Tests and screenings

You can have peace of mind that we place you first with a focus on giving you comprehensive benefits, value for money and services to improve the quality of care available to you. As a Discovery Health Medical Scheme member you have access to the broadest and best level of healthcare cover in the market based on your medical condition needs.

Depending on your benefit option, LA Health provides cover for in- and out-of-hospital tests and screening, including investigations, radiology and blood tests.

Refer to your benefit guide for more information.

What is my cover for investigations?

  • We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
  • If a scope is done in hospital, an upfront payment or deductible applies to the hospital account. This amount is based on your health plan.
  • We pay all other approved accounts related to the procedure from the Hospital Benefit, according to your plan type.
  • If a scope is done in the doctor’s rooms, we refer to this as an out-of-hospital investigation. An upfront payment does not apply. We pay for the scope without using your day-to-day benefits.
  • Please call us to confirm your benefits at least 48 hours before having a procedure.
  • Investigations done in hospital. Your hospital account is covered in full. We pay related accounts from your available funds in your Medical Savings Account or Above Threshold Benefit, up to 300% of the Discovery Health Rate for specialists and up to 100% of the Discovery health Rate for other healthcare services.
  • Investigations done out of hospital. We pay related accounts from the Medical Savings Account or Above Threshold Benefit, up to 300% of the Discovery Health Rate for specialists and up to 100% of the Discovery Health Rate for other healthcare services.
  • Investigations done in hospital. We pay the first R3 400 of your hospital account from your available day-to-day benefits. We pay the balance of the hospital account and related accounts from the Hospital Benefit, up to 200% of the Discovery Health Rate on Classic Plans and 100% on Essential Plans.
  • Investigations done out of hospital. There is no overall limit to these services. We pay claims without using your day-to-day benefits as we pay the cost from the Hospital Benefit, up to 100% of the Discovery Health Rate.
  • Investigations done in hospital. You need to pay the first R3 900 of your hospital account upfront to the hospital. We pay the balance of the hospital account and related accounts from the Hospital Benefit, up to 200% of the Discovery Health Rate on Classic Plan and 100% on Essential Plan.
  • Investigations done out of hospital. There is no overall limit to these health services. We pay claims without using your day-to-day benefits as we pay the cost from the Hospital Benefit, up to 100% of the Discovery Health Rate.
  • Investigations done in hospital. We pay the first R4 200 of your hospital account from your available funds in your Medical Savings Account. We pay the balance of the hospital account and related accounts from the Hospital Benefit, up to 200% of the Discovery Health Rate on Classic Plans and 100% on Essential and Coastal Plans.
  • Investigations done out of hospital. There is no overall limit to these health services. We pay claims without using your Medical Savings Account as we pay this cost from the Hospital Benefit, up to 100% of the Discovery Health Rate.
  • Investigations done in hospital. You pay the first R4 200 of your hospital account. We pay the balance of the hospital account and related accounts from the Hospital Benefit, up to 200% of the Discovery Health Rate.
  • Investigations done out of hospital. There is no overall limit to these health services. We pay claims from the Hospital Benefit, up to 100% of the Discovery Health Rate.
  • Investigations done in hospital. You pay the first R4 200 of your hospital account. We pay the balance of the hospital account and related accounts from the Hospital Benefit, up to 200% of the Discovery Health Rate on Classic Plans and 100% on Essential and Coastal Plans.
  • Investigations done out of hospital. There is no overall limit to these health services. We pay claims from the Hospital Benefit, up to 100% of the Discovery Health Rate.
  • Investigations done in day-case facility. We will cover your scope our network of day-case facilities only. We pay all accounts, including the anaesthetist and surgeon’s accounts, from the Hospital Benefit up to 100% of the Discovery Health Rate.
  • Investigations done out of hospital. We pay all accounts like the surgeon’s accounts, from the Hospital Benefit up to 100% of the Discovery Health Rate.
  • On KeyCare Access we cover these procedures in our network of contracted state facilities and in the KeyCare Access Hospital Network if related to emergencies, trauma, childbirth or care for your baby in the KeyCare Access.

What is my cover for radiology?

