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Discovery Health Gap Core

Overall, Discovery Health Gap Core is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Discovery Health Gap Core Plan starts from R143 ZAR. Discovery Health has a trust score of 4.1.

🔎 Provider	🥇 Discovery Health Gap Core
🟥 Years in Operation	31 years
🟧 Underwriters	Discovery Insure Ltd
🟨 Market Share in South Africa	>56%
🟩 Gap Cover Waiting Period	12 months
🟦 Do Exclusions Apply	✅ Yes
🟪 Average Monthly Premium	R143
🟥 Oncology Benefit	✅ Yes
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

Discovery Health Gap Core – 7 Key Point Quick Overview

Discovery Health Gap Core Overview

The Discovery Health Gap Core is one of two plans that starts from R143 per month. Discovery Health’s Gap Core has oncology, in and out-of-hospital, scope and scans, emergency room, and several other benefits.

Gap Cover is available on all Discovery Health plans, along with 24/7 medical emergency assistance.

Discovery Health Gap Cover has two Gap cover options:

- Discovery Health Gap Core
- Discovery Health Gap Comprehensive

Discovery Health Gap Core Premiums

🟥 Discovery Plan	🟧 Discovery Executive and Classic Plans	🟨 Discovery Executive and Classic Plans	🟩 Discovery Essential Plans	🟦 Discovery Essential Plans	🟪 Discovery Coastal Plans	🟫 Discovery Coastal Plans
🟧 Age of oldest member on the plan	Single Member	Family	Single Member	Family	Single Member	Family
🟨 0 – 54	R143	R247	R265	R247	R265	R478
🟩 55 – 64	R256	R305	R600	R305	R600	R991
🟦 65+	R297	R447	R899	R447	R899	R1,585

Discovery Health Executive Plan Benefits and Cover Breakdown

Discovery Gap Core Benefits Summary

In-Hospital Specialist Gap Cover

✅ Covers expenses beyond what your medical insurance plan pays for up to 250% of the medical scheme rate.

Hospital Admission Benefit Extender

✅ Covers up to R7,500 extra for shortfalls on approved specialist claims made in the hospital beyond what is covered by your In-hospital Specialist Gap Cover.

Benefit Extenders

✅ The Oncology Benefit Extender provides up to R75,000 additional cover per person per year.

Discovery Gap Core Benefits and Cover Explored in Detail

In-Hospital Specialist Gap Cover

✅ Discovery Health offers the In-hospital Specialist Gap Cover to address potential shortfalls in medical tariff payments when a patient is admitted.
✅ This cover compensates for the difference between what the patient’s medical scheme covers and the charges from the specialist.
✅ Cover extends to dental specialist claims covered by the hospital benefit from the medical scheme.

The cover extends to up to 250%.

Hospital Admission Benefit Extender

To address remaining shortfalls on approved specialist claims during hospital stays, the Core plan covers up to R7,500. The Hospital Admission Benefit Extender includes cover for various healthcare services if the medical plan approves the hospital admission.

These services include:

✅ Private ward cover
✅ Medication prescribed upon discharge
✅ Out-of-hospital specialist claims
✅ Out-of-hospital radiology
✅ Third-trimester maternity claims
✅ Out-of-hospital rehabilitation
✅ Deductible cover for a TytoHome Kit.

Additional Benefit Extenders

✅ Once the oncology threshold is reached, the Oncology Benefit Extender covers up to R100,000 for approved cancer-related expenses.

Discovery Vitality Health Benefit Extenders for Annual Hospital Admission

✅ The annual maximum cover of R185,000 is subject to variations based on factors such as family size, Discovery Vitality Health status, and the type of health plan held.

Discovery Gap Core

🟥 Family Structure	🟧 None / Blue	🟨 Bronze	🟩 Silver	🟦 Gold	🟪 Diamond
🅰️ Single Member	R1,875	R2,345	R2,815	R3,280	R3,750
🅱️ Family	R3,750	R4,685	R5,625	R6,565	R7,500

Discovery Health Gap Core Exclusions and Waiting Periods

Gap Core Exclusions

The following are excluded from Discovery Health Gap Core:

✅ Medical scheme-excluded claims.
✅ Hospital admissions without a medical scheme authorization number (except for in-hospital dentistry specialist claims).
✅ Claims that were not processed, approved, or covered by the medical scheme for any reason.
✅ Medical scheme-defined out-of-hospital claims unless approved by the policy’s Benefit Extenders.
✅ Oncology Innovation Benefit co-payments for innovative cancer treatments.
✅ Claims over the Discovery Gap Cover an annual limit of R185,000 per person.
✅ Weight-loss surgery claims.
✅ Claims for healthcare services or treatment not provided by a properly registered specialist.
✅ Claims outside South Africa or in foreign currency.

