Discovery Health Comprehensive Series Medical Aid Plans
Overall, the Discovery Health Comprehensive Series Medical Aid Plans are a series of trustworthy and comprehensive medical aid plans that have a trust score of 4.8. The Discovery Health Comprehensive Series Medical Aid Plans start from R4,949 ZAR.
| 🔍 Comp. Series Plan | 🥇 Classic Comp. | 🥈 Classic Delta Comp. | 🥉 Essential Comp. | 🏅 Essential Delta Comp. | 🏅 Classic Smart Comp. |
| 🌎 International Cover | R5 million | R5 million | R5 million | R5 million | R5 million |
| 👤 Main Member Contribution | R6,810 | R6,133 | R5,723 | R5,155 | R4,949 |
| 👥 Adult Dependent Contribution | R6,441 | R5,805 | R5,405 | R4,686 | R4,568 |
| 💙 Child Dependent Contribution | R1,358 | R1,221 | R1,155 | R1,032 | R1,574 |
| 🔁 Gap Cover | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 📉 Screening and Prevention | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | None |
| 🍼 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
Discovery Health Comprehensive Series – 15 Key Point Quick Overview
- ☑️ Discovery Health Comprehensive Series Overview
- ☑️ Discovery Health Comprehensive Series Contributions
- ☑️ Discovery Health Comprehensive Plan Benefits Summarized
- ☑️ Discovery Health Comprehensive Series Benefits and Cover Comprehensive Breakdown
- ☑️ Discovery WELLTH Fund
- ☑️ WHO Outbreak Benefit
- ☑️ Discovery Health Comprehensive Connected Care
- ☑️ Discovery Health Comprehensive Hospital At Home
- ☑️ Discovery Health Comprehensive Day-to-Day Benefits
- ☑️ Discovery Health Chronic Benefit Cover Summarized
- ☑️ Discovery Health Hospital Benefit
- ☑️ Discovery Health Comprehensive Series Exclusions and Waiting Periods
- ☑️ Discovery Health Comprehensive Series Plans Compared
- ☑️ Our Verdict on Discovery Health Comprehensive Series
- ☑️ Discovery Health Comprehensive Series Frequently Asked Questions
Medical Aid Discovery Health Comprehensive Series Overview
The Discovery Health Comprehensive Series starts from R4,949 and is a series of comprehensive medical insurance plans offered by Discovery Health. The Discovery Comprehensive Series provides an elevated level of cover for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses.
The Discovery Health Comprehensive Series includes the following plans:
It should be noted that all the plans that form part of the Discovery Health Comprehensive Series may be subject to a late joiner fee.
Gap Cover is available on the Discovery Health Comprehensive Series, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.
Discovery Health Comprehensive Series Contributions
| 🔎 Medical Aid Plan | 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| 🥇 Classic Comprehensive | R6,810 | R6,441 | R1,358 |
| 🥈 Classic Delta Comprehensive | R6,133 | R5,805 | R1,221 |
| 🥉 Essential Comprehensive | R5,723 | R5,405 | R1,155 |
| 🏅 Essential Delta Comprehensive | R5,155 | R4,868 | R1,032 |
| 📌 Classic Smart Comprehensive | R4,949 | R4,568 | R1,574 |
Discovery Health Comprehensive Plan Benefits Summarized
| 🔎 Comp. Plan | 🥇 Classic Comprehensive | 🥈 Classic Delta Comprehensive | 🥉 Essential Comprehensive | 🏅 Essential Delta Comprehensive | 🥇 Classic Smart Comprehensive |
| 💳 Medical Savings Account (MSA) | Consists of 25% of your monthly contributions | Consists of 25% of your monthly contributions | Consists of 15% of your monthly contributions | Consists of 15% of your monthly contributions | This plan lacks an MSA and DEB.
Daily benefits include Smart Network GP visits, certain specialist consultations, and other essential healthcare services with fixed co-payments or limits. |
| 📌 Day-to-Day Extender Benefit (DEB) | The DEB, or Day-to-Day Extender Benefit, increases your coverage for basic medical care provided by providers in the Discovery Health network. | The DEB, or Day-to-Day Extender Benefit, increases your coverage for basic medical care provided by providers in the Discovery Health network. | The DEB, or Day-to-Day Extender Benefit, increases your coverage for basic medical care provided by providers in the Discovery Health network. | The DEB, or Day-to-Day Extender Benefit, increases your coverage for basic medical care provided by providers in the Discovery Health network. | This plan lacks an MSA and DEB.
Daily benefits include Smart Network GP visits, certain specialist consultations, and other essential healthcare services with fixed co-payments or limits. |
| 📍 MRI and CT scans | The first R3,470 will come from your normal benefits, and the remaining amount will come from your Hospital Benefits.
One scan per spinal segment or neck area is the norm for conservative back and neck scans. | The first R3,470 will come from your normal benefits, and the remaining amount will come from your Hospital Benefits.
One scan per spinal segment or neck area is the norm for conservative back and neck scans. | The first R3,470 will come from your normal benefits, and the remaining amount will come from your Hospital Benefits.
One scan per spinal segment or neck area is the norm for conservative back and neck scans. | The first R3,470 will come from your normal benefits, and the remaining amount will come from your Hospital Benefits.
One scan per spinal segment or neck area is the norm for conservative back and neck scans. | Before reaching the Annual Threshold, you are responsible for paying R3,470, and the Hospital Benefit will cover the remainder. One scan per spinal segment or neck area is the norm for conservative back and neck scans. |
| 💊 Specialized Medicine and Technology Benefit | The Specialized Medicine and Technology Benefit covers the latest treatments up to R200,000 per person annually. | The Specialized Medicine and Technology Benefit covers the latest treatments up to R200,000 per person annually. | The Specialized Medicine and Technology Benefit covers the latest treatments up to R200,000 per person annually. | The Specialized Medicine and Technology Benefit covers the latest treatments up to R200,000 per person annually. | – |
| ✔️ Medicine Cover – Additional Disease List (ADL) | The Additional Disease List covers medicine for life-threatening or degenerative conditions (ADL) | The Additional Disease List covers medicine for life-threatening or degenerative conditions (ADL) | The Additional Disease List covers medicine for life-threatening or degenerative conditions (ADL) | The Additional Disease List covers medicine for life-threatening or degenerative conditions (ADL) | – |
| ☑️ Oncology Benefit | Discovery Health covers the first R500,000 of your approved cancer treatment over 12 months.
