Tests and scans

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What are tests and scans?

Tests and scans involve any investigative procedures that are undertaken to identify and diagnose medical conditions that would not normally be detected with the naked eye.

Depending on your plan type, Discovery Health Medical Scheme provides cover for in- and out-of-hospital tests and scans, including investigations, radiology, blood tests, MRI and CT scans.

Cover for investigations

We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.

  • An upfront deducible of R4 100 is paid from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit.
  • If both a gastroscopy and colonoscopy is performed in the same admission, we pay an upfront deductible of R5 150 from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit.
  • If done in the doctor's rooms, you will not have to pay an amount upfront. We pay the account from the hospital benefit.
Cover for radiology

X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital radiology expenses from your available day-to-day benefits.

Cover for MRI/CT Scans

Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.

We pay for scans as an out-of-hospital expense if:

  • A scan is done as part of a pre-operative work-up for a planned surgical procedure.
  • A scan is needed for conservative back and neck treatment during an approved admission. Specific rules and limits apply to conservative back and neck scans.

Scans done as part of an approved admission

We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.

Other scans

If it is not related to your admission or for conservative back and neck treatment, we pay an upfront deductible of R3 040 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate. For conservative back and neck scans a limit of one scan per spinal and neck region applies.

Cover for pathology

Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital radiology expenses from your available day-to-day benefits.

Cover for investigations

We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.

  • An upfront deducible of R4 100 is paid from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit. On Classic Smart Comprehensive, you pay the first R4 100 until you reach the Annual Threshold.
  • If both a gastroscopy and colonoscopy is performed in the same admission, we pay an upfront deductible of R5 150 from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit.
  • If done in the doctor's rooms, you will not have to pay an amount upfront. We pay the account from the hospital benefit.
Cover for radiology

X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital radiology expenses from your available day-to-day benefits.

On Classic Smart Comprehensive, we pay specialist-referred radiology at the Discovery Health rate, up to the Specialist Benefit limit. Out-of-hospital radiology is paid from your Above Threshold Benefit once you reach your Annual Threshold.

Cover for MRI/CT Scans

Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.

We pay for scans as an out-of-hospital expense if:

  • A scan is done as part of a pre-operative work-up for a planned surgical procedure.
  • A scan is needed for conservative back and neck treatment during an approved admission. Specific rules and limits apply to conservative back and neck scans.

Scans done as part of an approved admission

We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.

Other scans

If it is not related to your admission or for conservative back and neck treatment, we pay an upfront deductible of R3 040 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate. For conservative back and neck scans a limit of one scan per spinal and neck region applies.

On Classic Smart Comprehensive, if not related to your hospital admission, you must pay an upfront deductible of R3 040 for your MRI or CT scan until you reach the Annual Threshold. We cover the balance of the scan from your Hospital Benefit, up to the DHR.

Cover for pathology

Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital radiology expenses from your available day-to-day benefits.

On Classic Smart Comprehensive, we pay specialist-referred radiology at the Discovery Health rate, up to the Specialist Benefit limit. Out-of-hospital radiology is paid from your Above Threshold Benefit once you reach your Annual Threshold.

Cover for investigations

We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.

  • An upfront deducible of R4 650 is paid from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit.
  • If both a gastroscopy and colonoscopy is performed in the same admission, we pay an upfront deductible of R5 850 from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit.
  • If done in the doctor's rooms, you will not have to pay an amount upfront. We pay the account from the hospital benefit.
  • If performed outside of the day surgery network, the highest of the upfront amounts will apply.
Cover for radiology

X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital radiology expenses from your available day-to-day benefits.

Cover for MRI/CT Scans

Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.

We pay for scans as an out-of-hospital expense if:

  • A scan is done as part of a pre-operative work-up for a planned surgical procedure.
  • A scan is needed for conservative back and neck treatment during an approved admission. Specific rules and limits apply to conservative back and neck scans.

Scans done as part of an approved admission

We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.

Other scans

If it is not related to your admission or for conservative back and neck treatment, we pay an upfront deductible of R3 040 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate. For conservative back and neck scans, you must also pay the first R3 700 of the hospital account. A limit of one scan per spinal and neck region applies for conservative back and neck scans

Cover for pathology

Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital radiology expenses from your available day-to-day benefits.

Cover for investigations

We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.

  • An upfront deducible of R5 000 is paid from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit.
  • If both a gastroscopy and colonoscopy is performed in the same admission, we pay an upfront deductible of R6 250 from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit.
  • If done in the doctor's rooms, you will not have to pay an amount upfront. We pay the account from the hospital benefit.
  • If performed outside of the day surgery network, the highest of the upfront amounts will apply.
Cover for radiology

X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital radiology expenses from your available funds in your Medical Savings Account.

