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Medical Aid Year: 
2020
Day to day Benefits: 

Cover for medical emergencies when travelling.There is no overall limit for hospital
cover on the Core plans.You get comprehensive benefits
for maternity and early childhood
that cover certain healthcare
services before and after birth.Full cover for...

In Hospital Benefits
Hospital Rate of Payment: 
If you use doctors, specialists and otherhealthcare professionals that we havean agreement with, we will pay for theseservices in full. We pay up to 200% of theDiscovery Health Rate (DHR) on Classicplans, and up to 100% of the DHR forEssential ...
Hospitals: 

Hospital accounts are covered in full at the rate agreed upon with the hospital group.
No overall annual limit applies.
Provider - Any hospital, Ingwe Network hospitals or State hospitals

Upfront Payments to hospitals: 

We
pay for services related to your hospital
stay, including all healthcare professionals,
services, medicines authorised by the
Scheme for your hospital stay.

Casualty / Emergency Visits: 
We pay for all of the following medical servicesthat you may receive in an emergency:the ambulance (or other medical transport)the account from the hospital the accounts from the doctor who admittedyou to the hospitalthe anaesthetistany other ...
Specialists: 
If you use doctors, specialists and otherhealthcare professionals that we havean agreement with, we will pay for theseservices in full.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
We pay up to 200% of theDiscovery Health Rate (DHR) on Classicplans, and up to 100% of the DHR forEssential and Coastal plans for otherhealthcare professionals.
Radiology and pathology: 
The Discovery Health Rate (100%)
ICU and High Care: 
Prescribed Minimum Benefit (PMB) conditions in termsof the Medical Schemes Act 131 of 1998 and its Regulations,all medical schemes have to cover the costs related to thediagnosis, treatment and care of: An emergency medical condition A defined l...
Oncology / Cancer: 
If you are diagnosed with cancerand once we have approved yourcancer treatment, you are coveredby the Oncology Care Programme.We cover your approved cancertreatment over a 12-month cycle.We cover the first R200 000. If yourtreatment costs more...
Joint Replacements: 
MAJOR JOINT SURGERYNo limit for planned hip and kneejoint replacements if use a providerin our network.80% of the Discovery Health Rate if youuse a provider outside our network up to amaximum of R30 000 for each prosthesis foreach admission. T...
Prosthesis: 

There is no overall limit if you get your
prosthesis from our preferred suppliers.
A limit of R25 500 applies for the first
level and R51 000 for two or more levels,
limited to one procedure per person each
year outside of the network.

In Hospital Dentistry: 
You are responsible for paying the costof all dental appliances, their placementsand orthodontic treatment (including therelated accounts for orthognathic surgery).The Severe Dental and Oral Surgery Benefitcovers a defined list of procedures, wit...
Rehabilitation, Hospice and Step-down facilities: 
We pay for 21 days of rehabilitationper person each year. Three daysper approved admission per personfor detoxification.
Treatment for Mental Health: 
HIV / AIDS: 
If you are registered on the HIV programme, youare covered for the care you need, which includesadditional cover for social workers. You can beassured of confidentiality at all times. You have tosee a Premier Plus GP to avoid a 20% co-payment.Yo...
International Travel Benefit: 
You have cover for emergencymedical costs of up to R5 millionper person on each journey whileyou travel outside of South Africa.This cover is for a period of 90 daysfrom your departure from South Africa.We may cover you at equivalent localcost...
Day-to-day benefits
GP consultations: 

The Discovery Health Rate (100%)

Specialist consultations: 

Specialists we have an agreement with Up to rate we have agreed with the specialist
Specialists we do not have an agreement with The Discovery Health Rate (100%)

Acute medicine: 
Over-the-counter (OTC) Medicine: 

You can sign up for Healthy Care to get savings on
a vast range of personal and family
care products at any Clicks or Dis-Chem

Optometry benefits: 
You geta 20% discount for frames and lenses at an optometrist in your plan’snetwork of optometrists. You will receive the discount immediately when you pay.
Basic dentistry: 
You need to pay a portion of your hospitalor day clinic account upfront for dentaladmissions. This amount varies, dependingon your age and the place of treatment.We pay the balance of the hospital accountfrom your Hospital Benefit, up to 100%of...
Orthodontics: 

You are responsible for paying the cost
of all dental appliances, their placements
and orthodontic treatment (including the
related accounts for orthognathic surgery)

MRI and CT Scans (Out of Hospital): 
If it is not related to your admission, or for conservative back and neck treatment, we do not pay for it
Radiology and Pathology: 
The Discovery Health Rate (100%)
Chronic Conditions
Provider: 
You have access to treatment for a list of medicalconditions under the Prescribed Minimum Benefits(PMBs). The PMBs cover the 27 chronic conditionson the Chronic Disease List (CDL).
Chronic Conditions: 

Addison’s disease, asthma, Bipolar mood disorder, bronchiectasis, Cardiac failure,
cardiomyopathy, chronic obstructive pulmonary disease, chronic renal disease,
coronary artery disease, Crohn’s disease, Diabetes insipidus, diabetes Type 1,
diabete...

Total Contributions
Total Contribution Main Member: 
2449.00
Total Contribution Child*: 
980.00
Classic Core
Risk Contributions
Risk Contribution Child: 
980.00
Medical Aid Plan Name Term: 
Any