Principle Member
From R3905
Dependant Member
From R3083
Child Dependant
From R1562
Classic Core
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
Principle Member
From R3126
Dependant Member
From R2465
Child Dependant
From R1250
Classic Delta Core
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
Principle Member
From R3250
Dependant Member
From R2438
Child Dependant
From R1291
Coastal Core
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
Principle Member
From R3356
Dependant Member
From R2517
Child Dependant
From R1347
Essential Core
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
Principle Member
From R2681
Dependant Member
From R2018
Child Dependant
From R1076
Essential Delta Core
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
⚠️ Deferral: Contribution increases are delayed from January to 1 April 2026.
Overall, the Discovery Health Medical Scheme Core Series Medical Aid Plans are a series of trustworthy and comprehensive medical aid plans that offers 24/7 medical emergency assistance and gap cover to up to 3 Family Members. The Core Series Medical Aid Plans start from R2,681 ZAR.
| 🔎 Medical Aid Plan | 🥇 Classic Core | 🥈 Classic Delta Core | 🥉 Essential Core | 🏅 Essential Delta Core | 🥇 Coastal Core |
| 🌎 International Cover | R5 million | R5 million | R5 million | R5 million | R5 million |
| 👤 Main Member Contribution | R3,905 | R3,126 | R3,356 | R2,681 | R3,250 |
| 👥 Adult Dependent Contribution | R3,083 | R2,465 | R2,517 | R2,018 | R2,438 |
| 💙 Child Dependent Contribution | R1,562 | R1,250 | R1,347 | R1,076 | R1,291 |
| 📉 Annual Limit | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited |
| 💶 Oncology Cover (Maximum ZAR) | R250,000 | R250,000 | R250,000 | R250,000 | R250,000 |
| 🏥 Hospital Cover | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited |
| 📌 Prescribed Minimum Benefits (PMB) | ☑️ Yes | ✅ Yes | ☑️ Yes | ✅ Yes | ☑️ Yes |
| ☑️ Screening and Prevention | ✅ Yes | ☑️ Yes | ✅ Yes | ☑️ Yes | ✅ Yes |
The Discovery Health Medical Scheme Core Series starts from R2,681 and is a series of comprehensive medical insurance plans offered by Discovery Health Medical Scheme. These plans provide an elevated level of coverage for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses.
The Discovery Health Medical Scheme Core Series includes the following plans:
It is important to note that the Discovery Health Medical Scheme Core Series plans may be subjected to a Late Joiner Fee. Gap Cover is available on the Discovery Health Medical Scheme Core Series, and, according to the Trust Index, Discovery Health Medical Scheme has a trust rating of 4.8.
| 🔎 Medical Aid Plan | 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| 🥇 Classic Core | R3,905 | R3,083 | R1,562 |
| 🥈 Classic Delta Core | R3,126 | R2,465 | R1,250 |
| 🥉 Essential Core | R3,356 | R2,517 | R1,347 |
| 🏅 Essential Delta Core | R2,681 | R2,018 | R1,076 |
| 📌 Coastal Core | R3,250 | R2,438 | R1,291 |
| 🔎 Medical Aid Plan | Classic Core | Classic Delta Core | Essential Core | Essential Delta Core | Coastal Core |
| 💵 Prescribed Minimum Benefits (PMB) | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 📉 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 💳 Medical Savings Account | None | None | None | None | None |
| 🍼 Maternity Benefits | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 📌 Pre- and Postnatal Care | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 📍 Chronic Conditions | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 🏠 Home Care | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| ✔️ Oncology Cover (Maximum ZAR) | R250,000 | R250,000 | R250,000 | R250,000 | R250,000 |
| 🅰️ Extended Cover for Oncology | None | None | None | None | None |
| 🏥 Hospital Cover | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited |
| 👁️ Optometry Benefit | None | None | None | None | None |
| 🦷 Dentistry Benefit | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 🪥 Advanced Dentistry | None | None | None | None | None |
| 🦵 Internal Prosthesis | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 🦾 External Prosthesis | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 🧠 Mental Healthcare Programme | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 🍬 Diabetes Care Programme | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 😷 HIV Care Programme | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| ⚕️ Cardio Care Programme | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 💊 Back and Neck program | None | None | None | None | None |
| 💉 Disease Prevention Programme | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 📌 Cover for Covid-19 and other diseases (WHO Outbreak Benefit) | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 📊 Annual Limit | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited |
| 📈 Above Threshold Benefit (ATB) | None | None | None | None | None |
