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.
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:
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...
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...
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...