Discovery Health will cover 80% of additional costs without limit. | Discovery Health covers the first R500,000 of your approved cancer treatment over 12 months.
Discovery Health will cover 80% of additional costs without limit. | Discovery Health covers the first R500,000 of your approved cancer treatment over 12 months.
Discovery Health will cover 80% of additional costs without limit. | Discovery Health covers the first R500,000 of your approved cancer treatment over 12 months.
Discovery Health will cover 80% of additional costs without limit. | Discovery Health covers the first R375,000 of your approved cancer treatment over 12 months.
Discovery Health will cover 80% of additional costs without limit. |
| ✅ Extended Oncology Benefit | You are fully covered for certain cancers and treatments. | You are fully covered for certain cancers and treatments. | You are fully covered for certain cancers and treatments. | You are fully covered for certain cancers and treatments. | This benefit is not available on this plan |
| 🩺 Oncology Innovation Benefit | The Scheme covers a list of innovative cancer drugs.
This benefit has a co-payment of 25%. | The Scheme covers a list of innovative cancer drugs.
This benefit has a co-payment of 25%. | The Scheme covers a list of innovative cancer drugs.
This benefit has a co-payment of 25%. | The Scheme covers a list of innovative cancer drugs.
This benefit has a co-payment of 25%. | The Scheme covers a subset of innovative cancer medicines.
The member is responsible for 50% of the account. |
| 🏥 Hospitals you could go to | Scheme-approved private hospitals | Delta Hospital Network private hospitals | Scheme-approved private hospitals | Delta Hospital Network private hospitals | Private Smart Hospital Network hospitals |
| 🚑 Where there is a defined list of procedures that can be done in a Day Surgery Network | Private Day Surgery Network facility | Private Delta Day Surgery Network facility. | Private Day Surgery Network facility | Private Delta Day Surgery Network facility. | Private Smart Day Surgery Network facility. |
| 🩸 Cover for Specialists, GPs, and other Healthcare Providers/Professionals | Paid up to 200% of the DHR | Paid up to 200% of the DHR | Paid up to 100% of the DHR | Paid up to 100% of the DHR | Paid up to 200% of the DHR |
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Discovery Health Comprehensive Series Benefits and Cover Comprehensive Breakdown
Emergency Cover
In case of a traumatic incident or after a traumatic event, you can get help from a trained professional. Calling Emergency Assist will help you and your loved ones in need. Furthermore, family members can get help after a traumatic event at any time. The survivors of gender-based violence can receive counseling and other support as part of this service.
Discovery Health Emergency Cover covers the following medical services:
- ✅ The emergency vehicle (or other medical transport).
- ✅ The hospital’s account of the incident.
- ✅ The observations of the physician who admitted you to the hospital.
- ✅ The anesthesiologist.
Any additional approved healthcare provider.
Prescribed Minimum Benefits
All medical schemes are required by the Prescribed Minimum Benefit (PMB) provisions of the Medical Schemes Act 131 of 1998 and its Regulations to cover the costs associated with the diagnosis, treatment, and care of:
- ✅ A life-threatening medical condition
- ✅ A defined listing of 271 conditions
- ✅ A list of 27 chronic illnesses.
Your medical condition must be on the list of Prescribed Minimum Benefit (PMB) conditions to qualify for coverage. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits. In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health network.
Once your condition has stabilized, you will be transferred to a hospital or other service providers in the Discovery Health network, if necessary, according to the scheme’s rules. Discovery Health will cover up to 80% of the Discovery Health Rate if you do not use a DSP (DHR).
Your responsibility will be the difference between what Discovery Health will pay and the actual cost of your treatment. Furthermore, Discovery Health will pay according to your plan’s benefits if these criteria are unmet.
Screening and Prevention
This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases. The Discovery Health wellness providers cover a variety of screening tests, including blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms or ultrasounds, and prostate screenings.
After all your membership members have completed their health check, you can access additional screening and preventive healthcare services through the WELLTH Fund. The Discovery Health Screening and Prevention covers the following:
- ✅ Screening for kids will assess the child’s growth and development, including weight, height and body mass index measurements, blood pressure, and more.
- ✅ Screening for Adults includes blood pressure, blood glucose, HIV, and more. Discovery also covers mammograms, breast ultrasounds, pap smears, and more.
Screening for Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.
Additional Testing
Clinical eligibility requirements may apply to these tests:
- ✅ Diabetes and cholesterol screening tests are defined.
- ✅ Breast screening MRI or mammography and one-time BRCA testing.
- ✅ Colonoscopy for the detection of colon cancer.
- ✅ HPV test or Pap smear for cervical screening.
Vaccines (there may be clinical entry requirements):
- ✅ Seasonal influenza vaccination for pregnant members, 65 years or older, registered with certain chronic conditions, and healthcare professionals.
- ✅ Pneumococcal vaccination for members aged 65 or older or those registered with certain chronic conditions.
The WHO Global Outbreak Benefit covers the vaccines for COVID-19.
Discovery WELLTH Fund
The WELLTH Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your individual health requirements.
This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks. Your WELLTH Fund can be used up to its maximum for screening and prevention services.
However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines. The Discovery Health WELLTH Fund for the Comprehensive Series covers the following:
| 1️⃣ General Health | You have access to screenings for vision, hearing, dental, and skin conditions as part of your primary care.
Additionally, you are eligible for one GP screening consultation |
| 2️⃣ Physical Health | Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations. |
| 3️⃣ Mental Health | You have access to a mental health evaluation to promote mental health. |
| 4️⃣ Women and Men’s Health | You have access to various screening and prevention services for women and men.
These include, for instance:
Consultation with your doctor for gynecological, prostate, or cardiac issues
Bone density analysis |
| 5️⃣ Children’s Health | A pediatrician, speech pathologist, or physiotherapist can evaluate your child’s progress toward important developmental milestones as part of a well-child check-up. |
| 6️⃣ Medical Monitoring Devices | You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar. |
The WELLTH Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.
WHO Outbreak Benefit
The basket of care includes the following:
- ✅ COVID-19 vaccines and their administration according to the COVID-19 guidelines of the National Department of Health.
- ✅ Screening consultations with a network general practitioner (virtual, telephone, or in-person).
- ✅ COVID-19 PCR and Rapid Antigen screening tests if referred by a qualified medical practitioner.
- ✅ A set of defined pathology tests for COVID-19-positive individuals.
- ✅ A predetermined assortment of x-rays and scans for COVID-19-positive individuals.
