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Discovery Health Classic Comprehensive Plan

Overall, the Discovery Health Classic Comprehensive Medical Aid Plan is a trustworthy and comprehensive medical aid plan. The Discovery Health Classic Comprehensive Medical Aid Plan starts from R8,381 ZAR. Discovery Health has a trust score of 4.8.

👤 Main Member Contribution	R8,381
👥 Adult Dependent Contribution	R7,927
🍼 Child Dependent Contribution	R1,671
🔁 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 Classic Comprehensive – 22 Key Point Quick Overview

Discovery Health Classic Comprehensive Overview

The Discovery Health Classic Comprehensive starts from R8,381. It is part of a series of comprehensive medical insurance plans offered by Discovery Health. 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 Comprehensive Series includes the following plans:

It should be noted that a late joiner fee may apply to all Discovery Health Classic Comprehensive Series Plans.

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

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

Classic Comprehensive Monthly Contributions

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R8,381	R7,927	R1,671

Classic Comprehensive Annual Medical Savings Account (MSA)

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R25,104	R23,748	R5,004

Classic Comprehensive Annual Threshold Amounts

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R28,810	R28,810	R5,500

Discovery Health Comprehensive Plan Benefits Summarized

☑️ Day-to-Day Cover	–
🟥 Medical Savings Account (MSA)	Consists of 25% of your monthly contributions
🟥 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.
🟥 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.
☑️ Additional Chronic Cover	–
🟧 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	–
🟨 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 are fully covered for certain cancers and treatments.
🟨 Oncology Innovation Benefit	The Scheme covers a list of innovative cancer drugs. This benefit has a co-payment of 25%.
☑️ Hospital Cover	–
🟩 Hospitals you could go to	Scheme-approved private hospitals
🟩 Where there is a defined list of procedures that can be done in a Day Surgery Network	Private Day Surgery Network facility
🟩 Cover for Specialists, GPs, and other Healthcare Providers/Professionals	Paid up to 200% of the DHR

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Discovery Health 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 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 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.

Discovery WELLTH Fund

The WELLTH Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your 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 Classic Comprehensive covers the following:

🩺 General Health	You can access screenings for vision, hearing, dental, and skin conditions as part of your primary care. Additionally, you are eligible for one GP screening consultation
⚽ Physical Health	Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations.
🧠 Mental Health	You have access to a mental health evaluation to promote mental health.
👥 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
🍼 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.
📍 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 for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider. Furthermore, the benefit is available to new members in the joining year and subsequent years.

The benefit is available once per lifetime per beneficiary. Cover for eligible healthcare services is limited to the Discovery Health Rate (DHR), subject to the overall benefit maximum.

Your WELLTH Fund maximum is based on the size and composition of your family as stated in your policy:

✅ 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.

Furthermore, the WELLTH Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.

Discovery 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 Classic Comprehensive and, if necessary, the PMBs.

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How members of the Discovery Health Classic Comprehensive 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 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.

✅ 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 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.

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.

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 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.

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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.

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 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.
✅ 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 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 Classic plans, 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	You pay R60, and the Discovery Health Rate covers the rest (DHR). Video consultations are covered according to the DHR.
👩‍⚕️ Smart Specialist Benefit when a Smart Network GP refers members	If referred to 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.
👁️‍🗨️ Eye tests at an optometrist within the Smart Optometry Network	There is an upfront payment of R60 that covers one eye test.
🦷 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.
💊 Over-the-Counter medicine from any MedXpress Network Pharmacy	Over-the-counter medicine is covered up to R910 per family per year. Cover for MedXpress or MedXpress Network Pharmacy over-the-counter medicine categories.
💉 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 covers acute medicine categories, subject to the annual prescribed medicine limit.
🏈 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 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 R2,460 per day in a private ward during your delivery hospital stay.

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

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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.

Discovery 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 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 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.

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 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.

Discovery 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 Comprehensive	Any given pharmacy in the Discovery network (more than 2,500 pharmacies)

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. 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 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 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).

Discovery 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.

Discovery 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 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	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.
🟧 Upfront Payment for a defined list of procedures that are performed outside the Day Surgery Network	Subject to an R6,300 upfront payment.
🟨 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	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.

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	R4,050	This co-payment will be reduced from R5,900 to R4,700 if performed by a doctor in the Scheme’s value-based network.
🟧 If a gastroscopy and colonoscopy are performed during the same admission	–	–
🟨 Classic Comprehensive	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 scopes of Classic Comprehensive:

✅ The Classic Comprehensive plan 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.

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.

Discovery 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.
🦷 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. 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. 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. Dental Treatment In-Hospital: Dental admissions require prepaying 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. 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. 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.

✅ Discovery Health 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	R6,300

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
✅ Removal of a foreign body
✅ Simple superficial lymphadenectomy
✅ Skin procedures
✅ Urological procedures

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
✅ 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 R122,000 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 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 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 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 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’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 Classic Comprehensive Plans Compared

🔎 Medical Aid Plan	🥇 Discovery Health Classic Comprehensive	🥈 KeyHealth Platinum	🥉 Cape Medical Plan HealthPact Select
👤 Main Member Contribution	R8,381	R9,624	R7,987
👥 Adult Dependent Contribution	R7,927	R6,747	R7,987
🍼 Child Dependent Contribution	R1,671	R2,031	R1,290

Our Verdict on Discovery Health 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 Comprehensive Series plans:

Discovery Health 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 R8,381

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.

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.