Overall, the Discovery Health Coastal Core Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and Discovery Health Connected Care for its Family Members. The Discovery Health Coastal Core Medical Aid Plan starts from R3,011 ZAR.
π Medical Aid Plan | π₯ Discovery Health Coastal Core |
π€ Main Member Contribution | R3,011 |
π₯ Adult Dependent Contribution | R2,259 |
πΌ Child Dependent Contribution | R1,196 |
π International Cover | R5 million |
π Annual Limit | Unlimited |
ποΈ Oncology Cover | R250,000 |
π Prescribed Minimum Benefits | β Yes |
β οΈ Screening and Prevention | β Yes |
π΅ Medical Savings Account | None |
π The Discovery Health Coastal Core starts from R3,011. It is part of a series of comprehensive medical insurance plans offered by Discovery Health.
The Discovery Health Core Series includes the following plans:
π It should be noted that The Discovery Health Core Series plans may be subject to Late Joiner Fees.
π Gap Cover is available on the Discovery Health Coastal Core, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.
ππΏ Download the Core Series Guide for 2025
π€ Main Member | π₯ +1 Adult Dependent | πΌ +1 Child Dependent |
R3,011 | R2,259 | R1,196 |
β Hospital Cover
π °οΈ Hospitals you may go to | Any hospital approved in the four coastal provinces |
π ±οΈ Defined list of Procedures that can be done in a Day Surgery Network | Coastal Day Surgery Network facility for private day surgery |
π₯ Cover for Healthcare Professionals in the hospital | Covered up to 100% of the Discovery Health Rate (DHR) |
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π In case of a traumatic incident or after a traumatic event, you can get help from a trained professional.
π 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.
π 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:
π Any additional approved healthcare provider.
π 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:
π To qualify for coverage, your medical condition must be on the Prescribed Minimum Benefit (PMB) conditions list. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits.
π 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 schemeβs rules.
π 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.
π Furthermore, Discovery Health will pay according to your planβs benefits if these criteria are unmet.
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π This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases.
π 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.
π 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 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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π©Ί 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 |
π Physical Health | Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations. |
π§ Mental Health | You have access to a mental health evaluation to promote mental health. |
π Women and Menβs 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 |
πΌ Childrenβs 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. |
β‘οΈ Medical Monitoring Devices | You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar. |
πPersonal Health Pathways leverages a sophisticated digital health platform that combines actuarial and lifestyle data with behavioral science to engage you in a personalized programme that drives you
towards healthier habits and behavior change.
π Personal Health Pathways is a new, innovative personalized care programme designed to help everyone achieve better health. It combines data with actuarial and behavioral science to create a personalized pathway (a plan of what you must do) for each member. Your pathway consists of curated sequence of health and lifestyle actions, tailored to your unique needs, encouraging you to healthier habits and
positive behavior changes.
π Your healthcare pathway is personalized for you. For a member with 12 actions, there are more than 7 million possible pathways to completing those actions.
π By leveraging sophisticated data-science and machine-learning models, these actions have been personalized for you based on your unique health status and engagement patterns.
π Actions are clinically relevant, shown at the right time and in the right sequence, and automatically update and adjust based on your changing healthcare needs.
πΒ You can access your personalized health pathway through the Discovery Health app making it easy for you to seamlessly navigate
the healthcare system and to know what will have the biggest impact on your health.
π Completing these health and exercise actions
will not just have a positive impact on your health but you can get rewarded along the way. You donβt have to be a Discovery Vitality
member to access these rewards.
π You can also unlock additional healthcare benefits when you complete your health and exercise
next best actions.
π The Personal Health Fund is a new category of healthcare funding which you can accumulate as you engage in your Personal Health Pathway
and complete your next best health actions. The fund can be used for day-to-day medical expenses.
π Following the success of theΒ WELLTH Fund in 2023 and 2024, all new joining members will continue to get a once-per-lifetime benefit, built into theΒ Personal Health Fund in 2025
π You will accumulate additional value in your annual Personal Health Fund by completing your next best actions indicated on Personal Health Pathways. The amount available in additional day-to-day funding is defined by your membership.
πΒ The Personal Health Fund represents a new category of healthcare funding giving a you access to up to R10,000 in day-to-day, risk-funded benefits for medical expenses each year.
The benefit works in three simple steps:
πΒ Step 1
πΒ Step2
πΒ Step3
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π The Discovery Health app gives you access to a truly personalized health experience and allows you to navigate the healthcare system easily. Access the advice and healthcare support that you need, 24/7, through the appβs innovative features.
β€οΈ 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. |
𧑠Electronic Prescriptions | Electronic prescribing for expedited access to medications. |
π Home Nurses | Hospital-related care is provided at home by registered nurses. |
π Medicine Ordering and Tracking | Order and track the delivery of your medication from the dispensary to your door. |
π Online Coaches | At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19. |
π Condition-Specific Information | Educational content pertinent to your condition is readily accessible. |
π 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.
π 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 Discoveryβs Hospital at Home program.
πFor those who meet the programβs clinical and benefit criteria, this unlocks cover for approved medical devices and services.
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πΒ 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.
π 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.