| 🌎 International Cover | R5 million | R5 million | R5 million | R5 million | R5 million |
| 👤 Main Member Contribution | R3,905 | R3,126 | R3,356 | R2,681 | R3,250 |
| 👥 Adult Dependent Contribution | R3,083 | R2,465 | R2,517 | R2,018 | R2,438 |
| 💙 Child Dependent Contribution | R1,562 | R1,250 | R1,347 | R1,076 | R1,291 |
| 🔁 Gap Cover | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes | ✅ Yes |
| 🔎 Hospital Cover | 🥇 Classic Core | 🥈 Classic Delta Core | 🥉 Essential Core | 🏅 Essential Delta Core | 📌 Coastal Core |
| 🚑 Hospitals you may go to | Any private hospital that meets Scheme requirements | Private hospital affiliated with the Delta Network. | Any private hospital that meets Scheme requirements | Private hospital affiliated with the Delta Network. | Any hospital approved in the four coastal provinces |
| 📉 Defined list of Procedures that can be done in a Day Surgery Network | Private facility for day surgery within the Day Surgery Network | Private facility for day surgery within the Delta Day Surgery Network | Private facility for day surgery within the Day Surgery Network | Private facility for day surgery within the Delta Day Surgery Network | Coastal Day Surgery Network facility for private day surgery |
| ☑️ Cover for Healthcare Professionals in the hospital | Covered up to 200% of the Discovery Health Rate (DHR) | Covered up to 200% of the Discovery Health Rate (DHR) | Covered up to 100% of the Discovery Health Rate (DHR) | Covered up to 100% of the Discovery Health Rate (DHR) | Covered up to 100% of the Discovery Health Rate (DHR) |
In case of a traumatic incident or after a traumatic event, you can get help from a trained professional. Calling Emergency Assist will help you and your loved ones in need. Furthermore, family members can get help after a traumatic event at any time.
The survivors of gender-based violence can receive counseling and other support as part of this service.
Discovery Health Medical Scheme Emergency Cover covers the following medical services:
Any additional approved healthcare provider.
All medical schemes are required by the Prescribed Minimum Benefit (PMB) provisions of the Medical Schemes Act 131 of 1998 and its Regulations to cover the costs associated with the diagnosis, treatment, and care of:
Your medical condition must be on the list of Prescribed Minimum Benefit (PMB) conditions to qualify for coverage. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits. In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health network.
Once your condition has stabilized, you will be transferred to a hospital or other service providers in the network, if necessary, according to the scheme’s rules. Discovery Health Medical Schemewill cover up to 80% of the Discovery Health Rate if you do not use a DSP (DHR).
Your responsibility will be the difference between what Discovery Health Medical Scheme 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 unmet.
This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases. The Discovery Health Medical Scheme 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.
The Discovery Health Medical Scheme Screening and Prevention covers the following:
Screening for Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.
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Additional Testing
Clinical eligibility requirements may apply to these tests:
Vaccines (there may be clinical entry requirements):
The WHO Global Outbreak Benefit covers the vaccines for COVID-19.
The Personal Health Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your individual health requirements.
This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks.
Your Personal Health 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 Personal Health Fund for the Core Series covers the following:
| 🔎 General Health | You have access to screenings for vision, hearing, dental, and skin conditions as part of your primary care. Additionally, you are eligible for one GP screening consultation |
| 📌 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 | As a member, you can take advantage of a wellness visit for your children, which includes assessments of their growth and developmental milestones performed by a professional such as an occupational therapist, speech therapist, or physiotherapist. |
| ➡️ Medical Monitoring Devices | You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar. |
The Personal Health Fund is available 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 Personal Health Fund maximum is based on the size and composition of your family as stated in your policy:
Furthermore, the Personal Health Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.
The basket of care includes the following:
When you are admitted to the hospital because of symptoms of COVID-19, you will be covered by the Hospital Benefit of the Core Series and, if necessary, the PMBs.
Access to the Long COVID Recovery Programme:
A defined basket of x-rays and scans.