Deductibles, exclusions, and amounts claimed above health plan benefit limits will be excluded.

Gap Core Waiting Periods

Discovery Health applies waiting periods and exclusions to certain healthcare services starting from the policy start date and includes the following:

✅ There is an automatic three-month waiting period for all healthcare services and treatment, excluding authorized emergency hospital admissions.
✅ An automatic 12-month waiting period applies to claims related to pregnancy and childbirth, endometrial ablations, joint replacements, scopes, cataracts, dental procedures, and other specified treatments.
✅ Claims related to pre-existing medical conditions will have a 12-month waiting period if they exist during policy application or upgrade.

If a policyholder downgrades their health plan, a 12-month condition-specific waiting period may apply to any new conditions after completing a health questionnaire.

POLL: 5 Best Gap Cover Choices for Under R200

Discovery Health Gap Core vs Other Gap Cover Medical Aid Plans

🔎 Provider	🥇 Discovery Health Gap Core	🥈 Liberty Essential Gap Cover	🥉 Cura Administrators Gap Basic
🟥 Years in Operation	31 years	66 years	26 years
🟧 Underwriters	Discovery Insure Ltd	Guardrisk Life Limited (FSP 76)	GENRIC Insurance Company Limited
🟨 Market Share in South Africa	>56%	>25%	<5%
🟩 Gap Cover Waiting Period	12 months	12 months	3 – 12 months
🟦 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟪 Average Monthly Premium	R143	R372	R182
🟥 Oncology Benefit	✅ Yes	✅ Yes	None
🟧 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes	✅ Yes	✅ Yes
🟩 Maternity Benefit	✅ Yes	✅ Yes	None
🟦 Scopes and Scans	✅ Yes	✅ Yes	✅ Yes
🟪 Co-payment Cover	✅ Yes	✅ Yes	None
🟥 Emergency Room	None	✅ Yes	✅ Yes
🟧 Accidental Cover	None	✅ Yes	✅ Yes
🟨 Trauma Counseling	None	✅ Yes	None
🟩 Premium Waiver	None	✅ Yes	None
🟦 Non-DSP Co-Payment	None	✅ Yes	None
🟪 Prostheses	None	✅ Yes	None
🟥 Travel Cover Extender	None	None	None
🟧 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	None

Our Verdict on Discovery Health Gap Core

According to our research, the Discovery Health Gap Core plan is a basic plan that provides essential benefit extenders to help members save money, especially where the scheme does not cover certain items or only a certain portion.

However, in our experience, several mandatory waiting periods apply, during which members must pay shortfalls out of their own pockets.

Discovery Health Gap Core Frequently Asked Questions

What is Discovery Health Gap Core?

Discovery Health Gap Core is a specific health insurance plan offered by Discovery Health that provides additional coverage for medical expenses beyond what is covered by your primary medical scheme.

What are the waiting periods associated with Discovery Health Gap Core?

Discovery Health Gap Core has a general waiting period of three months for all healthcare services except authorized emergency hospital admissions. Additionally, there are specific waiting periods of 12 months for certain treatments and procedures.

Can I claim for pre-existing medical conditions with Discovery Health Gap Core?

You can claim for pre-existing medical conditions with Discovery Health Gap Core. However, there is a 12-month waiting period for pre-existing conditions if they exist during policy application or upgrade.

Are there any waiting period waivers available with Discovery Health Gap Core?

Yes, waiting periods may be waived for Discovery Health Gap Core if you have had continuous gap cover with another insurance company for at least six consecutive months without any gaps in cover.

What happens if I downgrade my health plan with Discovery Health Gap Core?

If you downgrade your health plan with Discovery Health Gap Core, there may be a 12-month condition-specific waiting period for new conditions. This waiting period can be applicable after completing a health questionnaire.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.