Trauma - Discovery

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.

What is trauma?

Trauma happens when a person is exposed to an extraordinary situation that causes physical and emotional after-effects. Someone doesn't have to be hurt to have experienced trauma. Witnessing any type of personal or environmental disaster or being threatened with an assault are also traumatic incidents. We offer cover after certain traumatic events as well as counselling support.

Discovery Trauma Support is available to assist you 24 hours a day, seven days a week. Mobile, face-to-face counselling (in Johannesburg, Pretoria, Durban and Cape Town) by trained counsellors is made possible by our fleet of dedicated Discovery Trauma Support vehicles.

Trauma Recovery Extender Benefit

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This benefit extends your cover for out-of-hospital claims related to certain traumatic events. Claims are paid from the Trauma Recovery Extender Benefit for the rest of the year in which the trauma occurred, as well as the year after the event occurred. You need to apply for this benefit. The Trauma Recovery Extender Benefit is available on all plans, except the Essential Smart Plan, the Core Series and KeyCare Core Plan.

How do I qualify?

You will have automatic access to this benefit if you meet the entry criteria (refer to the table below). The benefit will be activated after you have been admitted for one of the specific traumas and the event has been appropriately reviewed and your benefits approved.

You have to be a member of Discovery Health Medical Scheme at the time that the trauma happens to qualify for cover from the Trauma Recovery Extender Benefit. The benefit covers only the claims for the member who is registered for the benefit and claims that are related to the original diagnosis after the specific trauma.

Reason for not qualifying

You will not qualify for the Trauma Recovery Extender Benefit if the traumatic event happened in a previous benefit year while you were on a plan type that did not offer this benefit or while you were a member of another medical scheme.

How does the Trauma Recovery Extender Benefit work?

The Trauma Recovery Extender Benefits covers you for certain day-to-day medical costs resulting from any of the following events:

Crime-related injury

The condition must require an ICU stay of five days or more

Severe burns

The condition must require an ICU stay of five days or more

Poisoning

The condition must require an ICU stay of five days or more

Severe anaphylactic (allergic) reaction

The condition must require an ICU stay of five days or more

Conditions related to a near-drowning

The condition must require an ICU stay of five days or more

Loss of limb due to direct blunt force trauma

The condition must require an ICU stay of five days or more

External and internal head injuries

The condition must require an ICU stay of five days or more. We use Beta or FIMS* score indications to measure the severity of the physical trauma.

Paraplegia

Paralysis of the lower half of the body affecting both legs, due to blunt force injury to the spinal cord. Severe lessening of the strength or effectiveness of the limbs, shown by loss of reflexes, numbness and loss of motion in the spine. We use Beta or FIMS* score indications to measure the severity of the physical trauma.

Quadriplegia

Paralysis of both arms and legs due to blunt force injury to the spinal cord. Severe lessening of the strength or effectiveness of the limbs, shown by loss of reflexes, numbness and loss of motion in the spine. We use Beta or FIMS* score indications to measure the severity of the physical trauma.

*FIMS: Functional Independent Measure Scale – a universal measure of activities of daily living

The day-to-day costs that are covered

Allied, therapeutic and psychology healthcare services

Acousticians, biokineticists, chiropractors, counsellors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech-language therapists and audiologists

Medicine

Schedule 3 and above prescribed medicine

Radiology and pathology

Includes x-rays, scans, blood tests and other tests done in a laboratory

Medical devices and limb prostheses

External devices including wheelchairs and hearing aids

Day-to-day limits that apply to claims paid from your day-to-day benefits also apply to the Trauma Recovery Extender Benefit. Please refer to the benefit guide for the limits that apply to your health plan.

How we pay

The Trauma Recovery Extender Benefit provides cover up to the Discovery Health Rate, unless stated otherwise. The co-payment for MRI or CT scans that normally applies will not apply to scans that form part of treatment covered from the Trauma Recovery Extender Benefit.

Additionally, we will pay for prescribed medicine from the benefit, up to a certain limit which depends on your plan type. Please refer to the Trauma Recovery Extender Benefit guide for more information.

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