Discovery Health Essential Delta Core Medical Aid Plan

Overall, the Discovery Health Essential Delta Core Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures to up to 3 Family Members. The Discovery Health Essential Delta Core Medical Aid Plan starts from R2,281 ZAR.

🔎 Medical Aid Plan	🥇 Discovery Health Essential Delta Core
👤 Main Member Contribution	R2,281
👥 Adult Dependent Contribution	R1,716
🍼 Child Dependent Contribution	R915
🔁 Gap Cover	✅ Yes
🌎 International Cover	R5 million
💵 Oncology Cover (Maximum ZAR)	R250,000
💙 Hospital Cover	Unlimited
💶 Medical Savings Account	None
📉 Annual Limit	Unlimited

Discovery Health Essential Delta Core – 21 Key Point Quick Overview

Discovery Health Essential Delta Core Overview

The Discovery Health Essential Delta Core starts from R2,281. It is part of a series of comprehensive medical insurance plans offered by Discovery Health. Discovery Health Essential Delta Core Plan is a suitable choice for those seeking cost-effective medical coverage with fundamental benefits.

The Discovery Health Core Series includes the following plans:

It should be noted that the Discovery Health Core Series Plans may be subject to a late joiner fee. Gap Cover is available on the Discovery Health Essential Delta Core, and, according to the Trust Index, Discovery Health has a trust rating of 4.8.

Discovery Health Essential Delta Core Contributions

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R2,281	R1,716	R915

Discovery Health Core Plan Benefits at a Glance

Hospital Cover:

❤️ Hospitals you may go to	Private hospital affiliated with the Delta Network.
🖤 Defined list of Procedures that can be done in a Day Surgery Network	Private facility for day surgery within the Delta Day Surgery Network
🤍 Cover for Healthcare Professionals in the hospital	Covered up to 100% of the Discovery Health Rate (DHR)

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Discovery Health Essential Delta Core Benefits and Cover Comprehensive Breakdown

Emergency Cover

In case of a traumatic incident or after a traumatic event, you can get help from a trained professional. Calling Emergency Assist will help you and your loved ones in need. Furthermore, family members can get help after a traumatic event at any time. The survivors of gender-based violence can receive counseling and other support as part of this service. Discovery Health Emergency Cover covers the following medical services:

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

Any additional approved healthcare provider.

Prescribed Minimum Benefits

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

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

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

Once your condition has stabilized, you will be transferred to a hospital or other service providers in the Discovery Health network, if necessary, according to the scheme’s rules. Discovery Health will cover up to 80% of the Discovery Health Rate if you do not use a DSP (DHR).

Your responsibility will be to determine the difference between what Discovery Health will pay and the actual cost of your treatment. Furthermore, Discovery Health will pay according to your plan’s benefits if these criteria are unmet.

Screening and Prevention

This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases. The Discovery Health wellness providers cover a variety of screening tests, including blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms or ultrasounds, and prostate screenings.

After all your membership members have completed their health check, you can access additional screening and preventive healthcare services through the WELLTH Fund. The Discovery Health Screening and Prevention covers the following:

✅ Screening for kids will assess the child’s growth and development, including weight, height and body mass index measurements, blood pressure, and more.
✅ Screening for Adults includes blood pressure, blood glucose, HIV, and more. Discovery also covers mammograms, breast ultrasounds, pap smears, and more.

Screening for Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.

Discovery Health WELLTH Fund

The WELLTH 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 WELLTH Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.

The Discovery Health WELLTH Fund for the Essential Delta Core covers the following:

🩺 General Health	You can access screenings for vision, hearing, dental, and skin conditions as part of your primary care. Additionally, you are eligible for one GP screening consultation
⚽ Physical Health	Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations.
🧠 Mental Health	You have access to a mental health evaluation to promote mental health.
🚺 Women and Men’s Health	You have access to various screening and prevention services for women and men. These include, for instance: Consultation with your doctor for gynecological, prostate, or cardiac issues Bone density analysis
🍼 Children’s Health	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 WELLTH Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider. Furthermore, the benefit is available to new members in the joining year and subsequent years.

