Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% of Discovery Health Rate (DHR)
Upfront Payments to hospitals:
If you use a hospital outside of the Smart Hospital Network there will be an upfront payment of R9 650. Admissions to a facility outside of the Smart Day Surgery Network results in an upfront payment of R9 650
Casualty / Emergency Visits:
Specialists:
Full cover for specialists we have a payment arrangement with. Other specialists at 100% of DHR
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
You pay the first R5 000 of the account if done in a day surgery. If both a gastro-and colonoscopy are performed in the same admission amount rises to R6 250. Outside of the day surgery an upfront payment of R9 650 applies No upfront payment in dr's rooms
MRI and CT scans:
100% of DHR, if done as part of an approved admission. No benefit if not related to your admission. or for conservative back and neck treatment
Dialysis:
Covered at a provider in a state facility
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 R200 000 of your approved cancer treatment over a 12-month cycle, in full at 100% of DHR. If your treatment costs more than the cover amount, you pay 20% of the additional costs. Covered in the Discovery network
Neck and Back Operations:
Joint Replacements:
Limited to arthroscopies only
Medical and Surgical Appliances:
Maternity Confinements:
Subject to pre-authorisation. Unlimited at 100% of DHR
In Hospital Dentistry:
Cover for Severe Dental & Oral Surgery for a defined list of procedures only
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
HIV / AIDS:
Subject to registration on the HIV programme. Choose a Premier Plus HIV Network GP and Specialist to manage your condition to avoid a 20% co-payment
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
