Principle Member
From R10037
Dependant Member
From R9492
Child Dependant
From R2002
Classic Comprehensive
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
Principle Member
From R8576
Dependant Member
From R7920
Child Dependant
From R2002
Classic Smart Comprehensive
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
⚠️ Deferral: Contribution increases are delayed from January to 1 April 2026
Overall, the Discovery Health Medical Scheme Comprehensive Series are a series of trustworthy and comprehensive plans that have a trust score of 4.8. The Discovery Health Medical Scheme Comprehensive Series start from R8,576 ZAR.
| 🔍 Comp. Series Plan | 🥇 Classic Comp (2026) | 🏅 Classic Smart Comp (2026) |
| 🌎 International Cover | R5 million | R5 million |
| 👤 Main Member Contribution | R10,037 | R8,576 |
| 👥 Adult Dependent Contribution | R9,492 | R7,920 |
| 💙 Child Dependent Contribution | R2,002 | R2,002 |
| 🔁 Gap Cover | ☑️ Yes | ☑️ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ✅ Yes | ✅ Yes |
| 📉 Screening and Prevention | ☑️ Yes | None |
| 🍼 Maternity Benefits | ✅ Yes | ✅ Yes |
The Comprehensive Series starts from R8,576 and is a series of comprehensive plans offered by Discovery Health Medical Scheme. The Comprehensive Series provides an elevated level of cover for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses.
The Comprehensive Series includes the following plans:
It should be noted that all the plans that form part of Discovery Health Medical Scheme may be subject to underwriting guidelines such as waiting periods, pre-existing condition exclusions and a late joiner fee.
Gap Cover is available on the Discovery Health Medical Scheme.
24/7 medical emergency assistance.
According to the Trust Index, Discovery Health has a trust rating of 4.8.
| 🔎 Medical Aid Plan | 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| 🥇 Classic Comprehensive | R10,037 | R9,492 | R2,002 |
| 📌 Classic Smart Comprehensive | R8,576 | R7,920 | R2,002 |
| 🔎 Comp. Plan | 🥇 Classic Comprehensive (2026) | 🥇 Classic Smart Comprehensive (2026) |
| 💳 Medical Savings Account (MSA) | Consists of 25% of your monthly contributions | 15% of your monthly contribution |
| 📌 Day-to-Day Extender Benefit (DEB) | The DEB extends your day-to-day cover (while you are in your self-payment gap) for essential healthcare services in our network. | Not available on this plan |
| 📍 MRI and CT scans | We pay the first R4,000 from your available day-to-day benefits and the rest from your Hospital Benefit. For conservative back and neck scans, you have a limit of one scan per spinal and neck region | We pay the first R4,000 from your available day-to-day benefits and the rest from your Hospital Benefit. For conservative back and neck scans, you have a limit of one scan per spinal and neck region |
| 💊 Specialized Medicine and Technology Benefit | You have cover for a defined list of the latest treatments through this benefit. The benefit pays up to R200,000 per person per year. | – |
| ✔️ Medicine Cover – Additional Disease List (ADL) | You have cover for medicine for an additional list of life-threatening or degenerative conditions. This list is called the Additional Disease List. | – |
| ☑️ Oncology Benefit | We cover the first R500,000 of your approved cancer treatment over a 12-month cycle. We pay in full. After you reach the limit, we pay 80% your costs, and this is no upper limit. | We cover the first R375,000 of your approved cancer treatment over a 12-month cycle. We pay in full. After you reach the limit, we pay 80% of your costs, and there is no upper limit. |
| ✅ Extended Oncology Benefit | You have extended cover for defined cancers and treatments. | N/A |
| 🩺 Oncology Innovation Benefit | You have cover for a defined list of innovative cancer medicine that meet the Scheme’s criteria. You will need to pay 25% of the cost of the medicine. For a select list of innovative medicines and conditions, you will have to pay 50% of the account | You have cover for a sub-set of innovative cancer medicine (on our defined list) that meet the Scheme’s criteria. You will need to pay 50% of the account. |
| 🏥 Hospitals you could go to | Any private hospital approved by the Scheme | 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 Smart Day Surgery Network facility. |
| 🩸 Cover for GP consultations. | Claims are paid from the available money allocated to your MSA and limited ATB | You have access to unlimited GP consultations in the Smart GP Network. You will have to pay the first R75. We will pay the rest of the consultation fee, up to the DHR. We cover video consultations with a Smart Network GP in full, up to the DHR. Once you reach the Annual Threshold, we pay your claims from the available money in the limited Above Threshold Benefit |
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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 Medical Scheme’s Emergency Cover covers the following medical services:
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:
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 Medical Scheme’s 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.
This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases. The Discovery Health Medical Scheme’s 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.
The Discovery Health Medical Scheme Screening and Prevention covers the following:
Screening for Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.
Clinical eligibility requirements may apply to these tests:
Vaccines (there may be clinical entry requirements):
The WHO Global Outbreak Benefit covers the vaccines for COVID-19.
The Personal Health Fund covers a comprehensive list of out-of-hospital healthcare services according to your individual health needs once you’ve activated Personal Health Pathways and completed your recommended next best action.
However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines. The Discovery Personal Health 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 Personal Health Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.
The basket of care includes the following:
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:
How members of the Discovery Health Medical Scheme Comprehensive Series are covered in terms of Monkeypox:
Formulary of supportive medications for pain management.
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. |
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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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.
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:
Hospital-level diagnostics and intervention to manage post-surgical or medical care at home.
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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.
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).
However, you are covered by a defined set of daily benefits, including Smart GP visits, specific specialist consultations, and other essential healthcare services.
The Classic Smart Comprehensive Plan is not eligible for this benefit.
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You must continue to submit claims throughout the SPG so that we know when you reach your Annual Claims Threshold.
Over Threshold After your Annual Threshold, the benefit covers daily expenses. Some claims do not meet your Annual Threshold or ATB payment:
The Above Threshold Benefit (ATB) is unlimited unless where sub-limits are specified, so it covers all or a portion of daily expenses at the Discovery Health Rate (DHR). 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 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) |
| 🥇 Comprehensive Series | R43,600 | R51,100 | R59,350 | R67,650 |
OTC Medicine, Childhood vaccines and immunization, and lifestyle-enhancing products:
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 |
| 🥇 Comprehensive Series | R25,500 | R34,700 | R42,250 | R49,050 |
| 🦷 Dental appliances and orthodontic treatment | R37,500 per person | R37,500 per person | R37,500 per person | R37,500 per person |
| ☑️ Antenatal classes | R2,500 for your family | R2,500 for your family | R2,500 for your family | R2,500 for your 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) | R7,500 per person |
| 👩🏻🦼 External Medical Items (wheelchairs, crutches, prostheses) | Comprehensive Series | R64,200 per family |
| 🦻 Hearing Aids | Comprehensive Series | R31,250 for your family |
| 🔎 Day-to-Day Benefits | 📍 How Members of this plan are covered |
| 1️⃣ Unlimited GP Consultations within the Smart GP network | You pay R75, and the Discovery Health Rate covers the rest (DHR). Video consultations are covered according to the DHR. |
| 2️⃣ Cover for defined acute medicine categories prescribed by a Smart network GP. | Covered when prescribed by a Smart Network GP and obtained from a network pharmacy. There is an annual limit on these prescribed acute medicine categories (e.g., schedule 3 and above) — typically around R1,970 per person or R3,300 per family, after which the benefit ends. |
| 3️⃣ Eye tests at an optometrist within the Smart Optometry Network | One eye test per person per year is covered when you use a network optometrist. You pay a fixed upfront fee (about R75 per test) and the rest is covered at the DHR. |
| 4️⃣ Defined dental check-ups at any dentist, dental therapist, or an oral hygienist | One dental check-up per person per year is covered. You pay a fixed co-payment (about R130) and the balance is covered at the DHR. |
| 5️⃣ Over-the-Counter medicine from any MedXpress Network Pharmacy | OTC medicine is covered up to an annual family limit of around R905 per family per year when obtained from a network pharmacy. |
| 6️⃣ Maternity Cover | Classic Smart includes maternity and early-childhood benefits — supporting care during pregnancy and postnatal care when members register on the maternity programme. |
| 7️⃣ Sports injuries, when activated and referred by a Smart Network GP | ports injury benefits include basic X-rays, two specialist visits, and up to four visits to an allied therapist (physio, biokineticist, chiropractor) if referred by a Smart Network GP. You pay a fixed co-payment per visit (around R130) and the balance is covered at the DHR |
With the Discovery Health Medical Scheme 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:
Discovery Health Medical Scheme will cover predetermined blood tests to confirm your pregnancy.
After giving birth, Discovery Health Medical Scheme covers the following:
Postnatal care, including complications during delivery, nutritional assessment, etc.
Prenatal and postnatal care includes:
Try our free Menstrual Cycle Calculator
| 📌 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 Medical Scheme Comprehensive Plans (except Classic Smart Comprehensive) full list of conditions covered:
A full list will be provided.
Utilize our designated service providers (DSPs), MedXpress and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on your chronic medication.
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 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 Health Medical Scheme 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). |
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. On Classic Smart Comprehensive, we cover the first R375,000; on Classic Comprehensive, we cover the first R500,000 at 100% of the Discovery Health Rate. 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. |
The Comprehensive Series includes hospital cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
On Essential plans for other healthcare professionals, the scheme will pay up to 100% of the DHR.
Healthcare Providers and Services:
| ☑️ The Hospital Account | The total charge at the agreed-upon rate with the hospital. The Maternity Benefit provides up to R2,800 per day in a private ward. For planned admissions to hospitals outside of the Smart Hospital Network, Classic Smart Comprehensive requires an upfront payment of R12,650. |
| ✅ Upfront Payment for a defined list of procedures that are performed outside the Day Surgery Network | Classic: You will have to pay an upfront payment of R7,250. Classic Smart: You will have to pay an upfront payment of R12,650. |
| ☑️ 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. |
| ✅ 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 R3,850 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. |
| ✅Cataract Surgery at a network provider | DHMS pay the full account at the agreed rate at a network facility for cataract surgery. DHMS pay the hospital account at up to 80% of the Discovery Health Rate at any other facility. |
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:
This co-payment will be reduced from R6,800 to R5,450 if performed by a doctor in the Scheme’s value-based network.
Hospital Account:
This co-payment will be reduced from R8,100 to R6,600 if performed by a doctor in the Scheme’s value-based network.
Furthermore, the following will apply to the scope of the Comprehensive Series:
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.
| 📌 Cochlear Implants, Auditory Brain Implants, and processors | R252,000 per person per benefit |
| 📍 Internal Nerve Stimulators | R192,000 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 R51,500 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 R27,000, and two or more levels are R53,950, 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 R37,500 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 R70,8000 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 – R8,950 for members 13> and R5,750 for members <13 Day Clinic Account – R3,470 for members 12> and R1,550 for members <13 |
Discovery Health Medical Scheme 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 Medical Scheme 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 there is a payment arrangement, Discovery Health Medical Scheme will cover the full cost of these services.
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 Comprehensive | Day Surgery Network | R7,250 |
| 🥉 Classic Smart Comp. | Smart Day Surgery Network | R12,650 |
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 Day Surgery Network facility:
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:
Claims Relating to Traumatic Events
To qualify, members must apply for this benefit.
Africa Evacuation Cover
International Travel Benefit
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
Spinal Care Programme
In-Room Procedures
Specialized Medicine and Technology Benefit
This benefit is excluded from the Classic Smart Comprehensive plan.
Advanced Illness Benefit
Your palliative care treatment plan includes GP consultations.
The Scheme 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.
Exclusions include the following:
Discovery Health Medical Scheme’s waiting periods are as follows:
| 🔎 Comp. Series Plan | 🥇 Classic Comp. | 🥇 Classic Smart Comp. |
| 👤 Main Member Contribution | R10,037 | R8,576 |
| 👥 Adult Dependent Contribution | R9,492 | R7,920 |
| 💙 Child Dependent Contribution | R2,002 | R2,002 |
| 📌 Oncology Cover (Maximum ZAR) | R500,000 | R375,000 |
| 📉 Prescribed Minimum Benefits (PMB) | ✅ Yes | ✅ Yes |
| ➡️ Screening and Prevention | ☑️ Yes | ☑️ Yes |
| 🔁 Gap Cover | ✅ Yes | ✅ Yes |
| 🌎 International Cover | R5 million | R5 million |
As the name suggests, the Discovery Health Comprehensive Series provides some of the best cover. This ensures that South Africans can choose an option that provide Comprehensive cover as the name suggest.
The Comprehensive Series is known for its extensive 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 to learn more about the following Discovery has to offer:
This is a comprehensive medical scheme plan that offers policyholders and their families a wide range of medical benefits and additional services to help manage their health and wellness.
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A comprehensive medical scheme plan will typically provide full coverage for hospitalization at private hospitals, clinics, daily expenses at various medical providers and specialists, and chronic medication.
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 certain limitations above the threshold.
Yes, it includes specialists as part of the comprehensive in and out-of-hospital cover provided.
The Discovery Health Medical Scheme Comprehensive Series is a comprehensive medical plan to cover policyholders and their families.
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.
Anyone who is a resident of South Africa and meets the eligibility criteria set by Discovery Ltd. can join the Discovery Health Medical Scheme 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.
There is a limit of R7 500 per person for the year in 2026. 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.
Yes, but only for first time joiners, who never belonged to any medical scheme prior joining, or had a break of more than 90 days in medical scheme cover, or did not belong to a medical scheme for 24 months or longer.
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.
To claim from the Discovery Health Medical Scheme 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.
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.
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