- ✅ Members at risk who meet the clinical entry criteria will receive supportive care, including medication and a home monitoring device to track oxygen saturation levels.
When you are admitted to the hospital because of symptoms of COVID-19, you will be covered by the Hospital Benefit of the Comprehensive Series and, if necessary, the PMBs.
Access to the Long COVID Recovery Programme:
- ✅ A six-month support program for members whose COVID-19 symptoms persist beyond 21 days after acute diagnosis.
- ✅ According to the Scheme’s clinical entry criteria and treatment guidelines, the program includes the following:
- ✅ Up to two specialists and GP consultations.
- ✅ A defined basket of pathology tests.
- ✅ Allied healthcare professional support.
- ✅ A home monitoring device.
- ✅ A defined basket of x-rays and scans.
How members of the Discovery Health Comprehensive Series are covered in terms of Monkeypox:
- ✅ The treatment protocol for confirmed cases consists of a diagnostic PCR screening test
- ✅ Two visits to a dermatologist or general practitioner.
Formulary of supportive medications for pain management.
Discovery Health Comprehensive Connected Care
Discovery Health Medical Scheme provides home-based access to health and wellness services. Connected Care is an integrated ecosystem of benefits, services, and digitally connected capabilities designed to assist you in managing your health and wellness.
| 🔎 Health Monitoring Devices | Access to the most up-to-date medical examination, remote monitoring, and point-of-care devices to facilitate the delivery of quality care at home. |
| 📉 Electronic Prescriptions | Electronic prescribing for expedited access to medications. |
| 👩⚕️ Home Nurses | Hospital-related care is provided at home by registered nurses. |
| 💊 Medicine Ordering and Tracking | Order and track the delivery of your medication from the dispensary to your door. |
| 📍 Online Coaches | At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19. |
| ➡️ Condition-Specific Information | Educational content pertinent to your condition is readily accessible. |
Connected care for members at home.
Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations. Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions.
You will not see any changes to your regular benefits because of having cover approved for these gadgets.
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Connected care for those with chronic conditions.
Through Connected Care, you and your doctor can work together to keep your chronic condition under control while you are at home.
Eligible members can use various digital services connected to Comprehensive remote monitoring, point-of-care devices, and individualized coaching consultations to monitor and control their chronic condition in the comfort of their homes.
Discovery Health Comprehensive Hospital At Home
Hospital at Home patients receives specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being.
They all work together to make your healthcare more efficient and your life safer. Suppose you have a valid pre-authorization for hospitalization. In that case, Discovery Health will use your Hospital Benefit to cover any services provided as part of Discovery’s Hospital at Home program.
For those who meet the program’s clinical and benefit criteria, this unlocks cover for approved medical devices and services. Furthermore, Discovery Health covers the following:
- ✅ 24/7 clinical oversight from a care team virtually, including nurses, doctors, and allied healthcare professionals.
- ✅ 24/7 real-time remote monitoring, which is supported by innovative healthcare technology.
Hospital-level diagnostics and intervention to manage post-surgical or medical care at home.
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Acute Care at home
This includes cover and treatment for COVID-19, as well as post-discharge care. In addition, you are eligible for the Home Monitoring Device Benefit.
Home Monitoring Devices
- ✅ Suppose you meet the Scheme’s clinical entry criteria. In that case, you have healthcare coverage up to a limit of R4,250 per person per year at 100% of the Discovery Health Rate (DHR) for monitoring certain conditions like chronic obstructive pulmonary disease, congestive heart failure, diabetes, pneumonia, and COVID-19.
- ✅ If you meet the clinical entry criteria, the Scheme also covers up to 75% of the Discovery Health Rate (DHR) for defined point-of-care medical devices. You are responsible for 25% of the total cost of these devices. In addition, you have access to the most advanced remote medical examination device, known as TytoHome.
TytoHome enables you to conduct a medical examination by transmitting throat, ear images, and heart and lung sound to your doctor in real time.
Home Care Cover
- ✅ Discovery Home Care is a service that provides you with high-quality care in the comfort of your own home if your doctor recommends it as an alternative to hospitalization. Postnatal care, end-of-life care, intravenous infusions (drips), and wound care are provided. These services are covered by the Hospital Benefit, pending authorization.
- ✅ Discovery Home Care is the designated service provider (DSP) for intravenous infusion administration. Use Discovery Home Care for these infusions to avoid a 20% co-payment.
Home-based care for follow-up treatment after hospital admission
- ✅ Once discharged from the hospital, patients with clinically appropriate conditions such as chronic obstructive pulmonary disease, chronic cardiac failure, ischemic heart disease, and pneumonia have access to enhanced home-based care.
- ✅ If you meet the clinical entry criteria, you are covered for bedside medicine reconciliation before admission discharge, a follow-up consultation with a GP or specialist, and a defined basket of supportive care at home, including in-person and virtual consultations with a Discovery Home Care nurse.
Discovery Health Comprehensive Day-to-Day Benefits
Discovery Health will cover your day-to-day medical expenses with funds from your Medical Savings Account (MSA) or Day-to-Day Extender Benefit (DEB).
The Medical Savings Account (MSA)
- ✅ Discovery Health pays for the day-to-day medical expenses of its members, such as consultations with GPs and specialists, medicine (excluding registered chronic medicine), radiology, and pathology, from the available funds in the member’s Medical Savings Account (MSA).
- ✅ Any unused funds will be carried over to the next year. In addition, members can have their claims paid either at the Discovery Health Rate (DHR) or at cost.
- ✅ If you have elected to have your claims paid from the MSA at cost, the Scheme will automatically pay any claims that exceed the DHR.
- ✅ You can request a special payment from your MSA if you have elected to have claims paid from your MSA at the DHR.
- ✅ Furthermore, you will want to have claims paid more than the DHR or benefit limits from the available funds in your MSA.
- ✅ If they are over the DHR, claims paid from the MSA do not add up to the Annual Threshold.
- ✅ The Smart Classic Comprehensive Plan lacks an MSA.
However, you are covered by a defined set of daily benefits, including Smart GP visits, specific specialist consultations, and other essential healthcare services.
The Day-to-Day Extender Benefit (DEB)
- ✅ Pays for certain day-to-day benefits after the MSA has been depleted and before the Annual Threshold is reached.
- ✅ Covers video call consultations with a network of primary care physicians and pharmacy clinic consultations within our defined wellness network.
- ✅ You also have unlimited coverage for face-to-face consultations with a network GP when referred by a virtual GP in the pharmacy clinic or following a video call consultation.
