Discovery Health Medical Scheme Core Series Medical Aid Plans (🇿🇦 2025)

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 R2,507 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	R3,652	R2,923	R3,138	R2,507	R3,011
👥 Adult Dependent Contribution	R2,882	R2,305	R2,354	R1,887	R2,259
💙 Child Dependent Contribution	R1,461	R1,169	R1,260	R1,006	R1,196
📉 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

 

 

Discovery Health Medical Scheme Core Series – 17 Key Point Quick Overview

1. ☑️ Discovery Health Core Series Overview
2. ☑️ Discovery Health Core Series Contributions
3. ☑️ Discovery Health Core Series Compared
4. ☑️ Discovery Health Core Plan Benefits at a Glance
5. ☑️ Discovery Health Core Series Benefits and Cover Comprehensive Breakdown
6. ☑️ Discovery Personal Health Pathway
7. ☑️ WHO Outbreak Benefit
8. ☑️ Discovery Care Programmes
9. ☑️ Discovery Comprehensive Cancer Cover
10. ☑️ Discovery Hospital Benefit
11. ☑️ Pre-operative Management Programme for major surgeries
12. ☑️ Discovery Annual Limits
13. ☑️ Discovery Health Smart Cover for Day Surgery Network Procedures
14. ☑️ Discovery Core Series Value-Added Offers
15. ☑️ Discovery Health Core Series Exclusions and Waiting Periods
16. ☑️ Our Verdict on Discovery Health Core Series
17. ☑️ Discovery Health Core Series Frequently Asked Questions

 

Discovery Health Medical Scheme Core Series Overview

The Discovery Health Medical Scheme Core Series starts from R2,507 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:

• 👉 Classic Core
• 👉 Classic Delta Core
• 👉 Coastal Core
• 👉 Essential Core
• 👉 Essential Delta Core

 

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.

 

 

Core Series Contributions

🔎 Medical Aid Plan	👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
🥇 Classic Core	R3,652	R2,882	R1,461
🥈 Classic Delta Core	R2,923	R2,305	R1,169
🥉 Essential Core	R3,138	R2,354	R1,260
🏅 Essential Delta Core	R2,507	R1,887	R1,006
📌 Coastal Core	R3,011	R2,259	R1,196

 

Core Series Compared

🔎 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	R3,652	R2,923	R3,138	R2,507	R3,011
👥 Adult Dependent Contribution	R2,882	R2,305	R2,354	R1,887	R2,259
💙 Child Dependent Contribution	R1,461	R1,169	R1,260	R1,006	R1,196
🔁 Gap Cover	✅ Yes	✅ Yes	✅ Yes	✅ Yes	✅ Yes

 

 

Discovery Health Medical Scheme Core Plan Benefits at a Glance

🔎 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)

 

 

Discovery Health Medical Scheme Core Series Benefits and Cover Comprehensive Breakdown

 

Emergency Cover

In case of a traumatic incident or after a traumatic event, you can get help from a trained professional. Calling Emergency Assist will help you and your loved ones in need.  Furthermore, family members can get help after a traumatic event at any time.

The survivors of gender-based violence can receive counseling and other support as part of this service.

 

Discovery Health Medical Scheme Emergency Cover covers the following medical services:

• ✅ The emergency vehicle (or other medical transport).
• ✅ The hospital’s account of the incident.
• ✅ The observations of the physician who admitted you to the hospital.
• ✅ The anesthesiologist.

 

Any additional approved healthcare provider.

 

Prescribed Minimum Benefits

All medical schemes are required by the Prescribed Minimum Benefit (PMB) provisions of the Medical Schemes Act 131 of 1998 and its Regulations to cover the costs associated with the diagnosis, treatment, and care of:

• ✅ A life-threatening medical condition
• ✅ A defined listing of 271 conditions
• ✅ A list of 27 chronic illnesses.

 

Your medical condition must be on the list of Prescribed Minimum Benefit (PMB) conditions to qualify for coverage. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits.  In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health network.

Once your condition has stabilized, you will be transferred to a hospital or other service providers in the 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.

 

Screening and Prevention

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 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.

 

💙READ more: Best Medical Aids for Pensioners and People over 65

 

Additional Testing

Clinical eligibility requirements may apply to these tests:

• ✅ Diabetes and cholesterol screening tests are defined.
• ✅ Breast screening MRI or mammography and one-time BRCA testing.
• ✅ Colonoscopy for the detection of colon cancer.
• ✅ HPV test or Pap smear for cervical screening.

