Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% of Discovery Health Rate (DHR). If you use a Partial Cover Hospital Discovery pays 70% of cost. If the admission is a PMB, Discovery pays 80% of cost. No cover if you use a hospital outside of the KeyCare Network
Upfront Payments to hospitals:
If you use a KeyCare Partial Cover Hospital, you will have to pay 30% of the cost for a planned admission and 20% of the cost for a PMB admission
Casualty / Emergency Visits:
Approval required for one casualty visit pppa at a casualty unit at a KeyCare Network Hospital. You pay the first R390
Specialists:
Full cover for network specialists. 100% of DHR if not in the network
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
PMB only in KeyCare Day Surgery Network. Authorised scopes done in dr's rooms will be covered from the hospital benefit
MRI and CT scans:
If part of an approved admission 100% of DHR. If not related to admission or for back and neck treatment, paid from the Specialist Benefit up to the limit of R4 400 pppa
Dialysis:
When registered, a network provider will be allocated to you or you can go to a state facility. if you go elsewhere Discovery will pay 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:
Subject to registration on the Oncology Care Programme and treatment in the network. Cover is for a 12 month cycle from date of diagnosis. PMB's covered in full in the network. If you choose any other provider, you are covered up to 80% of DHR
Neck and Back Operations:
Medical and Surgical Appliances:
Cover for wheelchairs, their batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if they are from a network provider. There is an overall limit of R5 400 per family
Maternity Confinements:
Subject to pre-authorisation. Unlimited at 100% of DHR
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 KeyCare and Premier Plus HIV Network GP and Specialist to manage your condition to avoid a 20% co-payment
International Travel Benefit:
