Cover for planned hospital admissions
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 if we have an agreement with them, we will pay them directly. If they charge more than the Discovery Health Rate or if we do not have an agreement with them, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists who we have an agreement with
We pay your procedures and consultations in full if you consult a specialist who we have an agreement with.
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 150 a day.
Limits on healthcare services in hospital
Only the following healthcare services have a limit for the year:
| Dentistry* | There is an overall limit of R30 500 for each person. We pay the hospital account from the Hospital Benefit. We pay all related accounts from the Medical Savings Account and Above Threshold Benefit. |
| Cochlear implants and auditory brain implants and processors | R140 000 for each person for each benefit |
| Internal nerve stimulators | R106 000 for each person |
| Hip, knee and shoulder joint prostheses | There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R33 000 will apply to each prosthesis. |
| Prosthetic devices used in spinal surgery | R21 000 for the first level, R42 000 for two or more levels, limited to one procedure for each person |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
| Terminal care benefit | R28 000 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 account. We prorate this benefit according to when you join the medical scheme.
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.
Comprehensive Plans
There are four plans in the Comprehensive Series – Classic Comprehensive, Classic Delta Comprehensive network option, Essential Comprehensive and Essential Delta Comprehensive network option.
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 if we have an agreement with them, we will pay them directly. If we charge more than the Discovery Health Rate or if they do not have an agreement with them, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists who we have an agreement with
We pay your procedures and consultations in full if you consult a specialist who we have an agreement with.
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 an amount (deductible) of R4 550 upfront. This does not apply in an emergency. If you are admitted to a hospital that is not in the Delta Hospital Network in an emergency, you may be transferred to a Delta Network Hospital once stabilised.
Your cover for dental treatment in hospital
You need to pay a portionof your hospital or day clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment.
| Hospital | Day clinic | |
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
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‘s accounts, from your Hospital Benefit, up to 100% of the Discovery Health Rate.
No overall dental limit
There is no overall limit for dental treatment. However, all dental appliances , their placement, and orthodontic treatments (including the related accounts for orthognathic surgery) are paid at 100% of the Discovery Health Rate from your day-to-day benefits, up to an annual limit of R17 400 a person. 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.
Severe dental and oral surgery
The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. This benefit is subject to authorisation and the Scheme’s clinical rules.
Limits on healthcare services in hospital
Only the following healthcare services have a limit for the year:
| Dental appliances and orthodontic treatment* (including orthognathic surgery) | R17 400 a person for the year from your day-to-day benefits |
| Cochlear implants and auditory brain implants and processors | R140 000 for each person for each benefit |
| Internal nerve stimulators | R106 000 for each person |
| Hip, knee and shoulder joint prostheses | There is no overall limit if you get your prosthesis from our preferred suppliers.If you choose not to, a limit of R33 000 will apply to each prosthesis. |
| Prosthetic devices used in spinal surgery | R21 000 for the first level, R42 000 for two or more levels, limited to one procedure for each person |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
| Terminal care benefit | R28 000 for each person |
* If you join the medical scheme after January, you won’t get the full limit because it is calculated by counƟ ng the remaining months in the year.
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 an amount (deductible) to the hospital upfront 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 if we have an agreement with them, we will pay them directly. If they charge more than the Discovery Health Rate or if we do not have an agreement them , we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists who we have an agreement with
We pay your procedures and consultations in full if you consult a specialist who we have an agreement with.
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
Upfront payments for in-hospital procedures
You need to pay an amount upfront 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 750 |
| Colonoscopy, sigmoidoscopy, proctoscopy, gastroscopy, cystoscopy | R2 350 |
| Arthroscopy, functional nasal procedures, hysterectomy (except for pre-operatively diagnosed cancer), laparoscopy, hysteroscopy, endometrial ablation | R4 250 |
| Nissen fundoplication (reflux surgery), spinal surgery (back and neck), joint replacements | R8 600 |
If the procedure can be done out of hospital, for example in the doctor’s rooms, you won’t have to pay an amount upfront to the hospital. Please call us beforehand to confirm your benefits.
Your cover for dental treatment in hospital
You need to pay a portion of your hospital or day clinic account upfront for dental admissions. This amount varies depending on your age and the place of treatment.
| Hospital | Day clinic | |
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
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's accounts, from the Hospital Benefit, up to 100% of the Discovery Health Rate.
No overall dental limit
There is no overall limit for dental treatment. However, all dental appliances , their placements, and orthodontic treatments (including the related accounts for orthognathic surgery) are paid up to 100% of the Discovery Health Rate from your day-to-day benefits, up to an annual limit of R10 850 a person. 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.
Severe dental and oral surgery
The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. This benefit is subject to authorisation and the Scheme’s clinical rules.
Limits on healthcare services in hospital
Only the following healthcare services have a limit for the year:
| Dental appliances and orthodontic treatment* (including orthognathic surgery) | R10 850 for each person from your day-to-day benefits |
| Cochlear implants and auditory brain implants and processors | R140 000 for each person for each benefit |
| Internal nerve stimulators | R106 000 for each person |
| Hip, knee and shoulder joint prostheses | There is no overall limit if you get your prosthesis from a preferred supplier. If you choose not to, a limit of R33 000 will apply to each prosthesis. |
| Prosthetic devices used in spinal surgery | R21 000 for the first level, R42 000 for two or more levels, limited to one procedure for each person |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
| Terminal care benefit | R28 000 for each person in their lifetime |
| Chronic dialysis | We cover these expenses in full if we have approved your treatment plan and you use the provider in our network. If you go elsewhere, you have a co-payment. |
*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.
