Hospital Rate of Payment:
If you use doctors, specialists and otherhealthcare professionals that we havean agreement with, we will pay for theseservices in full. We pay up to 200% of theDiscovery Health Rate (DHR) on Classicplans, and up to 100% of the DHR forEssential ...
Upfront Payments to hospitals:
We
pay for services related to your hospital
stay, including all healthcare professionals,
services, medicines authorised by the
Scheme for your hospital stay.
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 hospital the accounts from the doctor who admittedyou to the hospitalthe anaesthetistany other ...
Specialists:
If you use doctors, specialists and otherhealthcare professionals that we havean agreement with, we will pay for theseservices in full.
Other healthcare professionals eg. Physio, Occupational, Dietician:
We pay up to 200% of theDiscovery Health Rate (DHR) on Classicplans, and up to 100% of the DHR forEssential and Coastal plans for otherhealthcare professionals.
Radiology and pathology:
The Discovery Health Rate (100%)
ICU and High Care:
Prescribed Minimum Benefit (PMB) conditions in termsof the 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 condition A defined l...
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:
MAJOR JOINT SURGERYNo limit for planned hip and kneejoint replacements if use a providerin our network.80% of the Discovery Health Rate if youuse a provider outside our network up to amaximum of R30 000 for each prosthesis foreach admission. T...
In Hospital Dentistry:
You are responsible for paying the costof all dental appliances, their placementsand orthodontic treatment (including therelated accounts for orthognathic surgery).The Severe Dental and Oral Surgery Benefitcovers a defined list of procedures, wit...
Rehabilitation, Hospice and Step-down facilities:
We pay for 21 days of rehabilitationper person each year. Three daysper approved admission per personfor detoxification.
Treatment for Mental Health:
21 days for all other mentalhealth admissions.All mental health admissions are coveredin full at a network facility. If you goelsewhere, we will pay up to 80% ofthe Discovery Health Rate (DHR)for the hospital account.
HIV / AIDS:
If you are registered on the HIV programme, youare 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.Yo...
International Travel Benefit:
You have cover for emergencymedical costs of up to R5 millionper person on each journey whileyou travel outside of South Africa.This cover is for a period of 90 daysfrom your departure from South Africa.We may cover you at equivalent localcost...
