The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Got itThe Chronic Illness Benefit (CIB) covers you for a defined list of chronic conditions. You need to apply to have your medicine covered for your chronic condition.
Click here to find out more about the chronic conditions we cover
To access Prescribed Minimum Benefits, certain rules apply.
You get full cover for approved chronic medicine on our medicine list. For medicine not on our list, we cover you up to a set monthly rand amount called the Chronic Drug Amount (CDA). The CDA does not apply to Smart and KeyCare plans. We pay up to the cost of the generic reference price (GRP) for these plans. The GRP is the cost of the least expensive medicine of the same kind on our medicine list for the condition. You may have a co-payment if you use medicine that is not on the medicine list.
The Executive and Comprehensive plans, except the Classic Smart Comprehensive plan, offer cover for medicine on the Additional Disease List (ADL). You are covered up to the set monthly Chronic Drug Amount (CDA) for your medicine. No medicine list applies.
For members on the Executive Plan, we pay the full cost of medicine on our exclusive medicine list.
We pay for medicine up to a maximum of the Discovery Health Rate for medicine. The Discovery Health Rate for medicine is the price of the medicine as well as the fee for dispensing it.
To avoid exceeding your annual chronic medicine quantity limit, please use your medicine as prescribed and only order another supply when you have two days’ supply on hand.
Designated service providers (DSPs)
On certain plans, to avoid a 20% co-payment, you need to use these DSPs:
Priority, Saver, Smart, Core plans and Delta options
MedXpress Network Pharmacies
KeyCare Plus
You must use a network pharmacy or get your medicine from your chosen primary or secondary GP
KeyCare Start plan
State facility
KeyCare Core
You must use a network pharmacy
On other plans, you can use a pharmacy in our pharmacy network.
You have access to treatment for a list of medical conditions under the Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions (including HIV/AIDS) on the Chronic Disease List (CDL).
All our plans offer benefits that are far richer than the Prescribed Minimum Benefits (PMBs). To access PMBs, certain rules apply.
Chronic Illness Benefit application form (PDF)
Cover for medicine and treatment of chronic conditions (PDF)
2021 Chronic Illness Benefit medicine list (formulary) (PDF)
Treatment baskets for the Prescribed minimum Benefit Chronic Disease List conditions (PDF)
Request for additional cover for conditions registered on the Chronic Illness Benefit (PDF)