Cover for MRI/CT Scans

Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.

We pay for scans as an out-of-hospital expense if:

  • A scan is done as part of a pre-operative work-up for a planned surgical procedure.
  • A scan is needed for conservative back and neck treatment during an approved admission. Specific rules and limits apply to conservative back and neck scans.

Scans done as part of an approved admission

We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.

Other scans

If it is not related to your admission or for conservative back and neck treatment, we pay an upfront deductible of R3 040 from the available funds in your Medical Savings Account and the balance from your Hospital Benefit, up to the Discovery Health Rate. For conservative back and neck scans a limit of one scan per spinal and neck region applies.

Cover for pathology

Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for out-of-hospital pathology expenses from your available funds in your Medical Savings Account.

Cover for investigations

We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.

  • You must pay an upfront deductible of R5 000. We cover the balance of the hospital and related accounts from your Hospital Benefit. If performed outside of the Smart Day Surgery network, you must pay an upfront deductible of R9 650.
  • If both a gastroscopy and colonoscopy is performed in the same admission, you must pay an upfront deductible of R6 250. We cover the balance of the hospital and related accounts from your Hospital Benefit.
  • If done in the doctor's rooms, you will not have to pay an amount upfront. We pay the account from the hospital benefit.
Cover for radiology

X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

You need to pay for out-of-hospital radiology expenses.

Cover for MRI/CT Scans

Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.

We pay for scans as an out-of-hospital expense if:

  • A scan is done as part of a pre-operative work-up for a planned surgical procedure.
  • A scan is needed for conservative back and neck treatment during an approved admission. Specific rules and limits apply to conservative back and neck scans.

Scans done as part of an approved admission

We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.

Other scans

Classic Smart: if not related to your admission or for conservative back and neck treatment, you will have to pay an upfront deductible of R3 040 and the balance will be paid up to the DHR. For conservative back and neck scans a limit of one scan per spinal and neck region applies.

Essential Smart: if not related to your admission or if for conservative back and neck treatment, we do not pay for it.

Cover for pathology

Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

You need to pay for out-of-hospital pathology expenses.

Cover for investigations

We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.

  • You must pay an upfront deductible of R5 000. We cover the balance of the hospital and related accounts from your Hospital Benefit.
  • If both a gastroscopy and colonoscopy is performed in the same admission, you must pay an upfront deductible of R6 250. We cover the balance of the hospital and related accounts from your Hospital Benefit.
  • If done in the doctor's rooms, you will not have to pay an amount upfront. We pay the account from your Hospital Benefit.
Cover for radiology

X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

You need to pay for out-of-hospital radiology expenses.

Cover for MRI/CT Scans

Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.

Scans done as part of an approved admission

We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.

Other scans

If it is not related to your admission, or for conservative back and neck treatment, we do not pay for it.

Cover for pathology

Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

You need to pay for out-of-hospital pathology expenses.

Cover for investigations

We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.

  • You have Prescribed Minimum Benefit (PMB) cover in the KeyCare Day Surgery Network (or KeyCare Start Day Surgery Network for KeyCare Start members).
  • Authorised scopes done in the doctor's rooms will be covered from your Hospital Benefit.
Cover for radiology

X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

On KeyCare Plus and KeyCare Start, we pay for a list of basic X-rays at a network provider. Your chosen GP must ask for the X-rays to be done.

Out-of-hospital radiology expenses are not covered on the KeyCare Core plan.

Cover for MRI/CT Scans

Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible.

We pay for scans as an out-of-hospital expense if:

  • A scan is done as part of a pre-operative work-up for a planned surgical procedure.
  • A scan is needed for conservative back and neck treatment during an approved admission. Specific rules and limits apply to conservative back and neck scans.

Scans done as part of an approved admission

We pay your accounts up to a maximum of the Discovery Health Rate for approved hospital admissions at a network hospital.

Other scans

KeyCare Plus and KeyCare Core: Your approved scan is paid from your Specialist Benefit, up to a limit of R4 400 per person per year. Your chosen GP must refer you to a specialist and you need a reference number from us before your consultation with the specialist.

KeyCare Start: Your approved scan is paid from your Specialist Benefit, up to a limit of R2 200 on KeyCare Start per person per year. Your chosen GP must refer you to a specialist and you need a reference number from us before your consultation with the specialist.

Please note that there is no benefit for MRI and CT scans related to conservative back or neck treatment on the KeyCare plans.

Cover for pathology

Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.

In-hospital

We cover up to the Discovery Health Rate (100%)

Out-of-hospital

We pay for a list of blood, urine and other fluid and tissue tests from a network provider. Your chosen GP must ask for these tests by filling in a KeyCare pathology form.

Out-of-hospital pathology expenses are not covered on the KeyCare Core plan

 
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