X rays
  • X-rays can be done in-hospital as part of a planned admission.
  • X-rays can also be done out-of-hospital as part of your day-to-day benefits.
  • X-rays done in hospital and out of hospital. We pay claims from your available funds in your Medical Savings Account or your Above Threshold Benefit if you have reached your annual threshold up to the Discovery Health Rate.
  • X-rays done in hospital. We pay claims from your Hospital Benefit up to the Discovery Health Rate.
  • X-rays done out of hospital. We pay claims from your available funds in your Medical Savings Account or your Above Threshold Benefit if you have reached your annual threshold up to the Discovery Health Rate. On Classic Zero MSA, x-rays are covered once you reach your Annual Threshold.
  • X-rays done in hospital. We pay claims from your Hospital Benefit up to the Discovery Health Rate.
  • X-rays done out of hospital. We pay claims from your available funds in your Medical Savings Account or your limited Above Threshold Benefit if you have reached your annual threshold up to the Discovery Health Rate.
  • X-rays done in hospital. We pay claims from your Hospital Benefit up to the Discovery Health Rate.
  • X-rays done out of hospital. We pay claims from your available funds in your Medical Savings Account.
  • X-rays done in hospital. We pay claims from your Hospital Benefit up to the Discovery Health Rate.
  • X-rays done out of hospital. You need to pay for any x-rays done out-of-hospital.
  • X-rays done in hospital. We pay claims from your Hospital Benefit up to the Discovery Health Rate.
  • X-rays done out of hospital. You need to pay for any x-rays done out-of-hospital.
  • We pay for a list of basic x-rays at a network provider.
  • Your chosen GP must ask for the x-ray to be done.

What is my cover for MRI/CT scans?

  • Only a specialist or a trauma unit GP in our network may refer you for a MRI or CT scan.
  • Approved scans are covered from the Hospital Benefit.
  • If a scan is done as part of a pre-operative work-up for a planned surgical procedure, we pay for the scan as an out-of-hospital scan.
  • If a scan is needed for conservative back and neck treatment during an approved admission, we pay for the scan as an out-of-hospital scan.
  • Specific rules and limits apply to conservative back and neck scans*
  • Phone us to confirm the benefits and cover on your plan.
  • MRI and CT scans done in hospital. We pay claims from your available funds in your Medical Savings Account or Above Threshold benefit up to the Discovery Health Rate.
  • MRI and CT scans done out of hospital. We pay claims from your available funds in your Medical Savings Account or Above Threshold benefit up to the Discovery Health Rate.
  • MRI and CT scans done in hospital. We pay claims from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for your admission. If the scan is performed during an approved hospital admission, but the scan is not related to the reason for your admission, we pay for the scan as an out-of-hospital scan.
  • MRI and CT scans done out of hospital. We pay the first R2 750 for each scan from your available funds in your Medical Savings Account or Above Threshold Benefit. We pay the balance of the scan costs from the Hospital Benefit up to the Discovery Health Rate.

*For conservative back or neck treatment, we pay the first R2 750 of the scan from your available funds in your Medical Savings Account and Above Threshold Benefit. We pay the balance from the Hospital Benefit.

On Classic Zero MSA, MRI and CT scans for conservative back or neck treatment or if the scan is not related to your admission is covered once you reach your Annual Threshold.

  • MRI and CT scans done in hospital. We pay claims from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for your admission. If the scan is performed during an approved hospital admission, but the scan is not related to the reason for your admission, we pay for the scan as an out-of-hospital scan.
  • MRI and CT scans done out of hospital. We pay the first R2 750 for each scan from your available funds in your Medical Savings Account or limited Above Threshold Benefit. We pay the balance of the scan costs from the Hospital Benefit up to the Discovery Health Rate.

*For conservative back or neck treatment, you need to pay the first R3 050 of the hospital account. We will also pay the first R2 750 of the scan from your available funds in your Medical Savings Account or the limited Above Threshold Benefit. We pay the balance from the Hospital Benefit up to the Discovery Health Rate.

  • MRI and CT scans done in hospital. We pay claims from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for your admission. If the scan is performed during an approved hospital admission, but the scan is not related to the reason for your admission, we pay for the scan as an out-of-hospital scan.
  • MRI and CT scans done out of hospital. We pay the first R2 750 for each scan from your available funds in your Medical Savings Account or Above Threshold Benefit. We pay the balance of the scan costs from the Hospital Benefit up to the Discovery Health Rate.

*For conservative back or neck treatment, you must pay the first R2 750 of the scan from your available funds in your Medical Savings Account. We pay the balance from the Hospital Benefit.

  • MRI and CT scans done in hospital. We pay claims from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for your admission. If the scan is performed during an approved hospital admission, but the scan is not related to the reason for your admission, we pay for the scan as an out-of-hospital scan.
  • MRI and CT scans done out of hospital.You need to pay the first R2 750 for each scan from your pocket. We pay the balance of the scan costs from the Hospital Benefit up to 100% of the Discovery Health Rate.