 

Vaccines (there may be clinical entry requirements):

• ✅ Seasonal influenza vaccination for pregnant members, 65 years or older, registered with certain chronic conditions, and healthcare professionals.
• ✅ Pneumococcal vaccination for members aged 65 or older or those registered with certain chronic conditions.

 

The WHO Global Outbreak Benefit covers the vaccines for COVID-19.

 

 

Discovery Personal Health Pathway

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:

• ✅ Limited to R2,000 per adult dependent.
• ✅ Limited to R1,000 per two-year-old or older child dependent.
• ✅ Limited to R8,000 per family.

 

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

 

 

WHO Outbreak Benefit

 

The basket of care includes the following:

• ✅ COVID-19 vaccines and their administration according to the COVID-19 guidelines of the National Department of Health.
• ✅ Screening consultations with a network general practitioner (virtual, telephone, or in-person).
• ✅ COVID-19 PCR and Rapid Antigen screening tests if referred by a qualified medical practitioner.
• ✅ A set of defined pathology tests for COVID-19-positive individuals.
• ✅ A predetermined assortment of x-rays and scans for COVID-19-positive individuals.
• ✅ Members at risk who meet the clinical entry criteria will receive supportive care, including medication and a home monitoring device to track oxygen saturation levels.

 

When you are admitted to the hospital because of symptoms of COVID-19, you will be covered by the Hospital Benefit of the Core Series and, if necessary, the PMBs.

 

Access to the Long COVID Recovery Programme:

• ✅ A six-month support program for members whose COVID-19 symptoms persist beyond 21 days after acute diagnosis.
• ✅ According to the Scheme’s clinical entry criteria and treatment guidelines, the program includes the following:
• ✅ Up to two specialists and GP consultations.
• ✅ A defined basket of pathology tests.
• ✅ Allied healthcare professional support.
• ✅ A home monitoring device.

 

A defined basket of x-rays and scans.

 

How members of the Discovery Health Core Series are covered in terms of Monkeypox:

• ✅ The treatment protocol for confirmed cases consists of a diagnostic PCR screening test
• ✅ Two visits to a dermatologist or general practitioner.
• ✅ Formulary of supportive medications for pain management.

 

Discovery Health Medical Scheme 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	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.

 

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.

 

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 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

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:

• ✅ 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

• ✅ 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.

 

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.

 

Maternity and Early Childhood Benefit

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.

 

💙Try our free Menstrual Cycle Calculator

 

Discovery Health Medical Scheme Maternity Benefit covers the following:

 

During Pregnancy

• ✅ Scans and Screenings
• ✅ Eight 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.

 

💙Best Medical Aids for Pregnant Women you might consider.

 

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:

• ✅ GP and Specialist help 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.

 

Chronic Benefits

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

• ✅ Addison’s disease
• ✅ Asthma
• ✅ Bipolar mood disorder
• ✅ Bronchiectasis
• ✅ Cardiac failure
• ✅ Cardiomyopathy
• ✅ Chronic obstructive pulmonary disease
• ✅ Chronic renal disease
• ✅ Coronary artery disease
• ✅ Crohn’s disease
• ✅ Diabetes insipidus
• ✅ Diabetes Type 1
• ✅ Diabetes Type 2
• ✅ Dysrhythmia
• ✅ Epilepsy
• ✅ Glaucoma
• ✅ Hemophilia
• ✅ HIV
• ✅ Hypertension

 

and many more!

 

Chronic Medicine

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:

 

• ✅ 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:

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.

 

 

Care Programmes

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.

 

 

Discovery Health Medical Scheme 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 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.

 

 

Hospital Benefit

The Core Series includes hospitalization cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.

 

• ✅ If you require hospitalization, Discovery Health will cover your hospital bills.
• ✅ There is no annual overall hospital limit on any of the plans. However, there are maximum reimbursement amounts for certain treatments.
• ✅ Discovery Health may not cover the expenses if you do not contact the scheme before being discharged.
• ✅ Subject to Delta options and Coastal plan network requirements, unlimited cover in Scheme-approved private hospitals. Furthermore, non-emergency hospital stays are covered.
• ✅ The Hospital Benefit covers planned hospital stays, and Discovery Health will cover all Scheme-authorized hospital services, including healthcare professionals, services, and medicine.
• ✅ Discovery Health will pay for doctors, specialists, and other healthcare professionals with whom Discovery Health has contracted.