Saver Plans
There are five plans in the Saver Series –Classic Saver, Classic Delta Saver network option, Essential Saver, Essential Delta Saver network option and Coastal Saver.
There is no overall hospital limit on the Saver Series.
Limits apply to some healthcare services and procedures.
Hospital networks apply to the Coastal Saver Plan and Delta Saver network options.
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 if we have angreement with them, we will pay them directly. If they charge more than the Discovery Health Rate or if we do not have an agreement with them, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists who we have an agreement with
We pay your procedures and consultations in full if you consult a specialist who we have an agreement with.
If you are on a Classic Plan we cover a wider range of specialists in full.
Other healthcare professionals
Classic Saver and Classic Delta Saver
We pay up to 200% of the Discovery Health Rate
Essential Saver and Essential Delta Saver
We pay up to 100% of the Discovery Health Rate
Network of hospitals
Coastal Saver
The Coastal Saver Plan covers you in any private hospital in the coastal provinces. On the Coastal Saver 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 an amount (deductible) of R4 550 upfront. This does not apply in an emergency. If you are admitted to a hospital that is not in the Delta Hospital Network in an emergency, you may be transferred to a Delta Network Hospital once stabilised.
Your cover for dental treatment in hospital
You need to pay a portion) of your hospital or day clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment.
| Hospital | Day clinic | |
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
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 accounts, from the Hospital Benefit up to 100% of the Discovery Health Rate.
No overall dental limit
There is no overall limit for dental treatment. We will pay the costs of all dental appliances, their placement, and orthodontic treatment (including the related accounts for orthognathic surgery) from your Medical Savings Account up to 100% of the Discovery Health Rate, as long as you have money available.
Severe dental and oral surgery
The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limits. This benefit is subject to authorisation and the Scheme’s clinical rules.
Limits on healthcare services in hospital
Only the following healthcare services have a limit for the year:
| Cochlear implants and auditory brain implants and processors | R140 000 for each person for each benefit |
| Internal nerve stimulators | R106 000 for each person |
| Hip, knee and shoulder joint prostheses | There is no overall limit if you get your prosthesis from our preferred supplier.If you choose not to, a limit of R33 000 will apply to each prosthesis. |
| Prosthetic devices used in spinal surgery | R21 000 for the first level, R42 000 for two or more levels, limited to one procedure for each person |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
| Terminal care benefit | R28 000 for each person in their lifetime |
* 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.
Core Series
There are five plans in the Core Series –Classic Core, Classic Delta Core network option, Essential Core, Essential Delta Core network option and Coastal Core.
There is no overall hospital limit on most plans in the Core Series. Limits apply to some healthcare services and procedures.
Hospital networks apply to the Coastal Core Plan and Delta Core network options.
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 if we have an agreement with them, we will pay them directly. If they charge more than the Discovery Health Rate or if we do not have an agreement with them, we will pay you.
You will have to make sure you pay your healthcare professionals the full amount.
Procedures and consultations by specialists who we have an agreement with
We pay your procedures and consultations in full if you consult a specialist who we have an agreement with.
If you are on a Classic Plan we cover a wider range of specialists in full.
Other healthcare professionals
Classic Core and Classic Delta Core
We pay up to 200% of the Discovery Health Rate
Essential Core, Essential Delta Core and Coastal Core
We pay up to 100% of the Discovery Health Rate
Network of hospitals
Coastal Core
The Coastal Core Plan covers you in any private hospital in the coastal provinces. 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.
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 an amount (deductible) of R4 550 upfront. This does not apply in an emergency. If you are admitted to a hospital that is not in the Delta Hospital Network in an emergency, you may be transferred to a Delta Network Hospital once stabilised.
Your cover for dental treatment in hospital
You need to pay a portion of your hospital or day clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment.
| Hospital | Day clinic | |
| Members younger than 13 years | R1 300 | R650 |
| Members 13 years and older | R3 300 | R2 200 |
We pay the balance of the hospital account and related accounts, which includes the dental surgeon’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 cost of all dental appliances, their placement 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 upfront payment and no overall limits. This benefit is subject to authorisation and the Scheme’s clinical rules.
Limits on healthcare services in hospital
Only the following healthcare services have a limit for the year:
| Overall limit | Core Plans have no overall hospital limit |
| Cochlear implants and auditory brain implants and processors | R140 000 for each person for each benefit |
| Internal nerve stimulators | R106 000 for each person |
| Hip, knee and shoulder joint prostheses | There is no overall limit if you get your prosthesis from a preferred supplier. If you choose not to, a limit of R33 000 will apply to each prosthesis |
| Prosthetic devices used in spinal surgery | R21 000 for the first level, R42 000 for two or more levels, limited to one procedure for each person |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
| Terminal care benefit | R28 000 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, you will have a co-payment. |
* 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.
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. You must let us know about and confirm your admission for it to be covered.
Procedures and consultations by specialists who we have an agreement with
The KeyCare Plans cover you in full for procedures and consultations if you are treated by a specialist who we have an agreement with.
If you are treated by a specialist who we do not have an agreement with, 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 healthcare services in hospital
| Terminal care benefit | R20 000 for each person |
| Chronic 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 |