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

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

✅ Limited to R2,500 per adult dependent.
✅ Limited to R1,250 per two-year-old or older child dependent.
✅ Limited to R10,000 per family.

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

Discovery Health 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 Essential Delta Core and, if necessary, the PMBs.

Access to the Long COVID Recovery Program.

How members of the Discovery Health Essential Delta Core 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 Connected Care

Discovery Health Medical Scheme provides home-based access to health and wellness services. Connected Care is an integrated ecosystem of benefits, services, and digitally connected capabilities designed to assist you in managing your health and wellness.

❤️ Health Monitoring Devices	Access to the most up-to-date medical examination, remote monitoring, and point-of-care devices to facilitate the delivery of quality care at home.
🔴 Electronic Prescriptions	Electronic prescribing for expedited access to medications.
🟥 Home Nurses	Hospital-related care is provided at home by registered nurses.
📌 Medicine Ordering and Tracking	Order and track the delivery of your medication from the dispensary to your door.
📍 Online Coaches	At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19.
🚩 Condition-Specific Information	Educational content pertinent to your condition is readily accessible.

Connected care for members at home

Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations. Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions. You will not see any changes to your regular benefits because of having cover approved for these gadgets.

Connected care for those with chronic conditions

Through Connected Care, you and your doctor can work together to keep your chronic condition under control while you are at home. Eligible members can use various digital services connected to smart remote monitoring, point-of-care devices, and individualized coaching consultations to monitor and control their chronic condition in the comfort of their homes.

Discovery Health Hospital At Home

Hospital at Home patients receive specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being. They all work together to make your healthcare more efficient and your life safer.

Suppose you have a valid pre-authorization for hospitalization. In that case, Discovery Health will use your Hospital Benefit to cover any services provided as part of Discovery’s Hospital at Home program.

For those who meet the program’s clinical and benefit criteria, this unlocks cover for approved medical devices and services.

Discovery Health covers the following:

✅ 24/7 clinical oversight from a care team virtually, including nurses, doctors, and allied healthcare professionals.
✅ 24/7 real-time remote monitoring, which is supported by innovative healthcare technology.
✅ Hospital-level diagnostics and intervention to manage post-surgical or medical care at home.

Acute Care at Home

This includes cover and treatment for COVID-19, as well as post-discharge care. In addition, you are eligible for the Home Monitoring Device Benefit.

Home Monitoring Devices

✅ Suppose you meet the Scheme’s clinical entry criteria. In that case, you have healthcare coverage up to a limit of R4,250 per person per year at 100% of the Discovery Health Rate (DHR) for monitoring certain conditions like chronic obstructive pulmonary disease, congestive heart failure, diabetes, pneumonia, and COVID-19.
✅ If you meet the clinical entry criteria, the scheme covers up to 75% of the Discovery Health Rate (DHR) for defined point-of-care medical devices. You are responsible for 25% of the total cost of these devices. In addition, you have access to the most advanced remote medical examination device, known as TytoHome.

TytoHome enables you to conduct a medical examination by transmitting throat, ear images, and heart and lung sound to your doctor in real time.

Home Care Cover

✅ Discovery Home Care is a service that provides you with high-quality care in the comfort of your own home if your doctor recommends it as an alternative to hospitalization. Postnatal care, end-of-life care, intravenous infusions (drips), and wound care are provided. These services are covered by the Hospital Benefit, pending authorization.
✅ Discovery Home Care is the designated service provider (DSP) for intravenous infusion administration. Use Discovery Home Care for these infusions to avoid a 20% co-payment.

Home-based care for follow-up treatment after hospital admission

✅ Once discharged from the hospital, patients with clinically appropriate conditions such as chronic obstructive pulmonary disease, chronic cardiac failure, ischemic heart disease, and pneumonia have access to enhanced home-based care.

If you meet the clinical entry criteria, you are covered for bedside medicine reconciliation before admission discharge, a follow-up consultation with a GP or specialist, and a defined basket of supportive care at home, including in-person and virtual consultations with a Discovery Home Care nurse.

Discovery Maternity and Early Childhood Benefit

With the Discovery Health Essential Delta Core, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your baby’s life. This applies from the date of activation of the benefit for each pregnancy and each child from birth until they are two years old.

Discovery Health Maternity Benefit covers the following:

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.

Discovery Health will pay for a defined list of blood tests to confirm pregnancy.

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After giving birth:

✅ GP and Specialist help for up to 2 years.
✅ Postnatal care, including complications during delivery, nutritional assessment, etc.

Discovery Health’s prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.

Discovery Health 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 on the Additional Disease List (ADL).

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

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

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

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 in the Chronic Disease List (CDL). Furthermore, Discovery Health’s Core plans to provide richer benefits than competitors.

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 covers you up to the Chronic Drug Amount monthly maximum (CDA).

Chronic Dialysis

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).

Discovery Health Essential Delta Core 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

and many more.

Chronic Medicine

Members can use Discovery Health’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.

Discovery Health Care Programs

Discovery Health will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions. You must be registered with these condition-specific care programs to access additional benefits and services.

On a personalized dashboard, you and your Premier Plus GP can identify the next steps to manage your condition and optimally maintain your health over time.

🟥 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.
🟧 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.
🟨 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.
🟩 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.
🟦 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.
🟪 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.

The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.

Discovery Health 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 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.
🟨 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.
🟡 Discovery Health Advanced Illness Benefit	Members receive comprehensive palliative care. This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services. Your palliative care treatment plan includes GP consultations.

Discovery Health Hospital Benefit

The Essential Delta Core includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by Hospital Benefits.

✅ 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. 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 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.

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Pre-operative Management Program for major surgeries:

✅ For arthroplasty, colorectal surgery, coronary artery bypass graft, radical prostatectomy, and mastectomy, you are covered for a pre-operative nurse assessment, a consultation (face-to-face, virtual, or telephonic) with your treating healthcare professional, and specific laboratory, pathology, and radiology tests.
✅ Clinical entry and treatment guidelines govern cover.

How Discovery Health will pay for approved hospital admissions on the Essential Delta Core:

🔴 The Hospital Account	Full hospital account paid at the agreed rate. For planned admissions to non-Delta Hospital Network hospitals, Delta requires R9,650 upfront. 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	There is an R9,650 co-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	Paid up to 200% of the Discovery Health Rate (DHR).
🟣 Radiology and Pathology	Paid up to 100% of the Discovery Health Rate (DHR).
🔴 MRI and CT scan	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

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 Plan	🅰️ Day Clinic Account	🅱️ Hospital Account
🟥 Essential Delta Core	R4,050	This co-payment will be reduced from R6,950 to R5,750 if performed by a doctor in the Scheme’s value-based network.
🟧 If a gastroscopy and colonoscopy are performed during the same admission	–	–
🟨 Essential Delta Core	R4,950	This co-payment will be reduced from R8,650 to R7,200 if performed by a doctor in the Scheme’s value-based network.

Furthermore, the following will apply to the scopes of the Essential Delta Core Plan:

✅ Scopes performed outside the Day Surgery Network will incur an upfront payment of R6,300 unless performed in a hospital outside the Day Surgery Network. Then, the upfront payment will be R6,950.
✅ If a gastroscopy and colonoscopy are performed, an up-front fee of R9,650 will be required.