π 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.
π With the Discovery Health Coastal Core, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your babyβs life.
π 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:
During Pregnancy:
π Discovery Health will pay for a defined list of blood tests to confirm pregnancy.
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After giving birth, Discovery Health covers the following:
π Furthermore, Discovery Health’s prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.
π 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 on the Additional Disease List (ADL).
β Discovery Health pays for consultations and medicines in the following ways:
π 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.
π 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.
π The DHR for medication consists of the price of the medication and the dispensing fee.
β Prescribed Minimum Benefit (PMB)
π 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).
π Furthermore, Discovery Healthβs Core plans provide richer benefits than competitors. However, to gain access to PMBs, certain rules must be followed.
β Medicine covered in terms of the chronic disease list (CDL)
π You have coverage for all chronic medications on the approved list. For medications not on the list, Discovery Health covers you up to the Chronic Drug Amount monthly maximum (CDA).
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β Chronic Dialysis
π If Discovery Health has approved your treatment plan and you use a provider in the network, Discovery Health will cover all costs associated with your chronic dialysis. Furthermore, Discovery Health will pay up to 80% of the Discovery Health Rate if you go elsewhere (DHR).
π You now have greater convenience and flexibility in managing your medicine needs. Order from your preferred pharmacy partner. Our partners include Clicks, Dis-Chem,Β Medirite and other independent
pharmacies. Our enhanced online platforms give you greater control.
π From uploading your prescriptions to tracking your deliveries, you can now manage all your medicine needs more smoothly than ever before. Alternatively, you can:
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Medicine Tracker
π 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.
π Discovery Health will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions.
π You must be registered with these condition-specific care programs to access additional benefits and services.
π 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.
β€οΈ Discovery Health Disease Prevention Program | Premier Plus GPs can enroll you in the Disease Prevention Program 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. |
𧑠Discovery Health Mental Health Care Program | 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. |
π Discovery Health Diabetes Care Program | Your Premier Plus GP can enroll you in the Diabetes Care Program 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. |
π Discovery Health HIV Care Program | 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. |
π Discovery Health Cardio Care Program | If your Premier Plus GP refers you to the Cardio Care Program 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. |
π 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. |
π The cover is subject to the Schemeβs clinical entry requirements, treatment protocols, and guidelines.
π You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
π₯ 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. |
π§ Discovery Health Oncology Benefit | After Discovery Health has approved your cancer treatment, the Oncology Care Program 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. |
π¨ Discovery Health Oncology Innovation Benefit | Subject to the Schemeβs clinical entry criteria, the Oncology Innovation Benefit covers a subset of innovative cancer medicine. Members must pay 50% of these treatments. |
π© Discovery Health β Covering Medicine | To avoid a 20% co-payment, get your approved oncology medicine from a DSP on the Schemeβs medicine list. Ask your doctor if they use the Schemeβs DSPs for your in-room or facility treatment. |
π¦ 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. |
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π The Coastal Core includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by Hospital Benefits.
π Discovery Health will pay up to 100% of the Discovery Health Rate (DHR).
Pre-operative Management Program for major surgeries
π How Discovery Health will pay for approved hospital admissions on the Coastal Core
π₯ The Hospital Account | Full hospital account paid at the agreed rate. 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. |
π§ Upfront payments for a defined list of procedures that are performed outside the Day Surgery Network | There is an R6,300 co-payment. |
π¨ A defined list of procedures that are performed in specialist rooms | Paid according to the agreed rate where Discovery Health has authorized procedures. |
π© Specialist with whom Discovery Health has an arrangement | The full account is paid according to the agreed rate. |
π¦ Specialists with whom Discovery Health does not have an arrangement, and other healthcare professionals | Paid up to 100% of the Discovery Health Rate (DHR). |
πͺ Radiology and Pathology | Paid up to 100% of the Discovery Health Rate (DHR). |
β¬ MRI and CT scan | Covered if it is related to your hospital admission from your Hospital Benefit. You must pay for anything unrelated to your admission or conservative back and neck treatment. |
Scopes
π 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.
π₯ Discovery Health Plan | π¦ Day Clinic Account | πͺ Hospital Account |
π§ Coastal Core | 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 Schemeβs value-based network. |
π¨ If a gastroscopy and colonoscopy are performed during the same admission | – | – |
π© Coastal Core | R5,500 | R9,600. This co-payment will reduce to R7,950 if scopes are performed by a doctor who is part of the Schemeβs value-based network. |
Furthermore, the following will apply to the scope of the Coastal Core Plan:
π If scopes are performed in the doctorβs 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.
