What are External Medical Items?
External medical items are used to assist or substitute parts of the body that are non-functional or missing. These items can withstand repeated use and can be inserted and taken out without surgical intervention.
How we pay for external medical items
We pay for external medical items from your day-to-day benefits subject to an overall annual limit, which depends on your plan.
Additionally, members on Executive and Comprehensive plans can also apply for additional cover through the External Medical Items Extender Benefit when they have reached their overall annual EMI benefit limit.
External medical items are funded at 100% of the Discovery Health Rate up to an overall annual limit, which varies according to plan type.
Please select a plan series
How cover works:
External medical items are paid from the Medical Savings Account (MSA) and the Above Threshold Benefit (ATB), up to the annual family limit of R64,200
These are not separate benefits. The limit applies to the combined claims paid from both the MSA and the ATB.
If you join the Scheme after January, your allocation is pro-rated according to the number of months left in the year. For example, you will not receive the full R64,200 if you join mid-year.
You will need to pay for external medical items out of pocket if your MSA funds run out before you reach your Annual Threshold.
Important information to know:
You will have to pay claims for external medical items if the funds allocated to your Medical Savings Account (MSA) are used up before you reach the Annual Threshold.
This is not a separate benefit and limits apply to claims paid from your Medical Savings Account (MSA) and Above Threshold Benefit (ATB). This limit will be adjusted if you join the Scheme after January.
Frequency Limits for External Medical Items
Certain categories of external medical items have a frequency limit. The limit will be prorated if a beneficiary joins after 1 January.
-
APAP's (Automatic Positive Airway Pressure)
CPAP's (Contiunous Positive Airway Pressure)
VPAP's (Variable Positive Airway Pressure)One every three (3) years
-
Apnoea and movement monitors
One per year
-
Blood pressure monitors
One every year
-
Breast Pump
One per year
-
Commode
One per year
-
Crutches
Two individual crutches or one pair per year
-
Glucometers
One per year
-
Hoist
One every two (2) years
-
Insulin Pump (entry level and sensor augmented pumps)
One every four (4) years
-
Nebulisers
One per year
-
Portable Oxygen Concentrator
One every three (3) years
-
Walkers
One every three (3) years
-
Wheelchairs, scooters and other specialised appliances for members with physical disability
One every three (3) years
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products.
Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
External Medical Items Extender Benefit
Once you reach the annual EMI benefit limit of R64,200, you may apply for additional cover through the EMI Extender Benefit.
This is available for qualifying conditions and cover is funded from the Hospital Benefit only once your application has been reviewed and approved.
The EMI Extender Benefit covers a defined list of approved items that must be obtained from a preferred supplier, subject to frequency limits and clinical review.
How to apply for the External Medical Items Extender Benefit
You need to complete the External Medical Items Extender Benefit application form and email this through to us on Clinicalhelp@discovery.co.za.
EMI Extender benefit application form (PDF)How cover works:
External medical items are paid from your Medical Savings Account (MSA) and your limited Above Threshold Benefit (ATB), up to the annual family limit of R64,200 and available funds in your limited ATB.
These are not separate benefits. The limit applies to the combined claims paid from both the MSA and the ATB.
If you join the Scheme after January, your allocation is pro-rated for the remaining months of the year. For example, you will not receive the full R64,200 if you join mid-year.
You will need to pay for external medical items out of pocket if:
- Your MSA funds run out before you reach the Annual Threshold, or
- You have used up the limited ATB funds available.
Important information to know:
You will have to pay claims for external medical items if the funds allocated to your Medical Savings Account (MSA) are used up before you reach the Annual Threshold.
This is not a separate benefit and limits apply to claims paid from your Medical Savings Account (MSA) and Above Threshold Benefit (ATB). This limit will be adjusted if you join the Scheme after January.
Frequency Limits for External Medical Items
Certain categories of external medical items have a frequency limit. The limit will be prorated if a beneficiary joins after 1 January.
