Scopes
What are scopes?
Cover for investigations
Scopes are used to investigate certain conditions such as gastric ulcers, reflux and infections. A scope can also be done to perform a specific surgical procedure.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) for investigations
These scopes are all used in the digestive system. Scopes may also be used in other body systems, but those fall outside of this benefit.
Where scopes are done in hospital, a co-payment or deductible applies to the hospital account. We pay all the other approved accounts that are related to the procedure from the Hospital Benefit.
For scopes that are done in the doctor’s rooms, the co-payment or deductible does not apply. Discovery Health pays for the scope without using the member’s day-to-day benefits.
Cover for gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy.
Please call us to confirm your benefits at least 48 hours before having this procedure.
Where the scope is performed in your doctor’s rooms we refer to this as “out-of-hospital”
Where the scope is performed in hospital, payment for this healthcare service is based on your health plan
Executive Plan
In-hospital
The hospital account is covered in full. 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.
Out-of-hospital
We pay all related accounts from the Medical Savings Account or Above Threshold Benefit
Comprehensive Series
In-hospital
We pay the first R2 100 of your hospital account from your available day-to-day benefits.
We pay the balance of the hospital account and your related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit to these health services. Discovery Health pays these claims without using your day-to-day benefits as we pay this cost from the Hospital Benefit. Please call us before having the scope to confirm your benefits.
Priority Series
In-hospital
The first R2 350 of your hospital account is a deductible which you need to pay. We pay the balance of the hospital account and your related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit on these health services. The deductible does not apply and Discovery Health pays these claims without using your day-to-day benefits as we pay this cost from the Hospital Benefit. Please call us before having the scope to confirm your benefits.
Saver Series
In-hospital
We pay the first R2 600 of your hospital account from your Medical Savings Account as long as you have money available. We pay the balance of the hospital account and all related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit to these health services. Discovery Health pays these claims without using your Medical Savings Account as we pay this cost from the Hospital Benefit. Please call us before having the scope to confirm your benefits.
Core Series
In-hospital
You pay the first R2 600 of your hospital account. We pay the balance of the hospital account and all related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit to these health services. Discovery Health pays these claims from the Hospital Benefit. Please call us before having the scope to confirm your benefits.
KeyCare Series
In-hospital
The claims are paid from the Hospital Benefit.
Scope done in a day-case facility
We will cover your scope in our network of day-case facilities only. Discovery Health pays all accounts including the anaesthetist and surgeon’s accounts, from the Hospital Benefit.