- ✅ Discovery Health will cover in-person visits up to the Discovery Health Rate (DHR).
- ✅ On Classic plans, children under 10 are eligible for two visits per year.
The Classic Smart Comprehensive Plan is not eligible for this benefit.
The Self-payment Gap (SPG)
- ✅ If your MSA runs out before you reach your Annual Threshold, you will be responsible for paying claims out of pocket until you reach your Annual Threshold.
- ✅ This time frame is referred to as the Self-Payment Gap (SPG).
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You must continue to submit claims throughout the SPG so that we know when you reach your Annual Claims Threshold.
The Above Threshold Benefit (ATB)
Over Threshold After your Annual Threshold, the benefit covers daily expenses. Some claims do not meet your Annual Threshold or ATB payment:
- ✅ Medicine that you do not need a prescription for (over-the-counter medicine)
- ✅ Childhood vaccines and immunizations
- ✅ Lifestyle-enhancing products
- ✅ Claims more than the Discovery Health Rate (DHR).
- ✅ Claims paid more than annual benefit limits.
The Above Threshold Benefit (ATB) is unlimited, so it covers all or a portion of daily expenses at the Discovery Health Rate (DHR), and various benefit caps may apply. You must pay the difference between the DHR and the claimed amount and any amount that exceeds the annual benefit limit (where applicable).
The tables below illustrate how much we cover your routine healthcare costs under the Comprehensive plans. When you file a claim, the following amounts are added to determine your Annual Threshold.
Healthcare Providers and Medicine
Healthcare Providers and Medicine Breakdown
| 🔎 Healthcare Providers and Medicine | 💶 What Discovery Health Pays: |
| 1️⃣ Specialists Discovery Health has arrangements with | Up to the agreed rate with the specialist |
| 2️⃣ Specialists Discovery Health does not have arrangements with | Up to 100% of the Discovery Health Rate |
| 3️⃣ GPS and other healthcare professionals | Up to 100% of the Discovery Health Rate |
| 4️⃣ Preferred Medicine | Up to 100% of the Discovery Health Rate |
| 5️⃣ Non-Preferred Medicine | Up to 75% of the DHR if the medicine falls within the 25% preferred equivalent.
Up to 50% if the medicine is 50%> the preferred equivalent. |
Healthcare Providers and Medicine Breakdown
| 🔎 Members and Dependants | 👤 Single Member | 👥 +1 Dependent | 2️⃣ 2 Dependents | ⬆️ 3 and More Dependents |
| 💊 Prescribed Medicine (Schedule 3 and higher) | 💊 Prescribed Medicine (Schedule 3 and higher) | 💊 Prescribed Medicine (Schedule 3 and higher) | 💊 Prescribed Medicine (Schedule 3 and higher) | 💊 Prescribed Medicine (Schedule 3 and higher) |
| 🥇 Classic | R37,900 | R44,450 | R51,600 | R58,850 |
| 🥈 Essential | R24,300 | R29,600 | R35,650 | R38,900 |
OTC Medicine, Childhood vaccines and immunization, and lifestyle-enhancing products:
- ✅ Discovery Health will pay claims from the MSA funds.
- ✅ However, these claims will not add up to the Annual Threshold, and neither are they paid from the ATB if the Self-Payment Gap reaches R0
Professional Services
🔍 Allied, therapeutic, and psychology healthcare services, including acousticians, biokinetics, chiropractors, counselors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists,
podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists) | 👤 Single Member | 👥 +1 Dependent | 2️⃣ 2 Dependents | ⬆️ 3 and More Dependents |
| 🥇 Classic | R22,200 | R30,150 | R36,750 | R42,650 |
| 🥈 Essential | R13,350 | R18,900 | R24,550 | R29,000 |
| 🦷 Dental appliances and orthodontic treatment | R32,600 per insured person/dependent | R32,600 per insured person/dependent | R32,600 per insured person/dependent | R32,600 per insured person/dependent |
| ☑️ Antenatal classes | R2,170 per family | R2,170 per family | R2,170 per family | R2,170 per family |
Appliances and Equipment
| 🤓 Optical (covers lenses, frames, contact lenses, and surgery or any healthcare service to correct refractive errors of the eye) | 👓 Optical (covers lenses, frames, contact lenses, and surgery or any healthcare service to correct refractive errors of the eye) | R6,550 per insured person |
| 👩🏻🦼 External Medical Items (wheelchairs, crutches, prostheses) | Classic | R64,200 per family |
| 🦾 External Medical Items (wheelchairs, crutches, prostheses) | Essential | R43,000 per family |
| 🦻 Hearing Aids | Classic | R28,200 per family |
| ➡️ Hearing Aids | Essential | R22,650 per family |
Classic Smart Comprehensive Day-to-day Cover
| 🔎 Day-to-Day Benefits | 📍 How Members of this plan are covered |
| 1️⃣ Unlimited GP Consultations within the Smart GP network | You pay R60, and the Discovery Health Rate covers the rest (DHR).
Video consultations are covered according to the DHR. |
| 2️⃣ Smart Specialist Benefit when a Smart Network GP refers members | If referred by your Smart Network GP, you can see a doctor, gynecologist, pediatrician, or ENT for up to R5,700 per person or R11,400 per family per year.
Specialist-referred radiology and pathology are DHR-paid up to the Specialist Benefit limit. |
| 3️⃣ Eye tests at an optometrist within the Smart Optometry Network | There is an upfront payment of R60 that covers one eye test. |
| 4️⃣ Defined dental check-ups at any dentist, dental therapist, or an oral hygienist | Annual dental check-up. The DHR covers the check-up after you pay R115. |
| 5️⃣ Over-the-Counter medicine from any MedXpress Network Pharmacy | Over-the-counter medicine is covered up to R910 per family per year.
Coverage for MedXpress or MedXpress Network Pharmacy over-the-counter medicine categories. |
| 6️⃣ Acute Medicine obtained from a pharmacy within the MedXpress Network | Smart Network GPs prescribe acute medicine up to R2,860 per person or R4,600 per family per year.
MedXpress or MedXpress Network Pharmacy coverage for acute medicine categories, subject to the annual prescribed medicine limit. |
| 7️⃣ Sports injuries, when activated and referred by a Smart Network GP | Basic x-rays, two specialist visits, four physiotherapists, biokinetics, or chiropractor visits for sports injuries are covered if activated and referred by your Smart Network GP.
R115 per x-ray or visit.