How members of the Discovery Health Core Series are covered in terms of Monkeypox:
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 | The Home Monitoring Device Benefit gives you access to a range of essential and registered home monitoring devices for certain chronic and acute conditions. Approved cover for these devices will not affect your day-to-day benefits. |
| 📍 Electronic Prescriptions | Electronic prescribing for expedited access to medications. |
| 📌 Home Nurses | Hospital-related care is provided at home by registered nurses. |
| 📍 Medicine Ordering and Tracking | Order and track the delivery of your medication from the dispensary to your door. |
| 📌 Online Coaches | At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19. |
| 📍 Condition-Specific Information | Educational content pertinent to your condition is readily accessible. |
Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations. Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions.
You will not see any changes to your regular benefits because of having cover approved for these gadgets.
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 smart remote monitoring, point-of-care devices, and individualized coaching consultations to monitor and control their chronic condition in the comfort of their homes.
Hospital at Home patients receives specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being. They all work together to make your healthcare more efficient and your life safer.
Suppose you have a valid pre-authorization for hospitalization. In that case, Discovery Health Medical Scheme will use your Hospital Benefit to cover any services provided as part of the Hospital at Home program.
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For those who meet the program’s clinical and benefit criteria, this unlocks cover for approved medical devices and services.
Furthermore, Discovery Health Medical Scheme covers the following:
Hospital-level diagnostics and intervention to manage post-surgical or medical 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
Home Care Cover
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
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.
With the Discovery Health Medical Scheme Core Series, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your baby’s life. This applies from the date of activation of the benefit for each pregnancy and for each child from birth until they are two years old.
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Discovery Health Medical Scheme Maternity Benefit covers the following:
During Pregnancy
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Discovery Health Medical Scheme will pay for a defined list of blood tests to confirm pregnancy.
After giving birth, Discovery Health Medical Scheme covers the following:
The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL). Furthermore, you are protected for 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 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.
Prescribed Minimum Benefit (PMB)
Under the Prescribed Minimum Benefits, you can receive treatment for a set of medical conditions (PMBs). The PMBs cover the 27 chronic conditions included in the Chronic Disease List (CDL). However, to gain access to PMBs, certain rules must be followed.
Medicine covered in terms of the chronic disease list (CDL)
You have coverage for all chronic medications on the approved list. For medications not on the list, Discovery Health Medical Scheme covers you up to the Chronic Drug Amount monthly maximum (CDA).
Chronic Dialysis
If Discovery Health Medical Scheme has approved your treatment plan and you use a provider in the network, Discovery Health Medical Scheme will cover all costs associated with your chronic dialysis. Furthermore, Discovery Health Medical Scheme will pay up to 80% of the Discovery Health Rate if you go elsewhere (DHR).
Discovery Health Medical Scheme Core Series Full List of conditions covered
Members can use Discovery Health Medical Scheme’s designated service providers (DSPs), MedXpress, and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on chronic medication. Through MedXpress, you can order or reorder your medication online and have it delivered to your place of business or residence. Alternatively, you can:
Medicine Tracker:
Furthermore, 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 Health Medical Scheme will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions. You must be registered with these condition-specific care programs to access additional benefits and services.
On a personalized dashboard, you and your Premier Plus GP can identify the next steps to manage your condition and maintain your health over time optimally. The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.
| 📌 Discovery Health Disease Prevention Programme | Premier Plus GPs can enroll you in the Disease Prevention Programme if you have cardiometabolic risk syndrome. Your GP, dietitian, and health coach will 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 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 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 may help you manage your condition. |
| 🩺 Discovery Health HIV Care Programme | Premier Plus GPs register HIV patients for care, including social worker cover. Always confidential. Avoid a 20% co-payment by getting your medicine from a DSP. |
| ☑️ Discovery Health Cardio Care Programme | If your Premier Plus GP refers you to the Cardio Care Programme and you are registered on the Chronic Illness Benefit (CIB) for hypertension, hyperlipidemia, or ischemic heart disease, you can receive a defined basket of care and an annual cardiovascular assessment. |
| 🚀 Track Your Health via the Discovery App | You can receive individualized exercise objectives that help you manage your health. If you are at risk for developing cardiovascular disease or diabetes or have been diagnosed with one of these conditions, Discovery Health will provide you with individualized goals. You can track your progress using the Discovery app and be rewarded for achieving your fitness objectives. |
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 cover PMB cancer treatment even if it exceeds the cover amount. |
| 📍 Discovery Health Oncology Benefit | After Discovery Health has approved your cancer treatment, the Oncology Care Programme covers you. Discovery Health will cover approved cancer treatment for 12 months. Discovery Health covers the first R250,000. Discovery Health will cover up to 80% of additional costs if your treatment exceeds the cover amount. Discovery Health Rate covers up to 100% of cancer-related healthcare services (DHR). If your doctor charges more, you may have a co-payment. |
| ☑️ Discovery Health Oncology Innovation Benefit | Subject to the Scheme’s clinical entry criteria, the Oncology Innovation Benefit covers a subset of innovative cancer medicine. Members must pay 50% of these treatments. |
| ✅ 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. Oncology medicine is paid up to 100% of the Discovery Health Rate or up to the Oncology Reference Price, whichever is applicable. |
| 🔎 Discovery Health advanced Illness Benefit | Members receive comprehensive palliative care. This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services. Your palliative care treatment plan includes GP consultations. |
The Core Series includes hospitalization cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
Discovery Health Medical Scheme will pay up to 200% of the Discovery Health Rate (DHR) on Classic plans and 100% on Essential and Coastal plans for other healthcare professionals.
