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Discovery Health Medical Scheme Classic Comprehensive Plan (🇿🇦 2025)

Overall, the Discovery Health Medical Scheme Classic Comprehensive Medical Aid Plan is a trustworthy and comprehensive medical aid plan. The Discovery Health Medical Scheme Classic Comprehensive Medical Aid Plan starts from R9,298 ZAR. Discovery Health has a trust score of 4.8.

👤 Main Member Contribution	R9,298
👥 Adult Dependent Contribution	R8,793
🍼 Child Dependent Contribution	R1,856
🔁 Gap Cover	✅ Yes
💶 Prescribed Minimum Benefits	✅ Yes
😷 Screening and Prevention	✅ Yes
💙 Medical Savings Account	✅ Yes
🤰 Maternity Benefits	✅ Yes
🤧 Chronic Conditions	✅ Yes
🏡 Home Care	✅ Yes

Discovery Health Medical Scheme Classic Comprehensive – 22 Key Point Quick Overview

Discovery Health Medical Scheme Classic Comprehensive Overview

👉 The Discovery Health Medical Scheme Classic Comprehensive starts from R9,298. It is part of a series of comprehensive medical insurance plans offered by Discovery Health Medical Scheme. The Classic Comprehensive plan is a top-tier medical aid plan that provides exceptional coverage for those willing to pay a premium price.

The Discovery Health Medical Scheme Comprehensive Series includes the following plans:

👉 It should be noted that a late joiner fee may apply to all Comprehensive Series Plans according to CMS guidelines.

👉 Gap Cover is available on the Classic Comprehensive Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health Medical Scheme has a trust rating of 4.8.

👉🏿 Download the comprehensive-plan-guide-2025 from DHMS.

Discovery Health Medical Scheme Classic Comprehensive Contributions, Annual Medical Savings Account, and Annual Threshold Amounts

Classic Comprehensive Monthly Contributions

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R9,298	R8,793	R1,856

Classic Comprehensive Annual Medical Savings Account (MSA)

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R27,876	R26,364	R5,568

Classic Comprehensive Annual Threshold Amounts

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R32,250	R32,250	R6,160

Comprehensive Plan Benefits Summarized

☑️ Day-to-Day Cover	➕ Benefits
🟥 Medical Savings Account (MSA)	Consists of 25% of your monthly contributions
🟥 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.
🟥 MRI and CT scans	We pay the first R3,850 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.
☑️ Additional Chronic Cover	➕ Benefits
🟧 Specialized Medicine and Technology Benefit	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)
☑️ Cancer Cover	➕ Benefits
🟨 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.
🟨 Extended Oncology Benefit	You have extended cover for defined cancers and treatments.
🟨 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.
☑️ Hospital Cover	➕ Benefits
🟩 Hospitals you could go to	Any private hospital approved by the Scheme
🟩 Where there is a defined list of procedures that can be done in a Day Surgery Network	Private day surgery facility in the Day Surgery Network
🟩 Cover for GP consultations	Claims are paid from the available money allocated to your MSA and limited ATB.

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Classic Comprehensive 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 Prescribed Minimum Benefit (PMB) conditions list 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 Medical Scheme will cover up to 80% of the Discovery Health Rate if you do not use a DSP (DHR). Your responsibility will be to determine the difference between what Discovery Health will pay and the actual cost of your treatment.

💙 Furthermore, Discovery Health Medical Scheme will pay according to your plan’s benefits if these criteria are met.

👉 Screening and Prevention

💙 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.

💙After all your membership members have completed their health check, you can access additional screening and preventive healthcare services through the Personal Health fund (Previously known as WELLTH Fund.)

The Discovery Health Medical Scheme 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.

Personal Health Pathways

💙Personal Health Pathways leverages a sophisticated digital health platform that combines actuarial and lifestyle data with behavioral science to engage you in a personalized programme that drives you
towards healthier habits and behavior change.