These visits and specialists with whom Discovery Health does not have a payment arrangement will be covered by the DHR.
The annual Allied, therapeutic, and psychology healthcare services limit applies. |
Discovery Maternity and Early Childhood Benefit
With the Discovery Health Comprehensive Series, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your baby’s life. This applies from the date of activation of the benefit for each pregnancy and for each child from birth until they are two years old.
Discovery Health Maternity Benefit covers the following:
During Pregnancy:
- ✅ Scans and Screenings
- ✅ Twelve antenatal consultations with a midwife, GP, or gynecologist.
- ✅ 2 x 2D ultrasound scans
- ✅ Nuchal translucency test
- ✅ 3D and 4D scans up to the 2D scan rate.
- ✅ Non-invasive Prenatal Test (NIPT)
- ✅ One flu vaccination during pregnancy.
- ✅ Your Hospital Benefit covers the costs associated with labor and delivery.
- ✅ You are also covered for up to R2,460 per day in a private ward during your delivery hospital stay.
What are Maternity Benefits?
Discovery Health will cover predetermined blood tests to confirm your pregnancy.
After giving birth, Discovery Health covers the following:
- ✅ Discovery Health will pay up to R5,650 for registered essential devices like breast pumps and smart thermometers. However, you are responsible for 25% of the total cost of these devices.
- ✅ GP and Specialist help for two visits for up to 2 years.
Postnatal care, including complications during delivery, nutritional assessment, etc.
Discovery Health prenatal and postnatal care includes:
- ✅ Five antenatal or postnatal classes.
- ✅ One Breastfeeding consultation.
Try our free Menstrual Cycle Calculator
Discovery Health Chronic Benefit Cover Summarized
| 📌 Prescribed Minimum Benefit (PMB) Conditions | Under the Prescribed Minimum Benefits, you can receive treatment for a set of medical conditions (PMBs).
The PMBs cover the 27 chronic conditions included in the Chronic Disease List (CDL). |
| 📌 Medicine Cover for the Chronic Disease List | You have cover for all chronic medications on the Scheme’s approved list.
Discovery Health will cover you up to the Chronic Drug Amount (CDA) monthly maximum for medications, not on the Scheme’s list. |
| 📌 Medicine Cover for Additional Diseases List (ADL) | Discovery Health provides cover for additional disease list medications (ADL).
You are covered for medications up to the monthly CDA.
No drug list is applicable. |
Discovery Health Comprehensive Plans (except Classic Smart Comprehensive) full list of conditions covered:
- ✅ Addison’s disease
- ✅ Asthma
- ✅ Bipolar mood disorder
- ✅ Bronchiectasis
- ✅ Cardiac failure
- ✅ Cardiomyopathy
- ✅ Chronic obstructive pulmonary disease
- ✅ Chronic renal disease
- ✅ Coronary artery disease
- ✅ Crohn’s disease
- ✅ Diabetes insipidus
and many more. A full list will be provided.
Chronic Medicine
Utilize our designated service providers (DSPs), MedXpress and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on your chronic medication.
| 🔍 Plan | 📌 Designated Service Provider (DSP) |
| 🅰️ Classic, Classic Smart, Essential | Any given pharmacy in the Discovery network (more than 2,500 pharmacies) |
| 🅱️ Delta Options | Only pharmacies in the MedXpress Network
Delta Options can order their medicine online |
Through MedXpress, you can order or reorder your medication online and have it delivered to your place of business or residence. Alternatively, you can:
- ✅ You can order your medication online and pick it up at a MedXpress Network Pharmacy or
- ✅ Fill a prescription as usual at any pharmacy in the MedXpress Network.
Medicine Tracker
You can set reminders and prompts to help you take your medication as prescribed and on time. For example, your approved chronic medication will be displayed automatically, and you will be prompted to take your medication and confirm each dose.
Discovery Care Programmes
Discovery Health will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions. You must be registered with these condition-specific care programs to access additional benefits and services.
On a personalized dashboard, you and your Premier Plus GP can identify the next steps to manage your condition and maintain your health over time optimally.
The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.
| 📌 Discovery Health Disease Prevention Programme | Comprehensive Premier Plus GPs can enroll you in the Disease Prevention Programme if you have cardiometabolic risk syndrome.
GPs, dietitians, and health coaches coordinate care.
Consultations, pathology tests, and medicine are covered for enrolled members.
Health coaching will help you manage your condition daily. |
| 📍 Discovery Health Mental health Care Programme | Once enrolled by your network psychologist or Comprehensive Premier Plus GP, you have defined major depression cover.
The program provides medication coverage, virtual and in-person psychotherapy, and additional GP visits for treatment evaluation, tracking, and monitoring.
Relapse prevention programs cover psychiatry consultations, counseling, and care coordination for qualifying members. |
| 📌 Discovery Health Diabetes Care Programme | Your Comprehensive Premier Plus GP can enroll you in the Diabetes Care Programme if you receive the Chronic Illness Benefit (CIB) for diabetes.
The program covers extra glucometer strips and dietitian and biokinetics visits.
A nurse educator can help you manage your condition. |
| 📍 Discovery Health HIV Care Programme | Your Comprehensive Premier Plus GP registers you on the HIV program, which includes social worker cover.
Confidentiality is guaranteed.
Avoid a 20% co-payment by getting your medicine from a DSP. |
| 📌 Discovery Health Cardio Care Programme | If referred by your Comprehensive Premier Plus GP and enrolled in the Cardio Care Programme, you can receive a defined basket of care and an annual cardiovascular assessment for hypertension, hyperlipidemia, or ischemic heart disease on the Chronic Illness Benefit (CIB). |
Comprehensive Cancer Cover
You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
| 💶 Discovery Health Prescribed Minimum Benefits (PMB) | PMB cancer treatment is always covered.
PMB treatment costs total the cover.
Discovery Health will fully cover PMB cancer treatment if it exceeds the cover amount. |
| ☑️ Discovery Health Oncology Benefit | After Discovery Health approves your cancer treatment, the Oncology Care Programme covers you.
Discovery Health will cover approved cancer treatment for 12 months.
Classic Smart Comprehensive covers the first R375,000, and all other Comprehensive plans cover R500,000.
Discovery Health will cover up to 80% of the additional costs if your treatment exceeds the cover amount unless the Oncology Innovation and Extended Oncology Benefit cover it.
Discovery Health Rate covers 100% of cancer-related healthcare services (DHR).
