Comprehensive benefits and cover

As a member of Discovery Health Medical Scheme you have access to the broadest and best level of healthcare cover in the market based on your medical needs.

Day-to-day cover

We pay for your day-to-day medical expenses like GP and specialist face-to-face and video call consultations, everyday medicine, radiology and pathology from the Medical Savings Account (MSA), Day-to-day Extender Benefit (DEB) and Above Threshold Benefit (ATB). The level of day-to-day cover depends on the plan you choose.

Medical Savings Account (MSA) on the Executive, Comprehensive, Priority and Saver plans

The Medical Savings Account (MSA) is only applicable to the Executive, Comprehensive, Priority and Saver Plans. It is a fixed amount that the Scheme gives you at the beginning of the year. Your total MSA amount and contribution is calculated as a fixed portion (15%, 20% or 25%, depending on your plan type) of your total and monthly contribution.

Any unused funds in your MSA will carry over to the next year. On the Executive, Comprehensive and Priority plans, when you run out of MSA, you will have to pay for some healthcare expenses from your pocket before you reach your Annual Threshold for the Above Threshold Benefit (ATB) to kick in. This temporary gap in cover is called a Self-payment Gap (SPG). You must still send claims to us so that we know when to start paying from your ATB.

Day-to-day Extender Benefit (DEB)

When you have spent your annual Medical Savings Account (MSA) allocation, we extend your day-to-day cover through the Day-to-day Extender Benefit for essential healthcare services in our network.

Select day-to-day benefits on the Smart, KeyCare Plus and KeyCare Access plans

• The Smart plans offer unlimited cover for GP consultations and other day-to-day benefits with fixed payments in the Smart Network.
• The KeyCare Plus and Access plans offer primary care cover through your chosen GP and day-to-day medicine from our medicine list.

You can get full cover when using our networks

Hospitals

If you have chosen a plan with a hospital network, make sure you use a hospital in that network to get full cover.

Medicine

Use MedXpress, a convenient cost-effective medicine ordering service or a MedXpress partner pharmacy to enjoy full cover and avoid co-payments when claiming for medicine on the medicine list. Alternatively, you can use one of over 2 500 pharmacies in our network. Cover depends on your chosen plan.

GPs and specialists

You have full cover for GPs and specialists who we have payment arrangements with.

Day-to-day Extender Benefit

Use a GP in the Premier Plus GP Network to access the Day-to-day Extender Benefit and get full cover depending on your plan for GP consultation fees, blood tests, preferred day-to-day medicine, antenatal consultations, kids casualty visits, video call consultations with paediatricians, and some external medical items.

Use the MaPS tool to find a provider near you.