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Medical Aid Year: 
2020
Day to day Benefits: 

The Day-to-day Extender Benefit (DEB) extends your day-to-day
cover for essential healthcare services in our network

In Hospital Benefits
Hospital Rate of Payment: 
We pay for planned hospital stays fromyour Hospital Benefit. We pay for servicesrelated to your hospital stay, includingall healthcare professionals, services,medicines authorised by the Schemefor 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 servicesthat you may receive in an emergency:the ambulance (or other medical transport)the account from the hospitalthe accounts from the doctor who admittedyou to the hospitalthe anaesthetistany other h...
Specialists: 
Specialists we have a payment arrangement with The full account at the agreed rateSpecialists we don’t have a payment arrangement with and otherhealthcare professionalsUp to twice the Discovery Health Rate (100%)
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of the DHR
Radiology and pathology: 
The Discovery Health Rate (100%)
ICU and High Care: 
Prescribed Minimum Benefit (PMB) conditions in terms ofthe 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 conditionA defined lis...
Dialysis: 
We cover these expenses in full if we have approvedyour treatment plan and you use a provider in ournetwork. If you go elsewhere, we will pay up to 80%of the Discovery Health Rate (DHR).
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: 
No limit for planned hip and knee joint replacementsif you use a provider in our network.80% of the Discovery Health Rate (DHR) if you use a provideroutside our network up to a maximum of R30 000 for eachprosthesis 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 adefined list of procedures, with no upfront paymentand no overall limit. Certain procedures are coveredin our day surgery network. This benefit is subject toauthorisation 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 careproducts at any Clicks or Dis-Chem. Healthy Care items include a list of baby care, dentalcare, 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 personeach year. Three days per approved admission per personfor detoxification.
Treatment for Mental Health: 
21 days for admissions or up to 15 out-of-hospitalconsultations per person for major affective disorders. All mental health admissions are covered in full at a networkfacility. If you go elsewhere, we will pay up to 80% of theDiscovery Health Rate...
HIV / AIDS: 
are 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.You need to get your medicine from a DesignatedSe...
International Travel Benefit: 
You have cover for emergency medicalcosts of up to R5 million per personper journey while you travel outsideof South Africa. This cover is for aperiod of 90 days from your departurefrom South Africa. We may cover youat 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.

Basic dentistry: 
You need to pay a portion of your hospital or dayclinic account upfront for dental admissions.This amount varies, depending on your age andthe place of treatment. We pay the balance of thehospital account from your Hospital Benefit, upto 100% of...
MRI and CT Scans (Out of Hospital): 
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).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: 
2608.00
Total Contribution Adult: 
1962.00
Total Contribution Child*: 
1053.00
Coastal Saver
Risk Contributions
Risk Contribution Main Member: 
2608.00
Risk Contribution Child: 
1053.00