How Discovery Health Medical Scheme will pay for approved hospital admissions on the Core Series
| 🔎 Procedures Overview | What Discovery Health Pays on the Core Series |
| 🏥 The Hospital Account | Full hospital account paid at the agreed rate. For planned admissions to non-Delta Hospital Network hospitals, Delta requires R11,100 upfront. The Coastal plan requires planned admissions to Coastal-approved hospitals. Discovery Health will pay 70% of the Discovery Health Rate (DHR) for Scheme-approved hospitals outside the coastal network. |
| ☑️ Upfront payments for a defined list of procedures that are performed outside the Day Surgery Network | Classic, Essential, and Coastal plans require an R7,250 upfront payment. Delta options require an R10,700 upfront payment. |
| ✅ A defined list of procedures that are performed in specialist rooms | Paid according to the agreed rate where Discovery Health has authorized procedures. |
| 👩⚕️ Specialist with whom Discovery Health has an arrangement | The full account is paid according to the agreed rate. |
| 👨⚕️ Specialists with whom Discovery Health does not have an arrangement, and other healthcare professionals | Classic plans are paid up to 200% of the Discovery Health Rate (DHR). Essential and Coastal plans are paid up to 100$ of the Discovery Health Rate (DHR). |
| 📈 Radiology and Pathology | Paid up to 100% of the Discovery Health Rate (DHR). |
| 📉 MRI and CT scan | pay up to the Discovery Health Rate (100%) if it is related to your hospital admission from your Hospital Benefit. If the scan is not related to your admission or for conservative back and neck treatment, you will have to pay for it. |
| 📌 Cataract Surgery at a network provider | We pay the full account at the agreed rate at a network facility for cataract surgery. We pay the hospital account at up to 80% of the Discovery Health Rate at any other facility. |
You are responsible for the following amount depending on where your scope is performed. Your Hospital Benefit will cover the remaining hospital and related charges.
| 🔎 Medical Aid | 📌 Day Clinic Account | 📍 Hospital Account |
| ☑️ Classic, Essential, Coastal, and Delta Options | R4,650 | R8,000. This co-payment will reduce to R6,650 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 | If a gastroscopy and colonoscopy are performed during the same admission | If a gastroscopy and colonoscopy are performed during the same admission |
| ☑️ Classic, Essential, Coastal, and Delta Options | R5,700 | R9,950. This co-payment will reduce to R8,250 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 the Smart Series:
If scopes are performed in the doctor’s office as part of a confirmed Prescribed Minimum Benefits (PMB) condition or if the patient is under 12 years old, no upfront payment is required. Furthermore, the Hospital Benefit covers the bill.