If your doctor charges more, you may have a co-payment. |
| ⚕️ Extended Oncology Benefit | After reaching your cover limit, you have full coverage for a specified list of cancers and treatments that meet the Scheme’s criteria.
Classic Smart Comprehensive lacks this. |
| ➡️ Discovery Health Oncology Innovation Benefit | The Scheme covers a list of innovative cancer drugs.
Members must cover these treatments up to 25%.
Classic Smart Comprehensive covers a subset of the Oncology Innovation Benefit’s innovative cancer medicine, subject to the Scheme’s clinical entry criteria.
Members of this option must pay 50%. |
| 💙 Discovery Health – Covering Medicine | To avoid a 20% co-payment, get your approved oncology medicine from a DSP on the Scheme’s medicine list.
Ask your doctor if they use the Scheme’s DSPs for your in-room or facility treatment. |
| 🔍 Discovery Health advanced Illness Benefit | Members receive comprehensive palliative care.
This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services.
Your palliative care treatment plan includes GP consultations. |
Discovery Health Hospital Benefit
The Comprehensive Series includes hospitalization cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
- ✅ This benefit covers the costs associated with hospitalization.
- ✅ Unlimited coverage in any private hospital approved by the Scheme, subject to network requirements for the Delta and Classic Smart Comprehensive options.
- ✅ You are covered for planned hospital stays.
- ✅ You must utilize a network hospital if you have Delta or Classic Smart Comprehensive coverage.
- ✅ You may visit any private hospital approved by the Scheme for funding on the remaining plans.
- ✅ On all health plans, the funding of newly licensed facilities is subject to Scheme approval.
- ✅ Your Hospital Benefit is used to cover planned hospital stays.
- ✅ Discovery Health will pay for hospitalization-related services, including all healthcare professionals, services, and medications authorized by the Scheme.
- ✅ If you utilize physicians, specialists, and other healthcare professionals with whom Discovery Health has an agreement, the scheme will pay in full for their services.
- ✅ On Classic plans, Discovery Health will pay up to 200% of the Discovery Health Rate (DHR).
On Essential plans for other healthcare professionals, the scheme will pay up to 100% of the DHR.
Pre-operative Management Programme for major surgeries
- ✅ For arthroplasty, colorectal surgery, coronary artery bypass graft, radical prostatectomy, and mastectomy, you are covered for a pre-operative nurse assessment, a consultation (face-to-face, virtual, or telephonic) with your treating healthcare professional, and specific laboratory, pathology, and radiology tests.
- ✅ Clinical entry and treatment guidelines govern cover.
Healthcare Providers and Services:
| ☑️ The Hospital Account | The total charge at the agreed-upon rate with the hospital.
The Maternity Benefit provides up to R2,460 per day in a private ward.
For planned admissions to hospitals outside the Delta Hospital Network, the Delta options require an upfront payment of R9,650.
For planned admissions to hospitals outside of the Smart Hospital Network, Classic Smart Comprehensive requires an upfront payment of R11,000. |
| ✅ Upfront Payment for a defined list of procedures that are performed outside the Day Surgery Network | Classic and Essential plans are subject to an R6,300 upfront payment.
Classic Smart Plans are subject to an R11,000 upfront payment.
Delta Options are subject to an R9,650 upfront payment. |
| ☑️ A defined list of procedures that are performed in a specialist’s room | According to the agreed rate where authorized by Discovery Health |
| ✅ Specialist with whom Discovery Health has an arrangement | The full account is covered according to the agreed rate |
| ☑️ Specialists with whom Discovery Health does not have an arrangement | Classic plans are covered up to 200% of the DHR.
Essential plans are covered up to 100% of the DHR. |
| ✅ Radiology and Pathology | Covered up to 100% of the DHR |
| ☑️ MRI and CT scans | Up to the Discovery Health Rate (DHR) if the scan is associated with your current, approved hospital admission under your Hospital Benefit.
If the dental treatment is unrelated to hospitalization or for conservative back and neck treatment, Discovery Health will first cover the first R3,470 from the available day-to-day benefits, and then the remaining cost will be covered by the Hospital Benefit, up to the Discovery Health Rate (DHR).
A maximum of one scan per spinal and cervical region applies to conservative back and neck scans.
On Classic Smart Comprehensive, if your MRI or CT scan is unrelated to your hospital admission, you are responsible for the first R3,470 up to your Annual Deductible.
Discovery Health will cover the remaining balance of the scan after the Hospital Benefit up to the Discovery Health Rate (DHR) |
Scopes
You are responsible for the following amount depending on where your scope is performed. Your Hospital Benefit will cover the remaining hospital and related charges.
Day Clinic Account:
- ✅ Classic, Essential, Classic Smart, and Delta Options
- ✅ R4,050
This co-payment will be reduced from R5,900 to R4,700 if performed by a doctor in the Scheme’s value-based network.
Hospital Account:
- ✅ Classic, Essential, Classic Smart, and Delta Options
- ✅ R4,950
This co-payment will be reduced from R7,300 to R5,950 if performed by a doctor in the Scheme’s value-based network.
Furthermore, the following will apply to the scope of the Comprehensive Series:
- ✅ The Classic and Essential plans will require an upfront payment of R6,300.
- ✅ When a gastroscopy and colonoscopy are performed, a higher initial payment of R7,300 will be required.
- ✅ For Delta options, a one-time payment of R9,650 is required.
- ✅ For Classic Smart, a one-time payment of R11,000 is required.
If scopes are performed in the doctor’s office as part of a confirmed Prescribed Minimum Benefits (PMB) condition or if the patient is under 12 years old, no upfront payment is required. Furthermore, the Hospital Benefit covers the bill.
Discover Annual Limits
| 📌 Cochlear Implants, Auditory Brain Implants, and processors | R230,400 per person per benefit |
| 📍 Internal Nerve Stimulators | R175,200 per person |
| 🦵 Major Joint Surgery | No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R30,900 per prosthesis per admission.
Emergency and trauma surgeries are excluded from the network. |
| 🦾 Shoulder Joint Surgery | If you use a provider outside the network, you can pay up to R45,550 for your prosthesis. |
| 💊 Alcohol and Drug Rehabilitation | Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission. |
| 💙 Mental health | Twenty-one days for admissions or 15 out-of-hospital consultations per person for major affective disorders, anorexia, and bulimia, and 12 for acute stress disorder with recent significant trauma.
Three days for attempted suicide admissions.
Other mental health admissions are 21 days.
Network facilities cover all mental health admissions.