𦻠Cochlear Implants, Auditory Brain Implants, and processors | R244,000 per person for each benefit. |
𧬠Internal Nerve Stimulators | R185,550 per person. |
π©Έ Major Joint Surgery | If you use a provider in our network, you will not have a limit for planned hip and knee joint replacements. We pay up to 80% of the Discovery Health Rate (DHR) if you use a provider outside our network, to a maximum of R30,900 for each prosthesis, for each admission. The network does not apply to emergency or trauma-related surgeries. |
π¦Ύ Shoulder Joint Surgery | If you get your prosthesis from a provider in our network, there is no limit. We pay up to R45,550 if you use a provider outside our network. |
πΉ Alcohol and Drug Rehabilitation | Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission. |
π§ 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. |
β οΈ Prosthetic Devices used during Spinal Surgery | There is no overall limit if you get your prosthesis from one of their 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. They cover you in full for approved spinal surgery admissions if you use a provider in their spinal surgery network. They will pay up to 80% of the DHR for your hospital account if you have a planned admission outside our network. |
π¦· Dental Treatment in the hospital | You need to pay a portion of your hospital or day clinic account upfront for dental admissions, except where you are approved for severe dental and oral surgery. The amount that you pay varies, depending on your age and where you are receiving treatment. They pay the balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate (DHR). The related accounts, which include the dental surgeonβs account, are paid from your Hospital Benefit. They pay up to 100% of the DHR. On Classic plans, they pay anaesthetists up to 200% of the DHR. Upfront payment for dental admissions: Hospital account Members 13 years and older: R8,650 Members under 13 years: R3,350 Day clinic account R5,550 – Members 13 years and older R1,500 – Members under 13 years |
π 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.
π Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.Β Discovery Health will cover the costs of doctors, specialists, and other healthcare providers with which the scheme has an arrangement.
π In addition, Discovery Health will pay 100% of the Discovery Health Rate (DHR) for other healthcare professionals.
1οΈβ£ Medical Aid Plan | 2οΈβ£ Day Surgery Network for Your Plan | 3οΈβ£ Your Out-of-Network Upfront Payment |
Coastal Core | Day Surgery Network | R7,000 |
π If you visit a facility not in your planβs Day Surgery Network, you must pay a co-payment according to the table above.
Discovery Health Coastal Core plan provides the following additional benefits.
In-Room Procedures
Advanced Illness Benefit
π Your palliative care treatment plan includes GP consultations.
Claims Relating to Traumatic Events
π To qualify, members must apply for this benefit.
Africa Evacuation Cover
International Travel Benefit
π Suppose the elective treatment is freely available in South Africa and covered by your plan. In that case, Discovery Health might cover it at equivalent local costs.
International Second Opinion Services
Spinal Care Program
π Conservative spinal treatment is out-of-hospital and includes virtual and face-to-face consultations with an appropriately registered allied healthcare professional.
π Discovery Health collaborates with myHealthTeam, a global leader in online patient communities.
π This gives members with diabetes, heart disease, and long-term COVID access to a digital community of patients to manage their conditions.
Exclusions include the following:
Discovery Healthβs waiting periods are as follows:
π 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.
π Medical Aid Plan | π₯ Discovery Health Coastal Core (2025) | π₯ Momentum Custom Plan 2025 | π₯ KeyHealth Equilibrium 2025 |
π€ Main Member Contribution | R3,011 | R2,580 | R2,368 |
π₯ Adult Dependent Contribution | R2,259 | R3,176 | R1,463 |
πΌ Child Dependent Contribution | R1,196 | R2,449 β R6,573 | R727 |
π International Cover | R5 million | Up to R9.01 million | β Yes |
π Annual Limit | Unlimited | None | None |
ποΈ Oncology Cover | R250,000 | R200,000 per year, 20% co-payment after that | R169,000 |
π Prescribed Minimum Benefits | β Yes | β Yes | β Yes |
β οΈ Screening and Prevention | β Yes | β Yes | β Yes |
π΅ Medical Savings Account | None | None | β Yes |
π The Coastal Core plan by Discovery Health Medical Scheme offers a range of features that make it an appealing option for individuals seeking medical insurance coverage.
π The plan provides Discovery Health Connected Care, which allows members to access telephonic medical advice and support and a range of pathology and radiology services.
π In terms of benefits, the Coastal Core plan offers both in and out-of-hospital cover, including hospitalization, specialist consultations, and medication.
The Discovery Health Core Series offers the following medical aid plans:
The Discovery Health Coastal Core plan is a medical insurance plan offered by Discovery Health Medical Scheme that provides comprehensive cover for in and out-of-hospital medical expenses, including hospitalization, specialist consultations, and medication.
The Coastal Core plan offers a range of benefits, including access to Discovery Health Connected Care, pathology and radiology services, and coverage for chronic conditions.
The Coastal Core plan has co-payment requirements for certain medical services, varying depending on the specific service and provider.Β Therefore, members should review the planβs benefits and costs carefully to understand their co-payment responsibilities.
The Coastal Core plan only covers treatment at coastal hospitals, which may be a limitation for individuals living or seeking treatment outside coastal regions.
Yes, the Coastal Core plan covers chronic conditions, including medication, consultations, and tests, up to a certain limit.
Yes, the Coastal Core plan limits certain medical services and only covers up to 100% of the Discovery Health Tariff (DHT). In contrast, other plans may cover up to 200% of the DHT.
The cost of the Coastal Core plan can vary depending on the memberβs age, location, and selected benefits. Main member starts from R3,011.
Individuals can enroll in the Coastal Core plan by visiting the Discovery Health website or contacting a Discovery Health representative for assistance with the enrolment process.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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