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Classic Delta Comprehensive

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Type of Medical Aid Plan: 
Medical Aid Year: 
Day to day Benefits: 

Day-to-day medical expenses such as GP and specialist consults, acute medicine, radiology and pathology are paid from the available funds in your Medical Savings Account- MSA, which is 15% of your monthly contribution. When your MSA runs out and before you reach the Annual Threshold-AT amount, you will have a Self-Payment Gap-SPG, where you pay claims from your pocket. Claims must still be sent to Discovery during this time. There is a Day-to-Day Extender Benefit-DEB, which pays for certain day-to-day benefits after your MSA runs out. It covers unlimited pharmacy clinic consultations in the Discovery wellness network, supported by video call consultations with a network GP. There is also cover for consultations with a network GP who meets the digital criteria, when referred. Paid at DHR. The scheme pays for day-to-day healthcare services once you reach your Annual Threshold. The Above Threshold Benefit-ATB is unlimited. Annual benefit limits may apply and are subject to a full calendar year membership. You also have additional cover for 2 kids casualty visits for children under 10

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Hospital Rate of Payment: 
Unlimited at 100% of Discovery Health Rate (DHR)

Delta Hospital Network

Upfront Payments to hospitals: 

If you use a hospital outside of the Delta Hospital Network there will be an upfront payment of R8 400

Casualty / Emergency Visits: 
Emergencies are covered in full, if the treatment meets the Discovery Health criteria. Cover for 2 kids casualty visits for children under 10
Full cover for specialists we have a payment arrangement with. Other specialists at 200% of DHR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited at 200% of DHR
Radiology and pathology: 
Unlimited at 100% of DHR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
The first R4 100 of the hospital account is paid from your day-to-day benefits. If both a colonoscopy and gastroscopy are performed in the same admission the amount increases to R5 150. No upfront payment if done in doctor's rooms
MRI and CT scans: 
100% of DHR, if done as part of an approved admission. If not related to your admission. or for conservative back and neck treatment, the first R3 040 is paid from your day-to-day benefits. Limits apply
ICU and High Care: 
Unlimited at 100% of DHR
Covered in full if treatment is approved and you use a network provider. If a non-network provider is used Discovery pays up to 80% of DHR
Organ Transplants: 
Cover for transplant surgery explained on authorisation request. Discovery pay for appropriate, approved work-up costs for recipient, procurement of organ and necessary tests done on donor before harvesting organ, even if donor is not a member of DH
Oncology / Cancer: 
Cover for the first R400 000 of your approved cancer treatment over a 12-month cycle in full at 100% of DHR. Cancer treatment that is a PMB is covered in full and adds up to the cover amount. 80% cover for additional costs
Neck and Back Operations: 
No overall limit if you get your prosthesis from a preferred supplier. Limited to 1 procedure per beneficiary per annum
Joint Replacements: 
No overall limit if you use a provider in the network

Cochlear implants, auditory brain implants and processors; R233 700 per beneficiary, per benefit: Internal nerve stimulators; R160 500 per beneficiary: Shoulder Joint; if you use a non-network provider, up to R41 700: Major joint surgery; if you use a non-network provider, 80% of DHR up to a maximum of R30 000 per prosthesis, per admission: Spinal surgery; if you use a non-network provider, limited to R25 500 for 1st level and R51 000 for 2 or more levels