| 🔎 Cochlear Implants, Auditory Brain Implants, and processors | R252,000 per person per benefit. A limit of R78,000 applies per person every three years for processor upgrades. |
| 👩⚕️ Internal Nerve Stimulators | R192,000 per person |
| ⚕️ Major Joint Surgery | No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R31,850 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 R46,000 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 | There is no overall limit if you get your prosthesis from one of our preferred suppliers. If you do not use a preferred supplier, a limit of R18,900 applies for the first spinal level and a limit of R37,800 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. We will pay up to 80% of the DHR for your hospital account if you have a planned admission outside our network. |
| 🦷 Dental Treatment in the hospital | Dental Limit: No overall dental limit. However, you must pay for all dental appliances, prostheses, orthodontic treatment, and orthognathic surgery accounts. |
| 🪥 Dental Treatment in the hospital | Severe Dental and Oral Surgery In-Hospital: The Severe Dental and Oral Surgery Benefit covers procedures without upfront payment or limit. This benefit requires authorization and Scheme Rules. |
| 🚑 Dental Treatment in the hospital | Basic Dental Trauma: The Basic Dental Trauma Benefit covers unexpected dental injuries requiring emergency treatment after an accident. Dental appliances and prostheses and their placement are covered up to R70,800 per year if clinical entry criteria are met. |
| 🏥 Dental Treatment in the hospital | Dental Treatment In-Hospital: Dental admissions require prepayment of your hospital or day clinic bill, except for severe dental and oral surgery. Age and treatment location determine this amount. Your Hospital Benefit pays the hospital bill up to 100% of the Discovery Health Rate (DHR). Your Hospital Benefit pays related accounts, including the dental surgeon’s, up to 100% of the Discovery Health Rate (DHR). Anesthetists receive 200% of Discovery Health Rate on Classic plans (DHR). |
| 💊 Dental Treatment in the hospital | Upfront Payments for Dental Admission: Hospital Account – R8,950 for members 13> and R3,470 for members <13 Day Clinic Account – R5,750 for members 12> and R1,550 for members <13 |
Discovery Health Medical Scheme will provide cover for certain day surgery procedures. A day surgery may take place in a hospital, a day clinic, or an independent facility. Furthermore, these services are covered by your Hospital Benefit. Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.
Discovery Health Medical Scheme will cover the costs of doctors, specialists, and other healthcare providers with which the scheme has an arrangement. For other healthcare professionals, Discovery Health Medical Scheme will pay 200% of the Discovery Health Rate (DHR) on Classic and 100% on Essential and Coastal plans.
If you visit a facility that is not in your plan’s Day Surgery Network, you will be required to pay a co-payment according to the table below.
| 🔎 Medical Aid Plan | ➡️ Day Surgery Network for Your Plan | ➡️ Your Out-of-Network Upfront Payment |
| 1️⃣ Classic, Essential, and Coastal | Day Surgery Network | R7,250 |
| 2️⃣ Delta Options | Delta Day Surgery Network | R11,100 |
The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:
Discovery Health Medical Scheme Core Series provides the following additional benefits.
Your palliative care treatment plan includes GP consultations.
To qualify, members must apply for this benefit.
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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.
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.
Exclusions include the following:
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:
The Discovery Health Medical Scheme Core Series aims to provide members unlimited coverage for when they are admitted to hospitals and full coverage for all chronic medicine on the Chronic Disease List.
Furthermore, Discover Health Medical Scheme offers connected care and extensive coverage for pregnant members. While this plan does not have an extensive day-to-day or medical savings plan, it has several other in-hospital benefits to cover members when they need it the most. Students can benefit from the more affordable Core Series while they focus on their studies.
Furthermore, Core Series members can expect coverage for medical emergencies while abroad and access to the Personal Health Fund, which covers an additional list of screening and prevention services.
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In addition to in-hospital care, you can receive quality medical attention in the comfort of your own home thanks to the Home Care Benefit and the Home Monitoring Device Benefit. With the Core Series, you also have protection in case of a medical emergency while away from home.
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The Core Series Medical Aid plans are a range of medical aid options offered by Discovery Health Medical Scheme that provide members with access to quality healthcare services. In addition, the plans are designed to cater to individuals and families with different healthcare needs and budget constraints.
The services covered under the Discovery Health Medical Scheme Core Series Medical Aid plans vary depending on your chosen plan. Furthermore, some of the services covered include hospitalization, doctor visits, medicine, laboratory tests, and diagnostic procedures.
Yes, you can choose your own healthcare provider with the Discovery Health Medical Scheme Core Series Medical Aid plans. However, you might have to pay more for certain services if you choose a provider not part of the Discovery Health network.
Yes, there could be waiting periods for coverage with the Discovery Health Core Series Medical Aid plans.
No, there is no limit to the number of hospitalization days covered under the Discovery Health Core Series Medical Aid plans. Unless if specified.
Pre-existing conditions are covered under the Discovery Health Core Series Medical Aid plans. However, certain conditions may have waiting periods and restrictions according to the rules and guidelines outlined by the Council of Medical Schemes.
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