If you go elsewhere, the Scheme will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account. |
| ⚕️ Prosthetic Devices used during Spinal Surgery | The preferred prosthesis suppliers have no limit. If you do not use a preferred supplier, the first level is R26,250, and two or more levels are R52,500, limited to one procedure per person per year.
The spinal surgery network covers approved spinal surgery admissions.
The hospital account will receive up to 80% of the Discovery Health Rate (DHR) for planned admissions outside the Scheme’s network. |
| 1️⃣ Dental Treatment in the hospital | Dental Limit:
Dental treatment is unlimited.
However, all dental appliances, prostheses, placement, and orthodontic treatment (including related accounts for orthognathic surgery) are paid at 100% of the Discovery Health Rate (DHR) and up to 200% for anesthetists on the Classic plan.
Your daily benefits cover these claims up to R32,600 per person.
If you join the Scheme after January, you will not get the full limit because it is calculated by counting the remaining months in the year.
Once the Annual Threshold is met, these benefits apply to the Classic Smart Comprehensive plan. |
| 2️⃣ Dental Treatment in the hospital | Severe Dental and Oral Surgery In-Hospital:
The Severe Dental and Oral Surgery Benefit covers procedures without upfront payment or limit.
This benefit requires authorization and Scheme Rules. |
| 3️⃣ Dental Treatment in the hospital | Basic Dental Trauma:
The Basic Dental Trauma Benefit covers unexpected dental injuries requiring emergency treatment after an accident.
Dental appliances, prostheses, and placement are covered up to R61,500 per person per year if clinical entry criteria are met. |
| 4️⃣ Dental Treatment in the hospital | Dental Treatment In-Hospital:
Dental admissions require prepayment of your hospital or day clinic bill, except for severe dental and oral surgery.
Age and treatment location determine this amount.
Your Hospital Benefit pays the hospital bill up to 100% of the Discovery Health Rate (DHR).
In addition, your Hospital Benefit covers related bills, including the dentist’s, up to 100% of the Discovery Health Rate (DHR).
Anesthetists receive 200% of the Discovery Health Rate (DHR).
Members 13 and older must pay for routine conservative dentistry like preventive care, fillings, and root canals. |
| 5️⃣ Dental Treatment in the hospital | Upfront Payments for Dental Admission:
Hospital Account – R7,800 for members 13> and R3,000 for members <13
Day Clinic Account – R5,000 for members 12> and R1,350 for members <13 |
Discovery Health Comprehensive Cover for Day Surgery Network Procedures
Discovery Health will provide cover for certain day surgery procedures. A day surgery may take place in a hospital, a day clinic, or an independent facility. Furthermore, these services are covered by your Hospital Benefit.
Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications. If you utilize physicians, specialists, and other healthcare professionals with whom Discovery Health will have a payment arrangement, Discovery Health will cover the full cost of these services.
- ✅ On Classic plans, Discovery Health will pay up to 200% of the Discovery Health Rate (DHR).
- ✅ On Essential plans for other healthcare professionals, Discovery Health will pay up to 100% of the DHR.
Furthermore, go to a facility not part of the Day Surgery Network. You must pay the following amounts upfront:
| 🔎 Discovery Comp. Plan | ⬆️ Day Surgery Network for Your Plan | ⬇️ Out-of-Network Upfront Payment |
| 🥇 Classic and Essential | Day Surgery Network | R6,300 |
| 🥈 Delta Options | Delta Day Surgery Network | R9,650 |
| 🥉 Classic Smart | Smart Day Surgery Network | R11,000 |
If any of these procedures are on the list of hospital admission procedures with an upfront payment, the higher of the two upfront payments will apply. The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:
- ✅ Biopsies
- ✅ Breast Procedures
- ✅ Ear, nose, and throat procedures
- ✅ Eye Procedures
- ✅ Ganglionectomy
- ✅ Gastrointestinal scopes and procedures
- ✅ Gynecological Procedures
- ✅ Orthopedic Procedures
and many more.
Discovery Health Comprehensive Additional Benefits
Assisted Reproductive Therapy (ART)
Depending on age, the Scheme covers one or two annual ART cycles if you meet its benefit entry criteria. This benefit covers the following:
- ✅ Consultations
- ✅ Ultrasounds
- ✅ Oocyte retrieval
- ✅ Embryo transfer and freezing
- ✅ Lab fees
- ✅ Medicine
- ✅ Embryo and sperm storage
Claims Relating to Traumatic Events
- ✅ Trauma Recovery Extender Benefit covers out-of-hospital trauma claims.
- ✅ The Trauma Recovery Extender Benefit pays claims for the rest of the year and the year after.
- ✅ For the year the trauma occurred and the year after, you and your dependents on your health plan can receive six counseling sessions per person per year from a psychologist, clinical social worker, or registered counselor.
To qualify, members must apply for this benefit.
Africa Evacuation Cover
- ✅ Emergency medical evacuations from sub-Saharan African countries to South Africa are covered.
- ✅ Excludes pre-existing conditions.
International Travel Benefit
- ✅ While traveling outside South Africa, you are covered for emergency medical costs up to R5 million per person.
- ✅ The cover lasts 90 days after leaving South Africa.
- ✅ This benefit excludes pre-existing conditions.
Suppose the elective treatment is freely available in South Africa and covered by your plan. In that case, Discovery Health might cover it at equivalent local costs.
International Second Opinion Services
- ✅ The Clinic by Cleveland Clinic provides second opinions for life-threatening and life-changing conditions through your specialist.
- ✅ Discovery Health will pay 75% for second opinions.
Spinal Care Programme
- ✅ Conservative spinal treatment out-of-hospital includes virtual and face-to-face consultations with an appropriately registered allied healthcare professional.
In-Room Procedures
- ✅ The cover is limited to specialist room procedures.
- ✅ Hospital Benefit covers up to the Scheme-authorized rate.
Specialized Medicine and Technology Benefit
- ✅ The Specialized Medicine and Technology Benefit covers specific new treatments.
- ✅ There is a limit of R200,000 per person per year.
- ✅ This benefit is subject to a 20% co-payment.
This benefit is excluded from the Classic Smart Comprehensive plan.
Advanced Illness Benefit
- ✅ Members receive comprehensive palliative care.
- ✅ This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services.
Your palliative care treatment plan includes GP consultations.
Discovery Comprehensive Series Value-Added Offers
- ✅ Healthy Care at Clicks or Dis-Chem offers discounts on a wide range of personal and family care products. Healthy Care includes baby care, dental care, eye care, foot care, sun care, hand care, first aid, and over-the-counter medicine.