Medical and Surgical Appliances: 
Limited to available day-to-day benefits and annual benefit limits. External items up to R58 800 per family. Hearing aids up to R25 800 per family
Maternity Confinements: 
Subject to pre-authorisation. Unlimited at 100% of DHR. Private ward cover of R2 150 per day
In Hospital Dentistry: 
Upfront payments for dental admissions, dependant on age & place of treatment. Balance of hospital & related accounts are paid at 100% of DHR. Limited to R29 850 pppa. Severe Dental & Oral Surgery has a separate benefit for a defined list of procedures
Take home Medicine: 
Subject to day-to-day benefits
Rehabilitation, Hospice and Step-down facilities: 
21 days of rehabilitation per person per annum. 3 days per approved admission per person for detoxification
Treatment for Mental Health: 
Covered in full at a network facility, or up to 80% of DHR at non-network facilities. Protocols apply. Up to 21 days for admissions or up to 15 out-of-hospital consultations pp
Subject to registration on the HIV programme. Choose a Premier Plus HIV Network GP and Specialist to manage your condition and avoid a 20% co-payment
Ambulance Service: 
Netcare 911
International Travel Benefit: 
Cover up to R5 million per person, per journey, for a period of 90 days, for emergency medical costs while travelling outside of SA
Day-to-day benefits
GP consultations: 

Subject to day-to-day benefits. MSA - Medical Savings Account, SPG - Self-Payment Gap, Day-to-Day Extender Benefit - DEB and unlimited ATB - Above Threshold benefit. Paid at 100% of DHR

Specialist consultations: 

Subject to day-to-day benefits: MSA, SPG and unlimited ATB. Paid at 100% of DHR

Acute medicine: 

Subject to day-to-day benefits: MSA, SPG, unlimited ATB and prescribed medicine limit. Paid at 100% of DHR

Over-the-counter (OTC) Medicine: 

Subject to MSA. These claims do not add up to the Annual Threshold and are not paid from the unlimited ATB

Optometry benefits: 
Subject to day-to-day benefits: MSA, SPG, unlimited ATB and annual optical limit of up to R6 000 pp
Basic dentistry: 
Subject to day-to-day benefits: MSA, SPG and unlimited ATB
Specialised Dentistry: 
Subject to day-to-day benefits: MSA, SPG, unlimited ATB and annual Dental appliance and Orthodontic treatment limit of R29 850 pp

Subject to day-to-day benefits: MSA, SPG, unlimited ATB and annual Dental appliance and Orthodontic treatment limit of R29 850 pp

MRI and CT Scans (Out of Hospital): 
The first R3 040 of the scan is paid from your day-to-day benefits. The balance is paid from the Hospital Benefit, up to 100% of DHR. A limit of 1 scan applies for conservative back and neck scans
Radiology and Pathology: 
Subject to day-to-day benefits: MSA, SPG and unlimited ATB
Pregnancy benefits: 
12 antenatal consultations, 2 x 2D scans, including 1 x nuchal translucency test. A defined basket of blood tests. 5 x antenatal or postnatal classes or consultations with a registered nurse up to 2 years after giving birth
Physiotherapy and Occupational Therapy day to day: 
Subject to day-to-day benefits: MSA, SPG, unlimited ATB and annual Allied, Therapeutic and Psychology benefit limits
Chronic Conditions
MedXpress Network Pharmacy
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes. Subject to approval by the Chronic Illness Benefit

Additional Chronic Conditions: 
23 extra conditions as per the Additional Disease List-ADL
Preventative Care Benefits
Preventative Benefits: 

Screening tests for adults and children at a wellness network provider. Age specific tests for: pap smear, mammogram, prostate and HIV screening tests. Flu vaccine during pregnancy and for members > 65 years. Bowel cancer screening tests for members 45-75 years

Total Contributions
Total Contribution Main Member: 
Total Contribution Adult: 
Total Contribution Child*: 
Classic Delta Comprehensive
Annual Medical Savings Account
Annual Medical Savings Main Member: 
Annual Medical Savings Adult: 
Annual Medical Savings Child*: 
Monthly Medical Savings
Savings Child*: 
Savings Adult: 
Savings Main Member: 
Annual Threshold Amounts
Annual Threshold Main Member: 
Annual Threshold Adult: 
Annual Threshold Child*: 
Risk Contributions
Risk Contribution Main Member: 
Risk Contribution Adult: 
Risk Contribution Child: