How it works

The Discovery Health Medical Scheme is the largest open medical scheme in South Africa, so you are in good hands.

Discovery Health understands the dynamics of the medical scheme industry and constantly evolves to make sure the industry continues to provide world-class quality care.

People are at the centre of Discovery Health and everything we do. With you, our member in mind, we pioneered products such as the Medical Savings Account and Vitality wellness programme. Discovery Health, more than any other medical scheme, empowers you to take control of your health and manage your day-to-day spend. Embracinginnovation to benefit you, we offer unique solutions and make sure your day-to-day cover matches your needs in an ever-changing environment.

We give you the peace of mind that when you need cover for major medical costs, we are there for you.

All Discovery Health plans cover hospitalisation for confirmed admissions, chronic medicine for chronic diseases and preventive screenings.

The ExecutiveComprehensivePriority and Saver plans cover you for day-to-day medical expenses in addition to the above.

 

Discovery 911 is there for all members in a medical emergency

In an emergency, contact Discovery 911 on 0860 999 911, 24 hours a day, seven days a week.

You have cover for emergency evacuations in sub-Saharan Africa

You have access to the Africa Evacuation Benefit*. The benefit is for emergency medical evacuations from certain sub-Saharan African countries back to South Africa. This benefit is not available on the KeyCare Series.

When travelling internationally you have cover for medical emergencies

The International Travel Benefit* covers you if you have emergency medical expenses while travelling outside South Africa.
The International Travel Benefit provides cover of up to R10 million per person on the Executive Plan and R5 million per person on other plans for a maximum of 90 days from the date of departure from South Africa.
If you incur day-to-day claims in an emergency, you will only need to pay the first US$150 or �100 of your claims and we will cover the rest.

* Applicable to all plans except the KeyCare Series

 

No overall limit applies to hospital cover

There are no overall limits for hospital cover on any Discovery Health Plans.

Full cover for specialists participating in our direct payment arrangements

Discovery Health has negotiated with the majority of specialists to ensure that you are covered in full for procedures and consultations.

Our Premier Rate applies to all plans

You have full cover for specialist consultations and procedures on all plans when you go to a specialist who charges the Premier Rate. If you join a KeyCare Plan, there is a separate group of specialists that we cover in full.

Extra benefits on Executive and Classic Plans

If you are on an Executive or Classic Plan, you have access to more specialists where we pay the specialist�s in-hospital claim in full.

Cover for other specialists is based on your plan choice

If you are treated in hospital by a specialist who does not participate in one our direct payment arrangements, we cover you according to your plan choice:

  • 300% of the Discovery Health Rate on Executive,
  • 200% of the Discovery Health Rate on Classic and
  • 100% of the Discovery Health Rate on all other plans.

All members have cover for approved medicines on the Chronic Disease List

We cover approved medicine on our medicine list for chronic diseases, up to the Discovery Health Medication Rate, on all health plans. If you choose to usemedicine not on our medicine list, we will cover it up to a fixed rand amount called the Chronic Drug Amount on all Health Plans except the KeyCare series .

Cover for additional chronic conditions on Executive and Comprehensive Plans

We will pay approved medicine for the conditions listed on the Additional Disease List up to the monthly Chronic Drug Amount at the Discovery Health medication rate.

All of our members have access to a comprehensive HIVCare Programme

The HIVCare Programme provides comprehensive disease management for members living with HIV and AIDSMembers registered on this programme have access tounlimited hospitalisation and antiretroviral treatment according to our medicine list. Members are assured of complete confidentiality.

You have cover for treating cancer through our Oncology Programme

DiscoveryCare�s professional case management team will coordinate your oncology benefits in conjunction with your treating doctor. We approve your treatment plan as long as it is in line with clinical guidelines. Treatment guidelines vary according to your Health Plan, and will be made available to you when you register.

The Executive and Comprehensive Plans offer access to specialty medicine and technology

Members on the Executive and Comprehensive Plans have access to a number of selected medicines and technologies through the Specialised Medical Technology Benefit.

Please call us to see whether your treatment qualifies.

This benefit includes access to the Overseas Treatment Benefit, where you are covered when you travel to seek evidence-based healthcare not available in South Africa at a registered healthcare professional, up to a limit of R500 000 for each person. You will need to pay and claim back from us when you return to South Africa.

Entry criteria and a deductible of up to 20% apply to both benefits.

 

Empowering you to manage your day-to-day healthcare costs

We pay your day-to-day expenses from your Medical Savings Account on Executive, Comprehensive, Priority and Saver Plans. At the end of each year we carry over any leftover funds in your Medical Savings Account to the next year.

The GP network extends your day-to-day benefits 
If you visit a general practitioner in the nationwide Discovery GP network, we will pay the consultation fee from your Medical Savings Account.

You have unlimited GP visits on KeyCare Plus 
On the KeyCare Plus Plan we cover you for unlimited consultations at your chosen general practitioner in the KeyCare GP Network.

Certainty of cover for specialists

We pay specialist consultations and procedures in full from your available day-to-day benefits when you go to a specialist who charges the Premier Rate. KeyCare Plans have a separate group of participating specialists.

Detect any health problems early by using the Screening Benefit

The Screening Benefit covers blood glucoseblood pressurecholesterol and body mass index measurements at a Discovery Wellness Network provider. The Screening Benefit also pays for a mammogram, Pap smearprostate specific antigens (PSA) and HIV screening tests. These tests are paid by Discovery Health and we will not use your Medical Savings Account.

Cover for trauma recovery on all Health Plans except Core and KeyCare Core Plans

Certain traumatic events can result in extremely high costs after you leave the hospital. We cover your out-of-hospital medical expenses for the rest of the year in which the trauma takes place from the Trauma Recovery Extender Benefit. A highly skilled case manager will assist you to manage your benefits when you register for the Trauma Recovery Extender Benefit.

The Above Threshold Benefit offers extra day-to-day cover for Executive, Comprehensive and Priority Plans

The ExecutiveComprehensive and Priority plans all include an Above Threshold Benefit that gives further day-to-day cover when your Medical Savings Account runs out and when your day-to-day claims add up to a set rand amount.

On the Executive and Comprehensive Plans, the Above Threshold Benefit is unlimited. On the Priority Plans, the Above Threshold Benefit has an overall limit.

The amounts we add up to your Annual Threshold

For you to get to your Above Threshold Benefit we add up claims to your Annual Threshold. Here are the amounts that we add up:

Comprehensive and Priority Plans

Specialists 
For Premier Rate specialists, we add up the Premier Rate. For non-participating specialists, we add up the Discovery Health Rate.

Medicine 
For generic medicines, we add up 100% of the Discovery Health Medication Rate. For non-generic medicines, we add up 75% of the Discovery Health Medication Rate.

All other health services 
We add up the Discovery Health Rate. Over-the-counter medicines do not add up to your Annual Threshold.

Executive Plan

Specialists 
For Premier Rate specialists, we add up the Premier Rate. For non-participating specialists, we add up to 300% of the Discovery Health Rate.

General practitioners 
We add up to R332 for each consultation.

Medicine 
For generic medicines, we add up 100% of the Discovery Health Medication Rate. For non-generic medicines, we add up 90% of the Discovery Health Medication Rate.

All other health services 
We add up the Discovery Health Rate. Over-the-counter medicines do not add up to your Annual Threshold. For each of these, we add up the amount to the benefit limit available.

 

We market our Discovery Health Plans through independent and accredited financial advisers. If you want a financial adviser to help you choose a Health Plan to suit the needs of your family, please send us your contact details and we will contact you.