- ✅ Your plan’s optometrists offer 20% off frames and lenses when you pay immediately.
- ✅ Expectant parents can cryogenically store their newborn baby’s umbilical cord blood and tissue stem cells at a discounted rate with Netcells’ exclusive offer.
- ✅ Vitality, the world’s leading science-based wellness program, rewards healthy living.
Discovery Health collaborates with myHealthTeam, a global leader in online patient communities. This gives members with diabetes, heart disease, and long-term COVID access to a digital community of patients to manage their conditions.
Discovery Health Comprehensive Series Exclusions and Waiting Periods
Exclusions include the following:
- ✅ Reconstructive surgical procedures and treatments, including cosmetic procedures and treatments.
- ✅ Otoplasty for bat ears, blepharoplasty, and port-wine stains (eyelid surgery).
- ✅ Breast reductions or augmentations and gynecomastia are considered cosmetic procedures.
- ✅ Obesity
- ✅ Unless included in Prescribed Minimum Benefits (PMBs) or Assisted Reproductive Therapy, infertility is not covered (ART) Benefit.
- ✅ Frail care
- ✅ Abuse of alcohol, drugs, or solvents.
- ✅ Willful and significant infraction of the law.
- ✅ Willful participation in a war, a terrorist act, a riot, a civil disturbance, a revolt, or an uprising.
- ✅ Injuries incurred or medical care rendered during travel to or within a country at war.
- ✅ Experimental, unproven, or unregistered treatments or practices.
- ✅ Rescue and search.
Discovery Health’s waiting periods are as follows:
- ✅ During your waiting periods, you will not have access to the Prescribed Minimum Benefits (PMBs) if you are subject to waiting periods due to never having belonged to a medical scheme or a break in membership of more than 90 days before joining Discovery Health Medical Scheme, including emergency admission cover.
- ✅ If you had less than a 90-day break in cover before enrolling in Discovery Health Medical Scheme, you might be eligible for Prescribed Minimum Benefits (PMBs) during waiting periods.
Discovery Health Comprehensive Series Plans Compared
| 🔎 Comp. Series Plan | 🥇 Classic Comp. | 🥈 Classic Delta Comp. | 🥉 Essential Comp. | 🏅 Essential Delta Comp. | 🥇 Classic Smart Comp. |
| 👤 Main Member Contribution | R6,810 | R6,133 | R5,723 | R5,155 | R4,949 |
| 👥 Adult Dependent Contribution | R6,441 | R5,805 | R5,405 | R4,686 | R4,568 |
| 💙 Child Dependent Contribution | R1,358 | R1,221 | R1,155 | R1,032 | R1,574 |
| 📌 Oncology Cover (Maximum ZAR) | R500,000 | R500,000 | R500,000 | R500,000 | R375,000 |
| 📉 Prescribed Minimum Benefits (PMB) | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| ➡️ Screening and Prevention | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 🔁 Gap Cover | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 🌎 International Cover | R5 million | R5 million | R5 million | R5 million | R5 million |
Our Verdict on Discovery Health Comprehensive Series
As the name suggests, the Discovery Health Comprehensive Series provides some of the best covers spread across different plans. This ensures that South Africans can choose an option that suits their need (and budget).
The Comprehensive Series is known for its amazing day-to-day benefits, generous medical savings account, Above Threshold Benefit, and superior in-hospital cover for most procedures and treatments.
Furthermore, the Comprehensive series offers additional benefits such as specialized medicine and technology benefit and assisted reproductive therapy (ART), which can only be found on one other plan, namely the Executive plan.
You might also like the following service Discovery has to offer
Discovery Health Comprehensive Series Frequently Asked Questions
What is Discovery Comprehensive Cover?
Discovery Comprehensive Cover is a comprehensive medical aid plan that offers policyholders and their families a wide range of medical benefits and additional services to help manage their health and wellness.
Get a Discovery Health Medical Aid quote from our Dedicated Medical Aid Specialists Broker
What is included in Comprehensive healthcare?
A comprehensive medical aid plan will typically provide full coverage for hospitalization at private clinics, daily expenses at various medical providers and specialists, and chronic medication.
What is the difference between Discovery Executive and Comprehensive?
The Executive Plan provides the most comprehensive in-hospital and outpatient care coverage, chronic medicine coverage, and an unlimited Above Threshold Benefit. In contrast, the Comprehensive covers hospitalization and day-to-day care, with coverage for chronic medications and an unlimited benefit above the threshold.
Does Discovery pay for specialists?
Discovery Health includes specialists as part of the comprehensive in and out-of-hospital cover provided.
What is the Discovery Health Comprehensive Series?
The Discovery Health Comprehensive Series is a health insurance product offered by Discovery Ltd. It provides comprehensive medical coverage to policyholders and their families.
How does the Discovery Health Comprehensive Series differ from other medical aid plans?
The Discovery Health Comprehensive Series is a comprehensive medical aid plan that covers a wider range of medical expenses than other medical aid plans. It also offers additional benefits, such as wellness programs, health management services, and telemedicine consultations.
Who is eligible to join the Discovery Health Comprehensive Series?
Anyone who is a resident of South Africa and meets the eligibility criteria set by Discovery Ltd. can join the Discovery Health Comprehensive Series.
Can I change my level of coverage under the Discovery Health Comprehensive Series?
Yes, you can change your level of coverage under the Discovery Health Comprehensive Series. However, it would help if you informed Discovery Ltd. in writing about the change and the effective date of the change.
Does Discovery Health Comprehensive Series Medical Aid cover laser eye surgery?
There is a limit of R6 180 per person for the year. The optometry limit covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye, like excimer laser. Eye tests are not subject to the limit and are paid from the available day-to-day benefits.
Are pre-existing medical conditions covered under the Discovery Health Comprehensive Series?
Pre-existing medical conditions are typically not covered under the Discovery Health Comprehensive Series. However, Discovery Ltd. may cover certain pre-existing conditions subject to specific conditions and waiting periods.
Can I choose my own healthcare provider under the Discovery Health Comprehensive Series?
Yes, you can choose your own healthcare provider under the Discovery Health Comprehensive Series. However, you need to ensure that the healthcare provider is registered with Discovery Ltd.
How do I claim the Discovery Health Comprehensive Series?
To claim the Discovery Health Comprehensive Series, you must inform Discovery Ltd. as soon as possible and provide all the necessary information and documentation. Then, you can submit the claim online, via email, or by post.