 

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.

 

 

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 coverage.

 

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 R10,700 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 R7,000 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.

 

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.

🔎 Medical Aid	📌 Day Clinic Account	📍 Hospital Account
☑️ Classic, Essential, Coastal, and Delta Options	R4,500	R7,700. This co-payment will reduce to R6,400 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	R5,500	R9,600. This co-payment will reduce to R7,950 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:

• ✅ Scopes performed outside of the Day Surgery Network will incur an upfront payment of R7,700 unless performed in a hospital outside the Day Surgery Network. Then, the upfront payment will be R6,400.
• ✅ If a gastroscopy and colonoscopy are performed, an up-front fee of R9,600 will be required.
• ✅ For Delta options, a one-time payment of R7,950 is required.

 

If scopes are performed in the doctor’s office as part of a confirmed Prescribed Minimum Benefits (PMB) condition or if the patient is under 12 years old, no upfront payment is required. Furthermore, the Hospital Benefit covers the bill.

 

 

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	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	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 R18,350 applies for the first spinal level and a limit of R36,700 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 R68,250 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 – R8,6500 for members 13> and R3,350 for members <13 Day Clinic Account – R5,550 for members 12> and R1,500 for members <13

 

Discovery Health Medical Scheme 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 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	R7,000
2️⃣ Delta Options	Delta Day Surgery Network	R10,700

 

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

 

and many more.

 

Core Series Extra Benefits

Discovery Health Medical Scheme Core Series provides the following additional benefits.

 

In-Room Procedures

• ✅ The cover is limited to specialist room procedures.
• ✅ Hospital Benefit covers up to the Scheme-authorized rate.

 

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.

 

Claims relating to Traumatic Events

• ✅ Trauma Recovery Extender Benefit covers out-of-hospital trauma claims.
• ✅ The Trauma Recovery Extender Benefit pays claims for the rest of the year and the year after.
• ✅ For the year the trauma occurred and the year after, you and your dependents on your health plan can receive six counseling sessions from a psychologist per person per year, 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 US$1 million per person.
• ✅ The cover lasts 90 days after leaving South Africa.
• ✅ This benefit excludes pre-existing conditions.

 

💙POLL 1: 5 Best Medical Insurance for International Travel

 

💙POLL 2: 5 Best Travel Medical Insurances

 

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 100% 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.

 

 

 

Core Series Value-Added Offers

• ✅ Healthy Care at Clicks or Dis-Chem offers discounts on a wide range of personal and family care products. Healthy Care includes baby care, dental care, eye care, foot care, sun care, hand care, first aid, and over-the-counter medicine.
• ✅ Your plan’s optometrists offer 20% off frames and lenses when you pay immediately.
• ✅ Expectant parents can cryogenically store their newborn baby’s umbilical cord blood and tissue stem cells at a discounted rate with Netcells’ exclusive offer.
• ✅ Vitality, the world’s leading science-based wellness program, rewards healthy living. 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.

 

 

Discovery Health Medical Scheme Core Series Exclusions and Waiting Periods

 

Exclusions include the following:

• ✅ Reconstructive surgical procedures and treatments, including cosmetic procedures and treatments
• ✅ Otoplasty for bat ears, blepharoplasty, and port-wine stains (eyelid surgery)
• ✅ Breast reductions or augmentations and gynecomastia are considered cosmetic procedures.
• ✅ Obesity
• ✅ 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.

 

 

Our Verdict on the Core Series

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.

 

💙Read more about 5 Best Medical Aids for Seniors and Elderly People

 

Discovery Health Medical Scheme Core Series Frequently Asked Questions

 

What do Core Health Services include?

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.

 

Get a Discovery Health Medical Aid quote from our Dedicated Medical Aid Specialists Broker

 

What are the Discovery Health Medical Scheme Core Series Medical Aid plans?

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.

 

What services are covered under the Discovery Health Medical Scheme Core Series Medical Aid plans?

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.

 

Can I choose my own healthcare provider with the Discovery Health Medical Scheme Core Series Medical Aid plans?

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.

 

Are there any waiting periods for coverage with the Discovery Health Medical Scheme Core Series Medical Aid plans?

Yes, there could be waiting periods for coverage with the Discovery Health Core Series Medical Aid plans.

 

Is there a limit to the number of hospitalization days covered under the Discovery Health Medical Scheme 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.

 

Are pre-existing conditions covered under the Discovery Health Medical Scheme Core Series Medical Aid plans?

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.