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
Cover:
External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit (ATB) subject to the limit of R64,200 per family per year. If you join the Scheme after January, your allocation will be prorated. You will not get the full R64,200, because it is calculated by counting the remaining months of the year.
Point-of-care medical devices not approved for cover from the Home Monitoring Device Benefit are paid at 100% of the Discovery Health Rate (DHR) from the available funds allocated to your Medical Savings Account and will accumulate and pay up to 75% of the DHR from the Above Threshold Benefit, subject to the annual External Medical Items limit.
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
-
TytoHome device
One every five (5) 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
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 you reach your overall annual External Medical items (EMI) benefit limit and you apply for cover.
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.
For a list of conditions and product categories for which we will consider applications for extended cover, please refer to the External Medical Items benefit guide.
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.
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)Cover:
External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit (ATB) subject to the limit of R64,200 per family per year. If you join the Scheme after January, your allocation will be prorated. You will not get the full R64,200, because it is calculated by counting the remaining months of the year.
Point-of-care medical devices not approved for cover from the Home Monitoring Device Benefit are paid at 100% of the Discovery Health Rate (DHR) from the available funds allocated to your Medical Savings Account and will accumulate and pay up to 75% of the DHR from the Above Threshold Benefit, subject to the annual External Medical Items limit.
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
-
TytoHome device
One every five (5) 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
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 you reach your overall annual External Medical items (EMI) benefit limit and you apply for cover.
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.
For a list of conditions and product categories for which we will consider applications for extended cover, please refer to the External Medical Items benefit guide.
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.
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)Classic plans:
External Medical Items are covered from available funds in your Medical Savings Account (MSA) and Above Threshold Benefit (ATB), subject to an annual limit subject to the External Medical Items (EMI) limit of R43,000 per family per year and the available funds in the limited Above Threshold Benefit (ATB). If you join the Scheme after January, your allocation will be prorated. You will not get the full R43,000, because it is calculated by counting the remaining months of the year.
Point-of-care medical devices not approved for cover from the Home Monitoring Device Benefit are paid at 100% of the Discovery Health Rate (DHR) from the available funds allocated to your Medical Savings Account and will accumulate and pay up to 75% of the DHR from the Above Threshold Benefit (ATB), subject to the annual External Medical Items (EMI) benefit limit.
Essential plans:
External Medical Items are covered from available funds in your Medical Savings Account and Above Threshold Benefit, subject to an annual limit and subject to the External Medical Items (EMI) limit of R28,900 per family per year and the available funds in the limited Above Threshold Benefit (ATB). If you join the Scheme after January, your allocation will be prorated. You will not get the full R28,900, because it is calculated by counting the remaining months of the year.
Point-of-care medical devices not approved for cover from the Home Monitoring Device Benefit are paid at 100% of the Discovery Health Rate (DHR) from the available funds allocated to your Medical Savings Account and will accumulate and pay up to 75% of the DHR from the Above Threshold Benefit (ATB), subject to the annual External Medical Items (EMI) benefit limit.
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
-
TytoHome device
One every five (5) 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 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.