Chronic illnesses and other medical conditions
Chronic Illness Benefit
All our plans provide comprehensive cover for a list of chronic conditions. For us to cover your medicine from the Chronic Illness Benefit, we need to approve your application.
To apply, complete the Chronic Illness Benefit application form.
Prescribed Minimum Benefits additional links
Guide to Prescribed Minimum Benefits (1.06 mb)
We cover you for cancer treatment on the DiscoveryCare Oncology programme. Please let us know as soon as you are diagnosed with cancer so that we can register you on the Oncology Programme. This will help you get the most out of your oncology benefits.
Benefits of the Oncology Programme include:
- Full cover for approved cancer-related treatment up to a rand amount over a 12-month cycle. Once your treatment costs go over this amount, Discovery Health will pay 80% of the costs of all further treatment and you will need to pay the balance from your pocket. This amount could be more than 20% if your treatment cost is higher than the Discovery Health Rate. This includes cover for chemotherapy, radiotherapy and other treatment prescribed by your cancer specialists.
- Cover for pathology, radiology, medicine and other cancer-related treatment provided by other healthcare professionals
- Access to donor searches for bone marrow transplants
Any cancer-related treatment that falls within the Prescribed Minimum Benefits is always covered in full, with no co-payment if you use service providers who we have an agreement with.
You need to register for the Oncology Benefit
You or your treating doctor can register for the Oncology Benefit. Contact the DiscoveryCare oncology team:
- Call 0860 99 88 77
- Email DCO_Oncology@discovery.co.za.
We need a copy of your histology or pathology.
Advanced Illness Benefit for advanced cancer
Members with cancer have access to a comprehensive palliative care programme. This programme offers extensive out-of-hospital care for members with cancer at home.
The existing Compassionate Care Benefit provides members, in their final months of life, with access to a defined basket of services such as pain, hydration, general nursing care and supportive care up to an overall benefit limit.
To ensure that members with advanced cancer benefit from optimal palliative care, we have enhanced the existing Compassionate Care Benefit. Members can discuss their options with their treating doctor or oncologist.
The Advanced Illness Benefit provides members with access to:
GPs specialising in end-of-life care who will assist in coordinating and improving the care of DHMS members on the Advanced Illness Benefit
- The healthcare provider will facilitate the care through HealthID by use of a Care Plan tailored for the member
- All medicine, oxygen and surgical requirements prescribed will be delivered via MedXpress when required
Personalised high-touch experience and a defined home-based care programme through Discovery HomeCare
- Access to personalised care services such as oxygen, wound care, home nursing and pain management for the member
- Access to counselling services for member and family
A dedicated care coordinator who will:
- Remain with the member and the family throughout
- Manage the relationship between the member and the multi-disciplinary team on an ongoing basis ensuring the member receives the best of care
HIV and AIDS can be a sensitive matter, whether one has the condition or not. Our skilled and professional consultants respect your right to privacy and will help you get access to clinically sound and cost-effective treatment for your individual case.
We will always deal with each case with complete confidentiality.
To register on the Discovery HIVCare Programme, call us on 0860 99 88 77 or email HIV_Diseasemanagement@discovery.co.za.
Designated service providers (DSPs) for HIV medicine
All members who are registered on the HIVCare Programme must use designated service providers (DSPs) to get their monthly HIV medicine to avoid a 20% non-designated service provider co-payment.
Currently, Discovery MedXpress is the designated service provider for HIV medicines for all members registered on the HIVCare Programme. Members on the Smart Plan also have the option to use their selected designated network pharmacy (Clicks or Dis-Chem) for their HIV medicine.
Should more pharmacies be added as designated service providers during 2016 an updated list of designated service providers for HIV medicine will be published.
Chronic Renal Dialysis
Discovery Health Medical Scheme covers renal dialysis in- and out-of-hospital.
Members need to get their out-of-hospital dialysis treatment from our designated service providers for full cover and to avoid co-payments on dialysis accounts.
To apply for Chronic Renal failure, complete the Chronic Illness Benefit application form.
About the KidneyCare Programme
The KidneyCare Programme focuses on members with chronic kidney disease who need dialysis.
Living with chronic kidney disease is a lifelong journey, often made difficult because of the significant need for regular care, complex medicine, restrictive diets, and numerous tests and investigations.
The KidneyCare Programme is designed to ensure that our medical scheme members living with chronic kidney disease are managed according to international best practice guidelines, to ensure the best quality of care and quality of life.