💙 Personal Health Pathways is a new, innovative personalized care programme designed to help everyone achieve better health. It combines data with actuarial and behavioral science to create a personalized pathway (a plan of what you must do) for each member. Your pathway consists of curated sequence of health and lifestyle actions, tailored to your unique needs, encouraging you to healthier habits and
positive behavior changes.

Next best actions are hyper-personalized just for you

💙 Your healthcare pathway is personalized for you. For a member with 12 actions, there are more than 7 million possible pathways to completing those actions.

💙 By leveraging sophisticated data-science and machine-learning models, these actions have been personalized for you based on your unique health status and engagement patterns.

💙 Actions are clinically relevant, shown at the right time and in the right sequence, and automatically update and adjust based on your changing healthcare needs.

Get rewarded for closing your rings

💙 You can access your personalized health pathway through the Discovery Health app making it easy for you to seamlessly navigate
the healthcare system and to know what will have the biggest impact on your health.

💙 Completing these health and exercise actions will not just have a positive impact on your health but you can get rewarded along the way. You don’t have to be a Discovery Vitality member to access these rewards.

💙 You can also unlock additional healthcare benefits when you complete your health and exercise next best actions.

Personal Health Fund

💙 The Personal Health Fund is a new category of healthcare funding which you can accumulate as you engage in your Personal Health Pathway
and complete your next best health actions. The fund can be used for day-to-day medical expenses.

💙 Following the success of the WELLTH Fund in 2023 and 2024, all new joining members will continue to get a once-per-lifetime benefit, built into the Personal Health Fund in 2025.

💙 You will accumulate additional value in your annual Personal Health Fund by completing your next best actions indicated on Personal Health Pathways. The amount available in additional day-to-day funding is defined by your membership.

✅ Limited to R2,500 per adult dependent.
✅ Limited to R1,250 per two-year-old or older child dependent.
✅ Limited to R10,000 per family.
✅ The allocation for child dependents will be unlocked once the adult members have unlocked the Personal Health Fund.

How the Personal Health Fund works

💙 The Personal Health Fund represents a new category of healthcare funding giving a you access to up to R10,000 in day-to-day, risk-funded benefits for medical expenses each year.

The benefit works in three simple steps:

👉 Step 1

💙 Download the Discovery Health App and understand your next best actions.
💙 You can view your next best actions on the Personal Health Pathways programme, available on the Discovery Health App and Discovery website.

👉 Step2

💙 Complete the recommended health actions and build up the Personal Health Fund, up to the maximum annual limit.
💙 For every completed next best action on Personal Health Pathways, you accumulate R500 into your Personal Health Fund.
💙 You can continue to accumulate funds up to a maximum limit each year, based on the family structure of the membership.
💙 Any unused funds in the Personal Health Fund expire at the end of a benefit year and do not carry over to the next benefit year.

👉 Step3

💙 You can use available funds on any day-to-day medical expenses, such as GP visits, specialist consultations, physiotherapy and medicine.

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Discovery Health app

💙 The Discovery Health app gives you access to a truly personalized health experience and allows you to navigate the healthcare system easily. Access the advice and healthcare support that you need, 24/7, through the app’s innovative features.

Your access to care at home

❤️ 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.

👉 Discovery Hospital at Home

💙 Hospital at Home patients receive 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.

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👉 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.

👉 Home Monitoring Device Benefit for essential home monitoring

💙 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.

Comprehensive Day-to-Day Benefits

💙 Discovery Health Medical Scheme 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 at the Discovery Health Rate (DHR) or at cost.
✅ If you have elected to have your claims paid by 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 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.
✅ On the Classic Smart Comprehensive Plan, you can access unlimited GP consultations in the Smart GP Network, until you reach
the Annual Threshold. You will have to pay the first R70; the rest of the consultation fee will be covered up to the Discovery Health Rate (DHR).

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 to 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 Comprehensive Classic plan, children under 10 are eligible for two visits yearly.

👉 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).

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).

Classic Comprehensive Day-to-day Cover

📌 Day-to-Day Benefits	🧮 How Members of this plan are covered
📍 Unlimited GP Consultations within the Smart GP network	100% of the Discovery Health Rate (DHR)
👩‍⚕️ Specialists who we have a payment arrangement with	They pay up to the rate that we have agreed on with the specialist
👨🏿‍⚕️ Specialists who we don’t have a payment arrangement with	100% of the Discovery Health Rate (DHR)
➕💊 Preferred medicine	100% of the Discovery Health Rate (DHR)
❌💊 Non-preferred medicine	They pay up to 75% of the Discovery Health Rate (if the price of the medicine is within 25% of the preferred equivalent; They pay up to 50% of the DHR if the price of the50% of the price of th e preferred equivalent.)
🤒 Over-the-counter medicine, childhood vaccines, immunisations and lifestyle-enhancing products.	They pay these claims from the available money in your MSA. These claims do not addup to the Annual Threshold and are not paid from the limited ATB.
💊 Prescribed medicine* (Schedule 3 and above)	Single member : R42,050 One dependent : R49,300 Two dependents: R57,250 Three or more : R65,250
👩‍⚕️ Allied, therapeutic and psychology healthcare services* (Acousticians, biokineticists, chiropractors, counsellors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.)	Single member : R24,600 One dependent : R33,450 Two dependents : R40,750 Three or more : R47,300
👁️‍🗨️ Eye tests at an optometrist within the Smart Optometry Network	R7,250 per person
🦷 Defined dental check-ups at any dentist, dental therapist, or an oral hygienist	R36,150 per person
🦽 External medical items* (Like wheelchairs, crutches and prostheses)	R64,200 for your family
🤰Antenatal classes	R2,400 for your family

Discovery Maternity and Early Childhood Benefit

💙 With the Discovery Health Classic Comprehensive, 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 each child from birth until they are two years old. Discovery Health Maternity Benefit covers the following:

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👉 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 R2,700 per day in a private ward during your delivery hospital stay.

Discovery Health Medical Scheme will cover predetermined blood tests to confirm your pregnancy.

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👉 After giving birth, Discovery Health Medical Scheme covers the following:

✅ Up to R6,300 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.

👉 Prenatal and postnatal care includes:

✅ Five antenatal or postnatal classes.
✅ One Breastfeeding consultation.

Chronic Benefits

💙 The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL). In addition, on Classic Comprehensive, you are covered for the 22 additional conditions listed on the Additional Disease List (ADL).

👉 Discovery Health Medical Scheme pays for consultations and medicines in the following ways:

✅ You must select a primary care physician from the Discovery Health Network to manage your chronic conditions.
✅ You must see a Discovery Health Network physician to receive full coverage for your doctor visits. Use of a non-network primary care physician will incur a 20% co-payment.

💙Discovery Health Medical Scheme will pay up to the Discovery Health Rate (DHR) for medications purchased at one of the network pharmacies. The DHR for medication consists of the price of the medication and the dispensing fee.

👉 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 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 that are 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.

Chronic Medicine

👉 Using a pharmacy in their networks

💙 Utilize their designated service providers (DSPs).

👉How to get your medicine

💙 You now have greater convenience and flexibility in managing your medicine needs. Order from your preferred pharmacy partner. Our partners include Clicks, Dis-Chem, Medirite and other independent pharmacies.
💙Our enhanced online platforms give you greater control. From uploading your prescriptions to tracking your deliveries, you can now manage all your medicine needs more smoothly than ever before.

👉Medicine tracker

You can set up reminders to help you take your medicine on time and as prescribed. Your approved chronic medicine will automatically be displayed; you will then be prompted to take your medicine and
confirm when you have taken each dose.

🅰️ Plan	🅱️ Designated Service Provider (DSP)
🟥 Classic Comprehensive	Any given pharmacy in the Discovery network (more than 2,500 pharmacies)

Discovery Health Medical Scheme’s Care Programs

💙 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 optimally maintain your health over time. 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 Depression Risk Management Programme	If you are identified as being at risk of depression, you will have access to a 6-month long care programme with a defined basket of care.
🍬 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. The cover is limited to R500,000 per member per year. 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.
🟢 Discovery Health Oncology Innovation Benefit	The Scheme covers a list of innovative cancer drugs. Members must cover these treatments up to 25%.
🔵 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.

Hospital Benefit

The Classic Comprehensive includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by Hospital Benefits.

✅ This benefit covers the costs associated with hospitalization.
✅ Unlimited cover in any private hospital approved by the Scheme, subject to network requirements.
✅ You are covered for planned hospital stays.
✅ It would help if you utilized a network hospital.
✅ 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 Medical Scheme pays up to 200% of the Discovery Health Rate (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	They pay the full account, at the rate agreed on with the hospital. They pay up to R2,700 per day in a private ward from the Maternity Benefit for deliveries.
🟧 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 R7,000
🟨 A defined list of procedures that are performed in a specialist’s room	Paid 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	Covered up to 200% of the DHR.
🟪 Radiology and Pathology	They pay up to the Discovery Health Rate (100%).
🟥 MRI and CT scans	We pay up to the The Discovery Health Rate (DHR) if the scan is related to your current and approved hospital admission from your Hospital Benefit. If the scan is not related to your admission or is for conservative back and neck treatment, we pay the first R3,850 from your available day-to-day benefits and the rest from your Hospital Benefit, up to the DHR. For conservative back and neck scans, cover is limited to one scan per spinal and neck region.

👉 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.

🔎 Discovery Plan	🅰️ Day Clinic Account	🅱️ Hospital Account
🟥 Classic Comprehensive	R4,500	R6,550. This co-payment will reduce to R5,250 if the scope is performed by a doctor who is part of the Scheme’s value-based network.
🟧 If a gastroscopy and colonoscopy are performed during the same admission	🅰️	🅱️
🟨 Classic Comprehensive	R5,500	R8,100. This co-payment will reduce to R6,600 if scopes are performed by a doctor who is part of the Scheme’s value-based network.

Furthermore, the following will apply to the scopes of Classic Comprehensive:

✅ The Classic Comprehensive plan will require an upfront payment of R7000
✅ When a gastroscopy and colonoscopy are performed, a higher initial payment of R8,100 will be required.

💙 No co-payment applies for scopes performed at an in-rooms network provider. The following co-payment will apply for scopes performed at a non-network provider :

Single Scope: R1,750 co payment.

Bi-directional scopes: R3,000 co payment.

Discovery Annual Limits

🦻 Cochlear Implants, Auditory Brain Implants, and processors	R244,000 per person per benefit
⚕️ Internal Nerve Stimulators	R185,550 per person.
📌 Major Joint Surgery	If you use a provider in our network, you will not have a limit for planned hip and knee joint replacements. We pay up to 80% of the Discovery Health Rate (DHR) if you use a provider outside our network, to a maximum of R30,900 for each prosthesis, for each admission. The network does not apply to emergency or trauma-related surgeries.
📍 Shoulder Joint Surgery	If you get your prosthesis from a provider in our network, there is no limit. DHMS pay up to R45,550 if you use a provider outside our network.
💊 Alcohol and Drug Rehabilitation	They pay for 21 days of rehabilitation for each person each year. For detoxification, we cover for three days per approved admission, per person.
🧠 Mental health	They cover the following: 21 days of admissions or up to 15 out-of-hospital consultations per person for major affective disorders, anorexia and bulimia. Up to 12 out-of-hospital consultations for acute stress disorder that is accompanied by recent significant trauma 3 days (per approved admission) for attempted suicide 21 days for all other mental health admissions. All mental health admissions are covered in full at a network facility. If you go somewhere else, we will pay up to 80% of the DHR for the hospital account.
🦾 Prosthetic Devices used during Spinal Surgery	There is no overall limit if you get your prosthesis from oneof our preferred suppliers. If you do not use a preferred supplier, a limit of R26,200 applies for the first spinal level, and a limit of R52,400 applies for two or more levels. This benefit is limited to one procedure per person per year. We cover you in full for approved spinal surgery admissions if you use a provider in our spinal surgery network. They will pay up to 80% of the DHR for your hospital account if you have a planned admission outside our network. You also have cover for out-of-hospital conservative spinal treatment.
🦷 Dental limit	There is no overall limit for basic dental treatment. They pay 100% of the Discovery Health Rate (DHR) for alldental appliances and prostheses, the placement of dental appliances and prostheses, and orthodontic treatment. For orthodontic treatment, we also pay the related accounts for orthognathic surgery. For anaesthetists, we pay up to 200% of the DHR. We cover these claims from your day-to-day benefits, up to a yearly limit of R36,150 per person or up to the Above Threshold Benefit limit – whichever one you reach first. If you join the Scheme after January, you will not receive the full limit, as we will calculate the benefit limit based on the number of months remaining in the year.

Discovery Health Medical Scheme Comprehensive Cover for Day Surgery Network Procedures

💙 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. Utilize physicians, specialists, and other healthcare professionals with whom Discovery Health Medical Scheme will have a payment arrangement.

Discovery Health Medical Scheme will cover the full cost of these services.

✅ Discovery Health Medical Scheme pays up to 200% of the Discovery Health Rate (DHR).

Furthermore, go to a facility not part of the Day Surgery Network. You must pay the following amounts upfront:

🔎 Discovery Plan	🅰️ Day Surgery Network for Your Plan	🅱️ Out-of-Network Upfront Payment
🥇 Classic Comprehensive	Day Surgery Network	R7,000

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 Day Surgery Network:

✅ Biopsies
✅ Breast Procedures
✅ Ear, nose, and throat procedures
✅ Eye Procedures
✅ Ganglionectomy
✅ Gastrointestinal scopes and procedures
✅ Gynecological Procedures
✅ Orthopedic Procedures
✅ Removal of a foreign body
✅ Simple superficial lymphadenectomy
✅ Skin procedures
✅ Urological procedures

Discovery Health Medical Scheme Comprehensive Additional Benefits

🔎 Extra Benefit	🥇 Description
🩺 Advanced Illness Benefit	Coverage for severe illness care
🚁 Africa Evacuation Benefit	Emergency evacuation in Africa
👶 Assisted Reproductive Therapy (ART)	Support for reproductive treatments
💔 Claims related to Traumatic Events	Coverage for trauma-related care
🛏️ In-room Procedures	Coverage for minor in-room treatments
🌍 International Second Opinion Services	Access to global medical expertise
🦴 Spinal Care Programme	Specialized spinal treatment options
✈️ Overseas Treatment Benefit	Coverage for treatment abroad
💊 Specialised Medicine and Technology Benefit	Advanced treatments and medications
🏥 Supportive Care after an Admission	Post-hospitalization supportive care
🌐 WHO Global Outbreak Benefit	Coverage during global health crises
🤕 Supportive Post-surgery Programme	Assistance and care after surgeries

👉 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
✅ This benefit covers egg donation cycles.
✅ Cryopreservation and egg and sperm storage for five years are available to Oncology Programme participants who meet clinical entry criteria.
✅ Discovery Health will pay 75% of the Discovery Health Rate up to R135,000 per person annually.

💙 You must pay up to 25% or any amount that exceeds the Discovery Health Rate (DHR).

👉 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 occurs 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 Medical Scheme 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 Benefits

✅ 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.

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 Medical Scheme 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
✅ 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 Classic Comprehensive and, if necessary, the PMBs.

Classic Comprehensive Value-Added Offers

✅ Healthy Care at Clicks or Dis-Chem offers discounts on personal and family 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. As a result, Discovery Vitality members live longer and healthier lives.

💙 Discovery Health Medical 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.

Classic Comprehensive 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
✅ 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.

💙 Unless included in Prescribed Minimum Benefits (PMBs) or Assisted Reproductive Therapy, infertility is not covered (ART) Benefit.

Discovery Health Medical Scheme’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.