*For conservative back or neck treatment, you must pay the first R2 750 of the scan from your pocket. We pay the balance from the Hospital Benefit up to 100% of the Discovery Health Rate.

  • MRI and CT scans done in hospital. We pay claims from the Hospital Benefit at 100% of the Discovery Health Rate, as long as the scan is related to the reason for your admission. If the scan is performed during an approved hospital admission, but the scan is not related to the reason for your admission, you will need to be pay for the cost of the scan from your own pocket.
  • MRI and CT scans done out of hospital. You do not have cover for scans done out-of-hospital.

*You are responsible for the costs if you’re admitted for conservative back or neck treatment.

  • MRI and CT scans done in hospital. We pay claims from the Hospital Benefit as long as the scan is related to the reason for your admission. If it is not related to an approved hospital admission, we pay it from your Specialist Benefit up to R3 860 for each person a year.
  • MRI and CT scans done out of hospital. We pay claims from the Specialist Benefit up to R3 860 for each person a year. A specialist or trauma GP must refer you. You must call us to get a reference number.

What is my cover for pregnancy scans?

  • You are allowed a maximum of two 2D scans during your pregnancy.
  • If you have a 3D or 4D scan it will only be paid up to the cost of a 2D scan.

We pay for pregnancy scans from your available funds in your Medical Savings Account or from your Above Threshold Benefit up to the Discovery Health Rate.

On Classic Comprehensive Zero MSA, pregnancy scans are covered once you reach your Annual Threshold.

You need to pay for pregnancy scans from your own pocket.

We pay for pregnancy scans from your available funds in your Medical Savings Account.

You need to pay for pregnancy scans from your own pocket.

We pay for one routine scan by your gynaecologist between 10 and 20 weeks of pregnancy from your Antenatal Benefit.

What is my cover for mammograms?

Executive, Comprehensive, Priority, Saver, Smart and Core plans
  • Mammograms are done out-of-hospital.
  • We pay for mammograms from your Screening Benefit up to the Discovery Health Rate.
  • We will not use your day-to-day benefits for this screening test. However, any consultations and related costs are paid from available day-to-day benefits.
  • Once you’ve reached the Screening Benefit limit, we will pay according to the cover on your plan.
KeyCare Series
  • We only cover mammograms on the KeyCare Plus Plans.
  • We pay for a mammogram if your chosen GP in the KeyCare GP network requests it.

What is my cover for pathology?

  • Blood tests done in hospital. We pay claims for your available funds in your Medical Savings Account or Above Threshold Benefit up to the Discovery Health Rate.
  • Blood tests done out of hospital. We pay claims for your available funds in your Medical Savings Account or Above Threshold Benefit up to the Discovery Health Rate.
  • Blood tests done in hospital. We pay claims from the Hospital Benefit up to the Discovery Health Rate. The tests must be part of your approved hospital admission.
  • Blood tests done out of hospital. We pay claims from your available funds in your Medical Savings Account or Above Threshold Benefit up to the Discovery Health Rate.

On Classic Zero MSA, blood tests are covered once you reach your Annual Threshold.

  • Blood tests done in hospital. We pay claims from the Hospital Benefit up to the Discovery Health Rate. The tests must be part of your approved hospital admission.
  • Blood tests done out of hospital. We pay claims from your available funds in your Medical Savings Account  up to the Discovery Health Rate.
  • Blood tests done in hospital. We pay claims from the Hospital Benefit up to the Discovery Health Rate. The tests must be part of your approved hospital admission.
  • Blood tests done out of hospital. You will have to pay for blood tests as you have no day-to-day cover.
  • Blood tests done in hospital. We pay claims from the Hospital Benefit up to the Discovery Health Rate. The tests must be part of your approved hospital admission.
  • Blood tests done out of hospital. You will have to pay for blood tests as you have no day-to-day cover.
  • Blood tests done in hospital. We pay claims from the Hospital Benefit up to the Discovery Health Rate. The tests must be part of your approved hospital admission.
  • Blood tests done out of hospital. We pay claims if your chosen GP in the KeyCare GP network requests the tests from the list of blood tests that we cover. Speak to your GP before you have a blood test.

We do not cover some blood tests, such as the ALCAT test. Find out what blood tests we cover by using Do We Cover

 

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