-
APAP's (Automatic Positive Airway Pressure)
CPAP's (Contiunous Positive Airway Pressure)
VPAP's (Variable Positive Airway Pressure)One every three (3) years
-
Apnoea and movement monitors
One per year
-
Blood pressure monitors
One every year
-
Breast Pump
One per year
-
Commode
One per year
-
Crutches
Two individual crutches or one pair per year
-
Glucometers
One per year
-
Hoist
One every two (2) years
-
Insulin Pump (entry level and sensor augmented pumps)
One every four (4) years
-
Nebulisers
One per year
-
Portable Oxygen Concentrator
One every three (3) years
-
Walkers
One every three (3) years
-
Wheelchairs, scooters and other specialised appliances for members with physical disability
One every three (3) years
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products.
Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
External Medical Items Extender Benefit
Once you have reached the annual EMI limit of R64,200 or depleted your limited ATB, you may apply for additional cover through the EMI Extender Benefit.
This additional cover is available for qualifying conditions and is funded from the Hospital Benefit once your application is reviewed and approved.
The EMI Extender Benefit applies only to a defined list of approved items, which must be obtained from a preferred supplier, and is subject to frequency limits and clinical review.
How to apply for the External Medical Items Extender Benefit
You need to complete the External Medical Items Extender Benefit application form and email this through to us on Clinicalhelp@discovery.co.za.
EMI Extender benefit application form (PDF)How cover works :
External medical items are covered from your Medical Savings Account (MSA) and limited Above Threshold Benefit (ATB), subject to the annual family limit for your plan and available funds in your ATB.
These are not separate benefits. The limit applies to the combined claims paid from both the MSA and the ATB.
If you join the Scheme after January, your EMI allocation is pro-rated for the remaining months of the year. For example, you will not receive the full annual EMI limit if you join mid-year.
You will need to pay for external medical items out of pocket if:
- Your MSA funds run out before you reach the Annual Threshold, or
- You have used up your limited ATB funds.
Important information to know:
This is not a separate benefit and limits apply to claims paid from your Medical Savings Account and Above Threshold Benefit. This annual limit will be adjusted if you join the Scheme after January.
Frequency Limits for External Medical Items
Certain categories of external medical items have a frequency limit. The limit will be prorated if a beneficiary joins after 1 January.
-
APAP's (Automatic Positive Airway Pressure)
CPAP's (Contiunous Positive Airway Pressure)
VPAP's (Variable Positive Airway Pressure)One every three (3) years
-
Apnoea and movement monitors
One per year
-
Blood pressure monitors
One every year
-
Breast Pump
One per year
-
Commode
One per year
-
Crutches
Two individual crutches or one pair per year
-
Glucometers
One per year
-
Hoist
One every two (2) years
-
Insulin Pump (entry level and sensor augmented pumps)
One every four (4) years
-
Nebulisers
One per year
-
Portable Oxygen Concentrator
One every three (3) years
-
Walkers
One every three (3) years
-
Wheelchairs, scooters and other specialised appliances for members with physical disability
One every three (3) years
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products.
Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
External Medical Items Extender Benefit
| EMI Limits on Priority Plans Plan |
Annual EMI limit (per family, per year) |
| Classic Priority | R43,000 |
| Essential Priority | R28,900 |
External Medical Items are covered from the available funds in your Medical Savings Account (MSA).
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products. Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
External Medical Items are covered from the available funds in your Medical Savings Account (MSA).
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products. Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
Not covered on these plans.
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products. Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
Not covered on these plans.
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products. Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.
Not covered on these plans.
Preferred Suppliers for External Medical Items
Please refer to the External Medical Items benefit guide for a full list of preferred suppliers for selected external medical items. Note that not all products supplied by these suppliers are preferred. Please contact us for the specific list of preferred products. Claims for non-preferred products, purchased from a preferred or non-preferred provider will be paid up to the applicable Discovery Health Rate.