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Medical Aid Year: 
2020
Day to day Benefits: 

These are the available funds allocated to the Medical Savings Account (MSA).The Day-to-day Extender Benefit (DEB)
extends your day-to-day cover for essential
healthcare services in our network. You
also have cover for kids casualty visits

In Hospital Benefits
Hospital Rate of Payment: 
We pay for planned hospital stays from your Hospital Benefit. We pay for services related to your hospital stay, including all healthcare professionals, services, medicines authorised by the Scheme for your hospital stay.
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: 

Upfront payment for a defined list of procedures performed outside
of the day surgery network : you must pay an upfront payment of R5 500

Casualty / Emergency Visits: 
We pay for all of the following medical services that you may receive in an emergency: the ambulance (or other medical transport) the account from the hospital the accounts from the doctor who admitted you to the hospital the anaesthetist any other h...
Specialists: 
Specialists we have a payment arrangement with The full account at the agreed rate Specialists we don’t have a payment arrangement with and other healthcare professionals Up to twice the Discovery Health Rate (200%)
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Up to twice the Discovery Health Rate (200%)
Radiology and pathology: 
The Discovery Health Rate (100%)
ICU and High Care: 
Prescribed Minimum Benefit (PMB) conditions in terms of the Medical Schemes Act 131 of 1998 and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of: An emergency medical condition A defined lis...
Dialysis: 
We cover these expenses in full if we have approved your treatment plan and you use a provider in our network. If you go elsewhere, we will pay up to 80% of the Discovery Health Rate (DHR).
Oncology / Cancer: 
If you are diagnosed with cancer and once we have approved your cancer treatment, you are covered by the Oncology Care Programme. We cover your approved cancer treatment over a 12-month cycle. We cover the first R200 000. If your treatment costs more...
Joint Replacements: 
No limit for planned hip and knee joint replacements if you use a provider in our network. 80% of the Discovery Health Rate (DHR) if you use a provider outside our network up to a maximum of R30 000 for each prosthesis for each admission. The network...
Prosthesis: 

No limit if you get your prosthesis from a provider in our
network or up to R41 700 if you use a provider outside
our network.There is no overall limit if you get your prosthesis from our
preferred suppliers. A limit of R25 500 applies for the first
...

In Hospital Dentistry: 
The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limit. Certain procedures are covered in our day surgery network. This benefit is subject to authorisation and the Scheme’s rules.W...
Take home 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. Healthy Care items include a list of baby care, dental care, eye care, foot care, sun care and hand care products, as well...
Rehabilitation, Hospice and Step-down facilities: 
We pay for 21 days of rehabilitation per person each year. Three days per approved admission per person for detoxification."We pay for 21 days of rehabilitation per person each year. Three days per approved admission per person for detoxification."
Treatment for Mental Health: 
21 days for admissions or up to 15 out-of-hospital consultations per person for major affective disorders. All mental health admissions are covered in full at a network facility. If you go elsewhere, we will pay up to 80% of the Discovery Health Rate...
HIV / AIDS: 
are covered for the care you need, which includes additional cover for social workers. You can be assured of confidentiality at all times. You have to see a Premier Plus GP to avoid a 20% co-payment. You need to get your medicine from a Designated Se...
International Travel Benefit: 
You have cover for emergency medical costs of up to R5 million per person per journey while you travel outside of South Africa. This cover is for a period of 90 days from your departure from South Africa. We may cover you at equivalent local costs fo...
Day-to-day benefits
GP consultations: 

We pay your day-to-day medical expenses such as GP and specialist consultations, medicine (excluding
registered chronic medicine), radiology and pathology from your available funds allocated to your MSA.
Any amount that is left over will carry over t...

Specialist consultations: 

If you use doctors, specialists and other
healthcare professionals that we have
an agreement with, we will pay for these
services in full. We pay up to 200% of the
Discovery Health Rate (DHR) on Classic
plans, and up to 100% of the DHR for
Essential ...

Acute medicine: 

You have full cover if you use a network provider
for approved chronic medicine on our medicine list.
For medicine not on our list, we cover you up to a
set monthly rand amount called the Chronic
Drug Amount (CDA).

Over-the-counter (OTC) Medicine: 

We pay for medicine up to a maximum of
the Discovery Health Rate (DHR). The DHR
for medicine is the price of the medicine and
the fee for dispensing it.

Optometry benefits: 
Basic dentistry: 
You need to pay a portion of your hospital or day clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment. We pay the balance of the hospital account from your Hospital Benefit, up to 100% of...
MRI and CT Scans (Out of Hospital): 
Up to the Discovery Health Rate (DHR) if the scan is related to your hospital admission from your Hospital Benefit If it is not related to your admission or for conservative back and neck treatment, we pay the first R3 040 from your available day-to-...
Radiology and Pathology: 
The Discovery Health Rate (100%)
Chronic Conditions
Provider: 
You have access to treatment for a list of medical conditions under the Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List (CDL). Our plans offer benefits that are richer than PMBs. To access PMBs...
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,
diabetes Type...

Total Contributions
Total Contribution Main Member: 
3290.00
Total Contribution Adult: 
2596.00
Total Contribution Child*: 
1318.00
Classic Saver
Risk Contributions
Risk Contribution Main Member: 
3290.00
Risk Contribution Child: 
1318.00