The External Medical Items (EMI) Benefit

We pay for external medical items from your Medical Savings Account (MSA) and Above Threshold Benefit (ATB) subject to funds being available and subject to the overall annual External Medical Items (EMI) limit, which depends on your health plan.

The Classic Comprehensive Zero MSA Plan does not have a Medical Savings Account and so there is no benefit for external medical items until you reach the Annual Threshold. After this, we pay claims from the Above Threshold Benefit, up to the overall annual EMI limit.

Please refer to your plan specific benefits to see your applicable limits.

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 refer to benefits available on the “Benefits available for your plan” section to see the limit applicable to your health plan.

External medical items with a frequency limit

Certain categories of external medical items have a frequency limit:

Product category Frequency limit
Wheelchairs,Scooters and other specialized appliances for members with physical disability One every three (3) years
Crutches Two individual crutches or one pair per year
Hoist One every 2 years
Commode One per year
Walkers One every three (3) years
CPAP's/APAP's/VPAP's One every three (3) years
Nebulisers One per year
Portable Oxygen Concentrator One every three (3) years
Insulin Pump (Entry level and Sensor Augmented pumps) One every four (4) years
Breast Pump One per year
Blood Pressure Monitors One per year
Glucometers One per year
Apnoea and Movement monitors One per year
Preferred suppliers for external medical items

The below table is a list of preferred suppliers for selected external medical items.

Note, 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 form a preferred or non-preferred provider will be paid up to the applicable reference price.

Preferred items Network providers Network provider contact details
Mobility and specialised appliances:
  • Standard wheelchair
  • Lightweight wheelchair

Motorised wheelchair

  • Specilaised Appliances  such as
  • Customised wheelchairs
  • Activity chairs
  • Gait trainers
  • Buggy’s
  • Standing frames
  • Scooters
  • Walkers
 CE Mobility (Practice number: 0063762) 086 023 6624
Chairman Industries (Practice number: 0063762) 011 624 122/3/4
MedOp (Practice number: 0057940)

011 827 5893

Breathing devices:

  • CPAP machines
  • APAP machines
  • VPAP/BI Level machines
 Ecomed (Practice number: 062510) 011 955 5710
VitalAire (Practice number: 0064459) 086 111 4578
SSEM Mthembu (Practice number: 0065862) 011 430 7000
Afrox 011 490 0435
Mysleep 087 944 7133
Breathing devices through Resmed distributors:
Sleep Easy Equipment –Johannesburg 011 465 7351/6939
Sleepnet –Cape Town, Durban and part of Johannesburg 021 551 0325
Resqbreeze –Johannesburg 083 510 5179
Netcocare –Cape Town 0861 275 337
Fountains Circle Medical –Pretoria 012 362 4142/6009
CPAP Essentials Pretoria 012 346 0309
Garden Route Sleep Lab –Mossel bay 083 262 2307
Jan Le Roux Pieterse –Bloemfontein 083 324 9151
SK & A Medical –– Mpumalanga 084 707 0008
  • The CPAP Shop -
 012 346 0309
Maries CPAP Solutions  Pietermaritzburg 033 394 6456

Medisleep solutions Bloemfontein

082 572 9899

Portable Oxygen Concentrator

Ecomed

011 955 5710

VitalAire

086 111 4578

SSEM Mthembu

011 430 7000

Afrox

011 490 0435

Oxygen and General

011 234 7373

Purchase Insulin pumps

 Roche Diabetes Car 086 069 7867
Medtronic 012 426 4000
Ethitech 087 551 1685/ 021 855 0307

Rental Continuous Glucose Monitoring Systems( Insulin pumps)

Vitalaire

086 111 4578
www.vitalaire.co.za

External Medical Items Extender Benefit

If you are on the Executive and Comprehensive Plan you can apply for additional cover from the External Medical Items (“EMI”) Extender Benefit. The EMI Extender benefit gives members with specific severe, complex medical conditions extended cover for clinically appropriate and cost effective external medical items as determined by Discovery Health Medical Scheme, subject to the Scheme’s guidelines and managed care criteria.

The External Medical Items (EMI) Extender Benefit is only available after your reach your overall annual External Medical items (EMI) benefit limit and you apply for cover.

The application form must be completed by your treating healthcare professional e.g. physician or neurologist and must be accompanied by a physical assessment performed by an occupational therapist or physiotherapist. We also need a quotation of the required external medical item.

