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.
Getting the most out of your Discovery Health Medical Scheme plan
Making your money go further when it comes to medical costs is a matter of doing some research, planning upfront and having a few important conversations. Take the time to read through your health plan guide to understand exactly what benefits are available on your health plan and know how you are covered. Here are some tips that could save you a heap of money, so make the Full Cover Choice and avoid co-payments.
Use GPs and specialists we have payment arrangements with
You have full cover out-of-hospital when you go to a GP who Discovery Health Medical Scheme has a payment arrangement with. You can also benefit by using specialists who we have a payment arrangement with, specific to your plan, because we will cover their procedures in full. Find out if your healthcare professional has a payment arrangement with us and what rates they charge before you make an appointment. If you are on a KeyCare Plus or Access plan you have unlimited cover for GP consultations in the KeyCare Network. Use MaPS Advisor tool to find a healthcare professional who we have an arrangement with or are part of a network.
Visit hospitals in our networks
If you are on the KeyCare, Delta or Coastal plans, make sure you always use a hospital in your plan’s designated network to avoid unexpected co-payments. Use the MaPS Advisor tool to find a hospital in your health plan’s network. To make informed decisions, use the HospitalAdvisor tool to see how your procedure, attending healthcare professional and hospital admission will be covered. Once you have all the necessary information, call us to preauthorise your hospital stay.
Manage your day-to-day healthcare expenses wisely
The Executive, Comprehensive, Priority and Saver plans have a Medical Savings Account which empowers you to make informed decisions on how you spend on your day-to-day healthcare expenses. Make it a habit to always track your claims and benefit usage by logging in here. You can also download the Discovery app for members in the App store or Google Play store and keep an eye out for a claims notification in your inbox.
We extend your day-to-day cover once your MSA runs out
Once you have spent your annual Medical Savings Account allocation and before your claims add up to the Annual Threshold on certain plans, we extend your day-to-day cover through the Insured Network Benefit. This unique benefit covers GP consultation fees, blood tests, kid’s casualty cover, paediatrician video call consultations, maternity costs and some external medical items.
This benefit is only available on plans with a Medical Savings Account. Read more
Ask for medicine on the Discovery Preferred Medicine List
You can preserve your Medical Account Savings funds, avoid co-payments and enjoy full cover when claiming for medicine on the Preferred Medicine List. Ask your healthcare professional to prescribe medicine on our Preferred Medicine List or speak to your pharmacist.
If you are registered for the Chronic Illness Benefit, you’ll have full cover for approved medicine on Discovery Health’s medicine list or up to a set monthly amount (Chronic Drug Amount) for approved medicine not on our medicine list. If you’re on a Delta plan, you have full cover for approved chronic medicine when using MedXpress, Discovery Health’s convenient medicine delivery service. If you don’t use MedXpress, you will have to pay a 20% co-payment. KeyCare members have full cover for a list of chronic medicines on the KeyCare medicine list.
Prevention is better than cure
You and your children have access to screening and prevention benefits that cover tests to detect early warning signs of serious illness. Having these tests done helps you to stay healthy, because prevention is better than cure.
If you are on a KeyCare Plan here a few important things to remember to enjoy full cover
- Keep your membership card with you at all times as it identifies you as a KeyCare member. Your membership card gives you access to your benefits.
- Only visit your chosen GP in the KeyCare network as you have full cover for consultations and some minor procedures when you visit them.
- Make sure you always use hospitals in the KeyCare network. If you don’t go to a KeyCare network hospital for planned admissions, you will have to pay the claims yourself.
- If your GP decides you have to see a specialist, your GP will get approval from us so that you can go to the specialist.