The Saver Series

Comprehensive hospital cover

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

Use a network hospital on the Delta network and Coastal options

Delta network options

On the Classic and Essential Delta network options, 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 of R4 550 upfront to the hospital.

The Delta Hospital Network

Gauteng

• Arwyp Medical Centre
• Life Bedford Gardens Hospital
• Netcare Bougainville Private Hospital
• Life Brenthurst Clinic
• Life Carstenhof Clinic
• Clinix Private Hospital – Lesedi
• Clinix Private Hospital – Sebokeng
• 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
• 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

Eastern Cape

• Life New Mercantile Hospital

Free State

• 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
• Ethekwini Hospital
• Midlands Medical Centre
• 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 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 a coastal hospital, we pay a maximum of 70% of the hospital account and you need to pay the difference.

Full cover for specialists who we have an agreement with

You can benefit by using healthcare professionals we have an agreement with because we will cover their approved procedures in full. If you are a Classic Plan member, you benefit from access to the broadest range of specialists who we pay in full, which represents over 88% of our members’ specialist interactions. These healthcare professionals, appropriate to your plan, 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 200% of the Discovery Health Rate on Classic Plans and up to 100% of the Discovery Health Rate on Essential Plans. You may have a co-payment if your specialist charges above these rates.

Other healthcare professionals

We cover GPs and other healthcare services up to 200% of the Discovery Health Rate on Classic Plans and up to the Discovery Health Rate on Essential and Coastal Plans.

We cover radiology and pathology up to the Discovery Health Rate on all plans.

Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy)

We pay the first R2 600 of your hospital account from your Medical Savings 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 or 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 hospital admission, we pay up to 100 % of the Discovery Health Rate from your Hospital Benefit.

If you are admitted for conservative back or neck treatment, or if the scan is unrelated to your admission, we pay the first R2 300 of the scan code from your Medical Savings Account. We pay the balance of the scan code from your Hospital Benefit, up to 100% of the Discovery Health Rate.  Specific rules and limits apply to conservative back and neck scans.

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.

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. We will pay the costs of all dental appliances, their placements and orthodontic treatment (including related accounts for orthognathic surgery) at 100% of the Discovery Health Rate from your Medical Savings Account, 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 upfront payments  no overall limit. This benefit is subject to authorisation and the Scheme’s clinical rules.

Most of your 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 an annual limit:

Your cover for chronic conditions

You have 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 monthly amount for medicine not on our list.

We pay medicine up to 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.

Delta network options

You have cover your approved chronic medicine, with no additional co-payment, if you use a Delta network pharmacy. If you don’t use a Delta network pharmacy, a 20% co-payment applies.

Your cover for cancer treatment

Our Oncology Programme covers the first R200 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 the Discovery Health Medicine Rate. We pay consultations, radiotherapy, radiology, pathology, scopes and scans up to 100% of the Discovery Health Rate. You might have to make a co-payment if your healthcare professional charges more than the Discovery Health Rate.

Cancer treatment that is a Prescribed Minimum Benefit is always covered in full, with no co-payment. Please call us to register on the Oncology Programme.

We pay day-to-day medical expenses like GP visits, radiology and pathology from your Medical Savings Account, as long as you have money available. If you run out of money in your Medical Savings Account, you will have to pay for your day-to-day expenses yourself.

The Insured Network Benefit ensures you have no gaps in cover for GPs

We extend your day-to-day cover through the Insured Network Benefit by paying 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:

How we make your Medical Savings Account last longer

We pay 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 (a prostate screening test) 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. The cover applies to the rest of the year in which the trauma took  place, and to the year after your trauma.
• We pay for scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) from your Hospital Benefit  if they are done in your doctor’s rooms. We pay up to 200% of the Discovery Health Rate if you are on a Classic Plan and up to 100% of the Discovery Health Rate if you are on an Essential or Coastal Plan. Please call us before you have a scope in your doctor’s rooms to confirm your benefits.

Your cover for day-to-day healthcare services is limited to the money in your Medical Savings Account

We pay for these healthcare services from your Medical Savings Account:

• GPs
• Specialists
• Allied healthcare professionals, like physiotherapists
• Radiology
• Pathology
• Dentistry
• Private nursing
• Prescribed and over the counter medicine
• External medical items
• Hearing aids
• Optical care
• MRI and CT scans: we pay the first R2 300 of your MRI or CT scan code from your Medical Savings Account. We cover the balance of the scan code from your Hospital Benefit up to the Discovery Health Rate. For conservative back and neck treatment, specific rules and limits may apply.

* 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.