We will consider applications for extended cover for the below conditions and products categories. All cases will be reviewed on individual merit and on a case-by-case basis, with the severity of the condition and disability taken into account:

Conditions:

  • Hemiplegia or Paraplegia
  • Quadriplegia or Tetraplegia
  • Cerebral Palsy
  • Motor Neuron Disease
  • Parkinson’s disease (and other movement disorders of the basal ganglia)
  • Connective Tissue disorder
  • Severe injuries resulting in severe disability
  • Spinal-muscular atrophy.

Product categories:

  • Wheelchairs
    • Standard wheelchairs
    • Lightweight wheelchairs
    • Motorized wheelchairs
    • Specialised appliances
  • Wheelchair accessories eg: cushions, arm rests, foot rests, side panels etc.
  • Hoists
  • Posture support appliances ie Standing frames
  • Scooters.
  • Preferred Suppliers
    • CE Mobility - 086 023 6624
    • Chairman Industries - 011 624 122/3/4
    • Medop - 011 827 5893
How External Medical Items Extender Benefit accounts are paid?

When your application is approved for the External Medical Items Extender Benefit we will fund your claims up to the Discovery Health Rate for approved items. If your healthcare provider charges more than the Discovery Health Rate, you will need to pay the difference.

How to apply for the External Medical Items Extender Benefit?

You can complete the External Medical Items Extender Benefit application form available here. The completed application form can be sent to us by:

For more information on the External Medical Items Extender Benefit click here

Benefits available for your plan type

External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit, subject to the limit of R58 800 per family per year.

When your Medical Savings Account is used up and you are in the Self-Payment Gap, you are responsible to fund External Medical Items out of your own pocket.

The External Medical Items (EMI) Extender Benefit is paid from the Hospital benefit and is only available after the annual External Medical items (EMI) Benefit limit had been reached and you have applied for cover

Classic Comprehensive and Classic Delta Comprehensive

External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit, subject to the limit of R58 800 per family per year. The Classic Comprehensive Zero MSA Plan does not have a Medical Savings Account and so there is no benefit for External Medical Items until you reach the Annual Threshold. 

When your Medical Savings Account is used up and you are in the Self-Payment Gap, you are responsible to fund External Medical Items out of your own pocket.

The External Medical Items (EMI) Extender Benefit is paid from the Hospital benefit and is only available after the annual External Medical items (EMI) Benefit limit had been reached and you have applied for cover.

Essential Comprehensive and Essential Delta Comprehensive

External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit, subject to the limit of R39 400 per family per year.

When your Medical Savings Account is used up and you are in the Self-Payment Gap, you are responsible to fund External Medical Items out of your own pocket.

The External Medical Items (EMI) Extender Benefit is paid from the Hospital benefit and is only available after the annual External Medical items (EMI) Benefit limit had been reached and you have applied for cover.

The External Medical Items (EMI) Extender Benefit is paid from the Hospital benefit and is only available after the annual External Medical items (EMI) Benefit limit had been reached and you have applied for cover.

Classic:

External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit, subject to the limit of R39 400 per family per year and subject to the limited Above Threshold Benefit.

Essential:

External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit, subject to the limit of R26 450 and subject to the subject to the limited Above Threshold Benefit.

External Medical Items are covered from the available funds in your Medical Savings Account.

Not covered on these plans.

Not covered on these plans.

Not covered on these plans.

Contact us

You can call us on 0860 99 88 77 or visit www.discovery.co.za for more information.

Complaints process

The following channels are available for your complaints and we encourage you to follow the process:

Step1 – To take your query further: If you have already contacted the Discovery Health Medical Scheme and feel that your query has still not been resolved, please complete our online complaints form on www.discovery.co.za. We would also love to hear from you if we have exceeded your expectations.

Step 2 – To contact the Principal Officer: If you are still not satisfied with the resolution of your complaint after following the process in Step 1 you are able to escalate your complaint to the Principal Officer of the Discovery Health Medical Scheme. You may lodge a query or complaint with Discovery Health Medical Scheme by completing the online form on www.discovery.co.za or by emailing principalofficer@discovery.co.za.

Step 3 – To lodge a dispute: If you have received a final decision from Discovery Health Medical Scheme and want to challenge it, you may lodge a formal dispute. You can find more information of the Scheme’s dispute process on the website.

Step 4 – To contact the Council for Medical Schemes: Discovery Health Medical Scheme is regulated by the Council for Medical Schemes. You may contact the Council at any stage of the complaints process, but we encourage you to first follow the steps above to resolve your complaint before contacting the Council. Contact details for the Council for Medical Schemes: Council for Medical Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion 0157 | complaints@medicalschemes.com | 0861 123 267 |www.medicalschemes.com

 

 

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