The Core Series

Comprehensive hospital cover

We cover you in any private hospital for emergencies and for planned hospital admissions that you have authorised with us. There is no overall limit.

Emergency cover when you need it most

In an emergency, go straight to hospital.

If you need medically-equipped transport in a medical emergency, call 0860 999 911. This line is managed by highly qualified emergency personnel who will send the most appropriate air or road emergency evacuation transport. It is important that you, your loved one or the hospital let us know about your admission as soon as possible.

Cover for planned hospital admissions

Please call us at least 48 hours before you go to hospital to confirm your admission.

Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital.

Going to hospital can be a stressful experience. Discovery’s HospitalXpress makes your admission to hospital convenient and seamless. This service offers you express pre-admissions and online tools to authorise your admission and confirm your cover. HospitalXpress also connects you to select partners, bringing you a range of value-added services at the reduced prices you’re accustomed to as a Discovery member.

Use a network hospital on the Delta network and Coastal options

Delta network options

On the Classic and Essential Delta network options, you are covered in full at hospitals in the Delta Hospital Network. For planned admissions at any other private hospital, you must pay an amount of R4 550 upfront to the hospital.

The Delta Hospital Network

Coastal

On the Coastal Plan, you must go to a hospital in one of the four coastal provinces for a planned hospital admission. If you don’t use a coastal hospital, we pay up to a maximum of 70% of the hospital account and you have to pay the difference.

Full cover for specialists who we have an agreement with

You can benefit by using healthcare professionals who we have an agreement with because we will cover their approved procedures in full. If you are a Classic Plan member, you benefit from access to the broadest range of specialists whom we pay in full, which represents over 88% of our member’s specialist interactions. These healthcare professionals, appropriate to your plan, are also the designated providers for Prescribed Minimum Benefits.

You may have a co-payment if you use other specialists

If you are treated by a specialist who we do not have an agreement with, we cover you up to a maximum of 200% of the Discovery Health Rate on Classic Plans and at 100% of the Discovery Health Rate on Essential and Coastal Plans.

Other healthcare professionals

We cover GPs and other healthcare services up to 200% of the Discovery Health Rate on Classic Plans and up to 100% of the Discovery Health Rate on Essential and Coastal Plans.

We cover radiology and pathology up to 100% of the Discovery Health Rate on all plans.

Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy)

You pay the first R2 600 of your hospital account. We pay the balance of the hospital account and your related accounts from your Hospital Benefit. A related account is the account from your admitting doctor, anaesthetist or any approved expense you incur during your hospital admission, other than the hospital account.

MRI and CT scans

If your MRI or CT scan is done as part of an approved admission, we pay it from your Hospital Benefit at 100% of the Discovery Health Rate. If you are admitted for conservative back or neck treatment or if the scan is unrelated to your admission, we do not pay for it.

You need to pay a portion of your hospital or day clinic account upfront for dental admissions. This amount varies depending on your age and the place of treatment.

We pay the balance of the hospital account and the related accounts, which include the dental surgeon’s account, from the Hospital Benefit, up to 100% of the Discovery Health Rate.

Dental appliances and orthodontic treatment

You are responsible for paying the costs of all dental appliances, their placement and orthodontic treatment (including the related accounts for orthognathic surgery).

Severe dental and oral surgery

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with no upfront payment and no overall limits. This benefit is subject to authorisation and the Scheme’s clinical rules.

Most of your in-hospital healthcare services have no overall limit. These are:

• GPs
• Specialists
• Allied healthcare professionals, like  physiotherapists
• Pathology
• Radiology
• HIV cover

Only the following healthcare services have an annual limit:

Your cover for chronic conditions

You have cover for a list of chronic conditions. You have full cover for approved medicine on Discovery Health’s medicine list or up to a set monthly amount for medicine not on our list.

We pay medicine up to a maximum of the Discovery Health Medicine Rate. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit.

When you use MedXpress, Discovery’s convenient medicine delivery service, you pay no delivery or administration fees. Discovery’s qualified service agents can also advise you on the most cost-effective alternatives and you will always be charged at the Discovery Health Medicine Rate or less – minimizing co-payments. Call us on 0860 99 88 77 to make use of this free service.

The Delta network options

You have cover for approved chronic medicine, with no additional co-payment, if you use a Delta network pharmacy. If you don’t use a Delta network pharmacy, a 20% co-payment applies.

Your cover for cancer treatment

Our Oncology Programme covers the first R200 000 of approved cancer treatment over a 12-month cycle. Cover is unlimited once cancer treatment costs go over this amount, but you will need to pay 20% of the costs of all further treatment.

We cover chemotherapy and oncology-related medicine up to the Discovery Health Medicine Rate. We pay consultations, radiotherapy, radiology, pathology and scans up to 100% of the Discovery Health Rate. You might have to make a co-payment if your healthcare professional charges more than the Discovery Health Rate.

Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. Please call us to register on the Oncology Programme.

You have access to the following day-to-day benefits:

• The Screening and Prevention Benefit covers certain tests at a Discovery Wellness Network provider,like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate screening) and HIV screening tests. Members
• 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine.
• We pay for scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) from your Hospital Benefit if they are done in your doctor’s rooms. We pay up to 200% of the Discovery Health Rate if you are on a Classic Plan and up to 100% of the Discovery Health Rate if you are on an Essential or Coastal Plan. Please call us before you go for your scope to confirm your benefits.

* We count a maximum of three children when we work out the monthly contribution.

Discovery Health does not cover certain healthcare services. You can find a full list of these exclusions here.

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.