Hospital Rate of Payment:
We pay for planned hospital stays from
your Hospital Benefit. We pay for services
related to your hospital stay, including
all healthcare professionals, services,
medicines authorised by the Scheme
for 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 R8 400
Casualty / Emergency Visits:
We pay for all of the following medical services
that you may receive in an emergency:
the ambulance (or other medical transport)
the account from the hospital
the accounts from the doctor who admitted
you to the hospital
the anaesthetist
any other h...
Specialists:
Specialists we have a payment arrangement with The full account at the agreed rate
Specialists we don’t have a payment arrangement with and other
healthcare professionals
Classic plans: Up 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 of
the Medical Schemes Act 131 of 1998 and its Regulations,
all medical schemes have to cover the costs related to the
diagnosis, treatment and care of:
An emergency medical condition
A defined lis...
Dialysis:
We cover these expenses in full if we have approved
your treatment plan and you use a provider in our
network. If you go elsewhere, we will pay up to 80%
of the Discovery Health Rate (DHR).
Oncology / Cancer:
If you are diagnosed with cancer
and once we have approved your
cancer treatment, you are covered
by the Oncology Care Programme.
We cover your approved cancer
treatment over a 12-month cycle.
We cover the first R200 000. If your
treatment costs more...
Joint Replacements:
No limit for planned hip and knee joint replacements
if you use a provider in our network.
80% of the Discovery Health Rate (DHR) if you use a provider
outside our network up to a maximum of R30 000 for each
prosthesis for each admission.
The network...
In Hospital Dentistry:
The Severe Dental and Oral Surgery Benefit covers a
defined list of procedures, with no upfront payment
and no overall limit. Certain procedures are covered
in our day surgery network. This benefit is subject to
authorisation and the Scheme’s rules.W...
Take home Medicine:
You can sign up for Healthy Care to get savings on a vast range of personal and family care
products at any Clicks or Dis-Chem. Healthy Care items include a list of baby care, dental
care, eye care, foot care, sun care and hand care products, as well...
Rehabilitation, Hospice and Step-down facilities:
We pay for 21 days of rehabilitation per person
each year. Three days per approved admission per person
for detoxification.
Treatment for Mental Health:
21 days for admissions or up to 15 out-of-hospital
consultations per person for major affective disorders. All mental health admissions are covered in full at a network
facility. If you go elsewhere, we will pay up to 80% of the
Discovery Health Rate...
HIV / AIDS:
are covered for the care you need, which includes
additional cover for social workers. You can be
assured of confidentiality at all times. You have to
see a Premier Plus GP to avoid a 20% co-payment.
You need to get your medicine from a Designated
Se...
International Travel Benefit:
You have cover for emergency medical
costs of up to R5 million per person
per journey while you travel outside
of South Africa. This cover is for a
period of 90 days from your departure
from South Africa. We may cover you
at equivalent local costs fo...
