts, for example accounts from a surgeon, anaesthetist, pathologist or radiologist.
Healthcare professionals are free to set their own rates. If they charge the Discovery Health Rate or participate in a payment arrangement, we will pay them directly. If they charge more than the Discovery Health Rate or choose not to participate in a payment arrangement, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Other healthcare professionals
We pay your procedures and consultations in full if you consult a specialist who charges the Premier Rate.
If you are on a Classic Core or Classic Delta Core Plan we cover a wider range of specialists in full.
Network of hospitals
Coastal Core
The Coastal Core Plan covers you in any private hospital in the coastal provinces. On the Coastal 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.
Delta Core
On the Classic Delta Core and Essential Delta Core plans 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. This does not apply in an emergency. If you are admitted to a hospital not in the Delta Hospital Network in an emergency, you may be transferred to a Delta Network Hospital once stabilised.
Limits on related healthcare services
| Dentistry | There is an overall limit of R13 100* per person. We pay the first R1 975 of your hospital account from your day-to-day benefits. We pay the balance of the hospital account.** |
| Cochlear implants and 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 | R31 500 for each prosthesis for each event |
| 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 |
| Dialysis | We cover these expenses in full as long as we have approved your treatment plan and you use a provider in our network |
* We pro-rate this benefit according to when you join the medical scheme. Your hospital account is subject to this limit.
** You must pay all related accounts. A related account is any approved account for expenses you incur during your hospital stay, other than the hospital account itself.
KeyCare Plans
There are two plans in the KeyCare Series – KeyCare Core and KeyCare Plus.
There is no overall hospital limit on the KeyCare Plans.
Limits apply to some healthcare services and procedures.
Find full details of your Health Plan
Network of hospitals for planned admissions
The KeyCare Plans cover you in any hospital in the KeyCare network.
You are covered at 100% of the Discovery Health Rate or agreed rate when admitted to a KeyCare network hospital. In an emergency, you can go to any hospital but you may be transferred to a KeyCare network hospital once you have been stabilised. We must confirm your admission for it to be covered.
Procedures and consultations by specialists participating in payment arrangements
The KeyCare Plans cover you in full for procedures and consultations if you are treated by a specialist who charges according to the KeyCare payment arrangement.
If you are treated by a specialist who does not participate in the KeyCare direct payment arrangement, you may need to pay for some of the costs yourself.
Other healthcare professionals
We pay up to 100% of the Discovery Health Rate
Limits on related healthcare services
| Terminal care benefit | R16 950 for each person |
| Dialysis | We cover these expenses in full as long as we have approved your treatment plan and you use a provider in our network |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
