Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
If you use a hospital in the Partial Cover Network, we pay up to 70% of the Discovery Health Rate. Non-network hospitals We will not pay the hospital and related accounts if you are admitted to a non-network hospital for a planned admission. If the admission is a Prescribed Minimum Benefit, we will pay 80% of the Discovery Health Rate.
Casualty / Emergency Visits:
Other than for emergencies and trauma, each person can go to casualty at one of the KeyCare network hospitals once a year. You have to pay the first R325 of the consultation. Subject to pre-authorisation.
Specialists:
In our network, full cover. Not in our network 100% of the Discovery Health Rate. If they charge above the Discovery Health Rate you must pay the balance of the account.
Other healthcare professionals eg. Physio, Occupational, Dietician:
In our network, full cover. Not in our network 100% of the Discovery Health Rate. If they charge above the DHR you must pay the balance of the account.
Radiology and pathology:
100 % of Discovery Health Rate.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
We cover scopes at our network of contracted state facilities and in the KeyCare Access Hospital Network if related to emergencies, trauma, childbirth and care for a newborn.
MRI and CT scans:
If done as part of an approved admission, we will pay up to 100% of the Discovery Health Rate from the Hospital Benefit. If not related to your admission, we pay it from the Specialist Benefit up to a limit of R3 860 each person each year.
ICU and High Care:
100 % of Discovery Health Rate.
Dialysis:
Once you are registered, we will allocate you to a network provider or you can go to a state facility. If you go elsewhere, we will pay up to 80% of the Discovery Health Rate.
Oncology / Cancer:
We cover cancer treatment according to the Prescribed Minimum Benefits in a network of contracted state facilities.
Neck and Back Operations:
No Benefit except for Prescribed Minimum Benefits.
Joint Replacements:
No Benefit except for Prescribed Minimum Benefits.
Medical and Surgical Appliances:
We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. Overall limit of R5 400 for each family.
Maternity Confinements:
100 % of Discovery Health Rate in a network hospital. You do not have to go to a state facility.
Rehabilitation, Hospice and Step-down facilities:
21 days for each person in our contracted network of state facilities.
Treatment for Mental Health:
21 days for admissions or 15 out-of-hospital consultations for each person for major affective disorders, anorexia and bulimia, & up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma in a state facility
HIV / AIDS:
When you register for our HIVCare Programme, you are covered for the care you need, which includes additional cover for social workers. Be assured of confidentiality at all times. You need to get your medicine from a DSP to avoid a 20 % co-payment.
International Travel Benefit:
