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.
Screening and Prevention
Preventive screening is important in making sure you detect medical conditions early and we can ensure the best care for you. The Screening and Prevention Benefit covers preventive tests, screenings and a seasonal flu vaccination (for members registered for certain chronic conditions and members over the age of 65) on all Discovery Health Medical Scheme Plans.
Having these specific tests (up to the specified number) does not affect your day-to-day benefits and you should not have any out-of-pocket expenses.
The tests that the Screening and Prevention Benefit covers
Tests covered by the benefit
The benefit covers the following tests:
- One mammogram (male and female)
- One Pap smear
- One prostate-specific antigen (PSA) test
- HIV blood tests, such as the Rapid, ELISA and Western blot
The Vitality Check
You also have cover for a group of tests called a Vitality Check, at one of our network pharmacies. The Vitality Check includes the following group of tests:
- Blood glucose
- Blood pressure
- Body mass index or weight assessment.
You can have one Vitality Check a year at a pharmacy in the Discovery Wellness Network.
Seasonal flu vaccination
You qualify for one seasonal flu vaccination each year if you are over the age of 65 or are registered for one of the below chronic conditions:
- Cardiac failure
- Chronic obstructive pulmonary disease (COPD)
- Chronic renal disease
- Coronary artery disease
- Diabetes (Types 1 and 2)
You must have all of the Vitality Check tests done at the same time at a pharmacy in the Discovery Wellness Network. The pharmacy will send the claim to Discovery Health. If you choose to have the tests done at any other provider, or separately, the costs of the tests will be paid from your day-to-day benefits, if available.
- The preventive tests, including the mammogram, Pap smear, prostate specific antigen and HIV tests are paid up to the Discovery Health Rate. You may be responsible for any shortfall if the healthcare provider charges more than the Discovery Health Rate.
- The Screening and Prevention Benefit does not cover the cost of any related consultations. Consultations are covered from the available funds in your day-to-day benefits.
- The Screening and Prevention Benefit covers the seasonal flu vaccines for members over the age of 65 and members registered for the specified chronic conditions only. Members who do not meet these criteria can still have a flu vaccination and this will be covered from the balance available in the Medical Savings Account.
- The Screening and Prevention Benefit covers one of each type of test in a year with the exception of HIV blood tests, which are unlimited. Further tests will be paid from your available day-to-day benefits.
- The preventive tests, screenings and flu vaccinations must be referred and done by an appropriately registered healthcare professional. You can visit any pathologist or radiologist to have the tests done.
- A liquid-based cytology Pap smear (code 4559) will be paid up to the Discovery Health Rate for a normal Pap smear (code 4566).
- You do not have to be a Vitality member to get cover for the Vitality Check from the Screening and Prevention Benefit. Only Vitality members will earn Vitality points for the screening tests.
- Find a pharmacy in the Discovery Wellness Network.
- Have the tests at a registered healthcare professional and make sure your pathology and radiology tests have been appropriately referred.
Go to hospital
Cover for all the costs while you are hospitalised is not automatic. When you know you are going to hospital, you need to tell us beforehand. You must preauthorise your admission to hospital at least 48 hours before you go in. In the event of an emergency please phone our DiscoveryCare Hospital Services on 0860 99 88 77 as soon as you can and follow the prompts to obtain approval.
Full Cover Choice
When you make the Full Cover Choice, you won’t be faced with any gaps or co-payments when you claim. Look out for the Full Cover Choice stamp – it shows you when you can make the Full Cover Choice and avoid co-payments.