Working to care for and protect you

What to do if you have a complaint

💙 Their goal is to provide you with support when you need it most.
They hold your privacy in the highest regard. Their unwavering
commitment to protecting your personal information and ensuring the security and confidentiality of your data is clearly outlined in their Privacy
Statement.

💙 To take your query further
If you have already contacted Discovery Health Medical Scheme (DHMS) and feel that your query has still not been resolved, please
complete our online complaints form on www.discovery.co.za. We would also love to hear from you if we have exceeded your expectations.
💙 To contact the Principal Officer
If you are still not satisfied with the resolution of your complaint after following the process in the first step, you can escalate your
complaint to the Principal Officer of the DHMS. You may lodge a query or complaint with the Scheme by completing the online form
on www.discovery.co.za or by emailing [email protected].
💙 To lodge a dispute
If you have received a final decision from DHMS and want to challenge it, you may lodge a formal dispute. You can find more information
of the Scheme’s dispute process on www.discovery.co.za.
💙 To contact the Council for Medical Schemes
DHMS is regulated by the Council for Medical Schemes. You may contact the Council at any stage of the complaints process. However,
we encourage you to follow the steps above to resolve your complaint before contacting the Council.
💙 Contact details for the Council for
Medical Schemes: Council for Medical Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park,
Centurion 0157 | [email protected] | 0861 123 267 | www.medicalschemes.co.za

Classic Comprehensive Plans Compared

🔎 Medical Aid Plan	🥇 Discovery Health Classic Comprehensive (2025)	🥈 KeyHealth Platinum (2025)	🥉 Cape Medical Plan HealthPact Select (2025)
👤 Main Member Contribution	R9,298	R9,624	R7,987
👥 Adult Dependent Contribution	R8,793	R6,747	R7,987
🍼 Child Dependent Contribution	R1,856	R2,031	R1,290

Our Verdict on Classic Comprehensive

💙 The Classic Comprehensive plan offered by Discovery Health Medical Scheme is their most premium cover option, offering extensive benefits and generous cover. It includes extended coverage for oncology with a maximum cover of up to R500,000 for cancer and a medical savings account to cover day-to-day medical expenses.

💙 The plan also provides extensive out-of-hospital coverage for procedures such as consultations, diagnostic tests, and medication. However, while the plan is also the most expensive option in their range, co-payments may apply for out-of-hospital procedures such as scopes and scans.

You might like to read more about The Discovery Health Medical Scheme Comprehensive Series plans:

👉🏿 Classic Comprehensive
👉🏿 Classic Smart Comprehensive

Classic Comprehensive Frequently Asked Questions

What is the Classic Comprehensive medical aid plan?

The Classic Comprehensive plan is a premium medical aid plan offered by Discovery Health Medical Scheme, providing extensive benefits and cover for medical expenses.

How much does the Classic Comprehensive plan cost?

The cost of the Classic Comprehensive plan varies based on individual circumstances such as age, health status, and chosen cover options. The main member starts at R9,298

What oncology cover is included in the Classic Comprehensive plan?

The Classic Comprehensive plan offers extended coverage for oncology with a maximum coverage of up to R500,000 for cancer 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.

Does the Classic Comprehensive plan have a medical savings account?

Yes, the Classic Comprehensive plan includes a generous medical savings account to cover day-to-day medical expenses.

What out-of-hospital benefits are included in the Classic Comprehensive plan?

The Classic Comprehensive plan provides extensive out-of-hospital coverage for procedures such as consultations, diagnostic tests, and medication.

Are any co-payments required for certain out-of-hospital procedures with the Classic Comprehensive plan?

Yes, co-payments may apply for certain out-of-hospital procedures such as scopes and scans.

Can I choose my healthcare provider with the Classic Comprehensive plan?

Yes, you can choose your healthcare provider with the Classic Comprehensive plan, including any doctor or hospital registered with the scheme.

What makes the Classic Comprehensive plan different from other medical aid plans?

The Classic Comprehensive plan is the most premium cover option in the Discovery Health Medical Scheme range, offering extensive benefits and cover for medical expenses.

Adriaan Schoeman

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