Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
You pay the first R4 550 of the hospital account and we pay the balance of the hospital account and related accounts from the Hospital Benefit. If done in the doctor’s rooms, you won’t have to pay an amount upfront. We pay the account from the Hospital Benefit. If performed outside of the day surgery network facilities an upfront payment of R5 000
Casualty / Emergency Visits:
Specialists:
Specialists we have a payment arrangement with Full cover Specialists we don’t have a payment arrangement with and other healthcare professionals 100% of the Discovery Health Rate (DHR)
Other healthcare professionals eg. Physio, Occupational, Dietician:
In our network, full cover. Not in our network 100% of the Discovery Health Rate.
Radiology and pathology:
100 % of Discovery Health Rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
You pay the first R4 550 of the hospital account, balance (and related accounts) from the Hospital Benefit. If done in doctor’s rooms, no upfront amount payable. Outside day surgery network, upfront payment of R7 650 on Delta options.
MRI and CT scans:
If related to your approved admission, they will pay up to 100% of the Discovery Health Rate from the Hospital Benefit.If not related to your admission or if for conservative back or neck treatment, they do not pay for it.
ICU and High Care:
100 % of Discovery Health Rate.
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.
Oncology / Cancer:
We cover the first R200 000 of the approved cancer treatment in full, over a 12-month cycle. You will be required to pay 20% of the cost on all further treatment once costs for cancer treatment go over R200 000. Prescribed Minimum Benefits fully covered.
Neck and Back Operations:
There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, a limit of R25 500 applies for the first level and R51 000 for two or more levels, limited to one procedure for each person each year.
Joint Replacements:
There is no overall limit if you get your prosthesis from our preferred suppliers. If you choose not to, certain limits may apply to each prosthesis.
Medical and Surgical Appliances:
Maternity Confinements:
100 % of Discovery Health Rate.
In Hospital Dentistry:
Upfront payment. Balance of hospital account, dental surgeon & related accounts 100% of the DHR. Dental appliances & orthodontic treatment incl related accounts for orthognathic surgery we pay from your savings if you have money available.
Take home Medicine:
If collected before discharge from hospital from hospital benefit. If collected after discharge from hospital, from own pocket.
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
21 days for admissions or up to 15 out-of-hospital consultations for each person for major affective disorders, anorexia and bulimia, and up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma.
HIV / AIDS:
When you register for our HIVCare Programme, you are covered for the care you need, which includes additional cover for social workers. Be assured of confidentiality at all times. You need to get your medicine from a DSP to avoid a 20 % co-payment.
International Travel Benefit:
Cover up to R5 million for each person on each journey for emergency medical costs while travelling outside of South Africa, for a period of 90 days from your departure from South Africa. Specific rules apply and pre-existing conditions are excluded.