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

Discovery Health Annual Limits

🦻 Cochlear Implants, Auditory Brain Implants, and processors	R230,400 per person per benefit
🧬 Internal Nerve Stimulators	R175,200 per person
🩹 Major Joint Surgery	No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R30,900 per prosthesis per admission. Emergency and trauma surgeries are excluded from the network.
🦾 Shoulder Joint Surgery	If you use a provider outside the network, you can pay up to R45,550 for your prosthesis.
🍹 Alcohol and Drug Rehabilitation	Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission.
🧠 Mental health	Twenty-one days for admissions or 15 out-of-hospital consultations per person for major affective disorders, anorexia, and bulimia, and 12 for acute stress disorder with recent significant trauma. Three days for attempted suicide admissions. Other mental health admissions are 21 days. Network facilities cover all mental health admissions. If you go elsewhere, the Scheme will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account.
🩹 Prosthetic Devices used during Spinal Surgery	The preferred prosthesis suppliers have no limit. If you do not use a preferred supplier, the first level is R26,250, and two or more levels are R52,500, limited to one procedure per person per year. The spinal surgery network covers approved spinal surgery admissions. The hospital account will receive up to 80% of the Discovery Health Rate (DHR) for planned admissions outside the Scheme’s network.
🦷 Dental Treatment in the hospital	Dental Limit: No overall dental limit. However, you must pay for all dental appliances, prostheses, orthodontic treatment, and orthognathic surgery accounts. Severe Dental and Oral Surgery In-Hospital: The Severe Dental and Oral Surgery Benefit covers procedures without upfront payment or limit. This benefit requires authorization and Scheme Rules. Basic Dental Trauma: The Basic Dental Trauma Benefit covers unexpected dental injuries requiring emergency treatment after an accident. Dental appliances and prostheses and their placement are covered up to R61,500 per year if clinical entry criteria are met. Dental Treatment In-Hospital: Dental admissions require prepaying your hospital or day clinic bill, except for severe dental and oral surgery. Age and treatment location determine this amount. Your Hospital Benefit pays the hospital bill up to 100% of the Discovery Health Rate (DHR). 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). Upfront Payments for Dental Admission: Hospital Account – R7,800 for members 13> and R3,000 for members <13 Day Clinic Account – R5,000 for members 12> and R1,350 for members <13

Discovery Health Cover for Day Surgery Network Procedures

Discovery Health will provide cover for certain day surgery procedures. A day surgery may take place in a hospital, a day clinic, or an independent facility. Furthermore, these services are covered by your Hospital Benefit.

Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications. Discovery Health will cover the costs of doctors, specialists, and other healthcare providers with which the scheme has an arrangement.

For other healthcare professionals, Discovery Health will pay 200% of the Discovery Health Rate (DHR) on Classic and 100% on Essential and Coastal plans.

If you visit a facility not in your plan’s Day Surgery Network, you must pay a co-payment.

Discovery Essential Delta Core Extra Benefits

Discovery Health Essential Delta Core plan 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.
✅ The year during which trauma occurred and the year after, you and your dependents on your health plan can receive six counseling sessions per person per year from a psychologist, clinical social worker, or registered counselor.
✅ To qualify, members must apply for this benefit.

Africa Evacuation Cover

✅ Emergency medical evacuations from sub-Saharan African countries to South Africa are covered.
✅ Excludes pre-existing conditions.

International Travel Benefit

✅ While traveling outside South Africa, you are covered for emergency medical costs up to US$1 million per person.
✅ The cover lasts 90 days after leaving South Africa.
✅ This benefit excludes pre-existing conditions.
✅ Suppose the elective treatment is freely available in South Africa and covered by your plan. In that case, Discovery Health might cover it at equivalent local costs.

International Second Opinion Services

✅ The Clinic by Cleveland Clinic provides second opinions for life-threatening and life-changing conditions through your specialist.
✅ Discovery Health will pay 100% for second opinions.

Spinal Care Program

Conservative spinal treatment is out-of-hospital and includes virtual and face-to-face consultations with an appropriately registered allied healthcare professional.

Discovery Essential Delta Core Value-Added Offers

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

Discovery Health collaborates with myHealthTeam, a global leader in online patient communities. This gives members with diabetes, heart disease, and long-term COVID access to a digital community of patients to manage their conditions.

Discovery Health Essential Delta Core Exclusions and Waiting Periods

Exclusions include the following:

✅ Reconstructive surgical procedures and treatments, including cosmetic procedures and treatments
✅ Otoplasty for bat ears, blepharoplasty, and port-wine stains (eyelid surgery)
✅ Breast reductions or augmentations and gynecomastia are considered cosmetic procedures.
✅ Obesity
✅ Frail care
✅ Abuse of alcohol, drugs, or solvents
✅ Willful and significant infraction of the law
✅ Willful participation in a war, a terrorist act, a riot, a civil disturbance, a revolt, or an uprising.
✅ Injuries incurred or medical care rendered during travel to or within a country at war.
✅ Experimental, unproven, or unregistered treatments or practices
✅ Rescue and search.

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

Discovery Health’s waiting periods are as follows:

✅ During your waiting periods, you will not have access to the Prescribed Minimum Benefits (PMBs) if you are subject to waiting periods due to never having belonged to a medical scheme or a break in membership of more than 90 days before joining Discovery Health Medical Scheme, including emergency admission cover.

If you had less than a 90-day break in cover before enrolling in Discovery Health Medical Scheme, you might be eligible for Prescribed Minimum Benefits (PMBs) during waiting periods.

Discovery Health Essential Delta Core Plan vs Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 Discovery Health Essential Delta Core	🥈 Medihelp MedVital	🥉 Fedhealth FlexiFED 1
👤 Main Member Contribution	R2,281	R2,256	R2,031
👥 Adult Dependent Contribution	R1,716	R1,722	R1,591
🍼 Child Dependent Contribution	R915	R744	R743
🔁 Gap Cover	✅ Yes	None	None
🌎 International Cover	R5 million	Scheme Tariff	None
💵 Oncology Cover (Maximum ZAR)	R250,000	R242,000	Unlimited at cost at PMB level of care at DSP
💙 Hospital Cover	Unlimited	Unlimited	Unlimited
💶 Medical Savings Account	None	None	✅ Yes
📉 Annual Limit	Unlimited	None	Unlimited Hospital Cover

Our Verdict on Discovery Health Essential Delta Core

provides affordable medical coverage with essential benefits for people who want a basic level of healthcare coverage. One of the key features of the plan is that it covers hospitalization for both planned and emergency procedures, including accommodation and theatre costs.

The plan also covers chronic medication for 27 chronic conditions, which include asthma, hypertension, and diabetes. Members also have access to a network of doctors and specialists, as well as a 24-hour medical helpline.

The Discovery Health Core Series includes the following plans:

Discovery Health Essential Delta Core Frequently Asked Questions

What are the benefits of Discovery Health Essential Delta Core?

The benefits of Discovery Health Essential Delta Core include unlimited private hospital cover, chronic medication benefits, and day-to-day benefits such as doctor consultations, blood tests, and X-rays.

What does Discovery Health Essential Delta Core cover?

Discovery Health Essential Delta Core covers in-hospital treatment, chronic medication, and day-to-day medical expenses such as GP consultations and pathology tests.

Which hospitals are in the Discovery Health Essential Delta Core network?

The Discovery Health Essential Delta Core network includes over 100 private hospitals in South Africa, as well as some hospitals in neighboring countries.

How much does Discovery Health Essential Delta Core cost?

The cost of Discovery Health Essential Delta Core depends on various factors such as your age, location, and health status. Overall, Discovery Health Essential Delta Core is an affordable plan starting from R2,281 per month for the main member.

Is there a waiting period for Discovery Health Essential Delta Core?

Yes, there is a waiting period of 3 months for general healthcare services and 12 months for pre-existing conditions.

Does Discovery Health Essential Delta Core cover pre-existing conditions?

Yes, but there is a waiting period of 12 months for pre-existing conditions.

Does Discovery Health Essential Delta Core cover chronic medication?

Yes, Discovery Health Essential Delta Core covers certain chronic medication subject to a formulary list and certain limits.

Adriaan Schoeman

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