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Discovery Health Executive Plan Medical Aids

Overall, the Discovery Health Executive Medical Aid Plan is a trustworthy and comprehensive medical aid plan that provides an elevated level of coverage for in-hospital expenses to up to 3 Family Members. The Discovery Health Executive Medical Aid Plan starts from R10,303 ZAR.

🔎 Medical Aid Plan	🥇 Discovery Health Executive Plan	🥈 Bonitas Medical Fund BonComprehensive	🥉 Medihelp MedPlus
🌎 International Cover	Up to US$1 million	R10 million	Scheme Tariff
👤 Main Member Contribution	R10,303	R8,217	R10,980
👥 Adult Dependent Contribution	R10,303	R7,749	R10,980
💙 Child Dependent Contribution	R1,969	R1,672	R2,742
📉 Annual Limit	Unlimited	Unlimited	Unlimited
💶 Prescribed Minimum Benefits (PMB)	☑️ Yes	☑️ Yes	☑️ Yes
✔️ Screening and Prevention	☑️ Yes	☑️ Yes	☑️ Yes
➡️ Home Care	☑️ Yes	☑️ Yes	None
⚕️ Oncology Cover (Maximum ZAR)	R500,000	R400,000	Unlimited

Discovery Health Executive Plan – 13 Key Point Quick Overview

☑️ Discovery Health Executive Plan Overview
☑️ Discovery Health Executive Plan Contributions
☑️ Discovery Health Executive Plan Benefits and Cover Comprehensive Breakdown
☑️ Discovery WELLTH Fund
☑️ Discovery WHO Outbreak Benefit
☑️ Discovery Health Executive Plan Hospital At Home
☑️ Discovery Health Executive Plan Day-To-Day Benefits and Cover
☑️ Discovery Maternity and Early Childhood Benefit
☑️ Discovery Care Programmes
☑️ Discovery Health Executive Plan Exclusions and Waiting Periods
☑️ Discovery Health Executive Plan vs. Similar Plans from Other Medical Schemes
☑️ Our Verdict on Discovery Health Executive Plan
☑️ Discovery Health Executive Plan Frequently Asked Questions

Discovery Health Executive Plan Overview

The Discovery Health Executive Plan starts from R10,303 and is a comprehensive medical insurance plan offered by Discovery Health. It provides an elevated level of coverage for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses. Gap Cover is available on the Discovery Health Executive Plan, along with 24/7 medical emergency assistance. Discovery Health Executive Plan has a trust rating of 4.8 according to the Trust Index.

Discovery Health Executive Plan Contributions

🔎 Members	👤 Main Member	👥 +1 Adult Dependent	💙 +1 Child Dependent
➡️ Contributions (January 23 – March 23)	R10,303	R10,303	R1,969
➡️ Annual Medical Savings Account	R30,900	R30,900	R5,904
➡️ Annual Threshold Amount	R35,230	R35,230	R6,680

Discovery Health Executive Plan Benefits and Cover Comprehensive Breakdown

Discovery Health Executive Plan 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.

Discovery Health Executive Plan 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 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 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 not met.

Discovery Health Executive Plan 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.

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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 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 Executive Plan 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	You have access to a wellness visit for children that includes assessments of growth and developmental milestones by 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 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 Executive plan 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.

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How members of the Discovery Health Executive Plan 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.

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 and point-of-care devices, as well as individualized coaching consultations, to monitor and control their chronic condition in the comfort of their homes.

Discovery Health Executive Plan 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 will use your Hospital Benefit to cover any services provided as part of Discovery’s Hospital at Home program. For those who meet the program’s clinical and benefit criteria, this unlocks cover for approved medical devices and services. Furthermore, Discovery Health covers the following:

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

Acute Care at home

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

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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 also 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 Health Executive Plan Day-To-Day Benefits and Cover

🔎 Discovery Health Medical Savings Account (MSA)	Discovery Health pays day-to-day medical expenses from the MSA, including GP and Specialist visits, radiology, pathology, and more. Members can have their claims paid from their MSA at the Discovery Health Rate or Cost. Claims will be funded above the DHR if claims are paid at cost from MSA. Claims paid from MSA above the DHR do not count towards the ATB. Amounts left in the MSA at the end of the year will be carried over to the next.
☑️ Discovery Day-to-Day Extender Benefit (DEB)	This pays for certain claims once your MSA has been depleted but before you reach the ATB. For instance: Video Consultations with GPS Pharmacy Clinic Consultations Furthermore, children <10 years have 2 casualty visits per year
📌 The Self-Payment Gap	If the MSA runs out before the end of the year, the member must pay claims from their pocket until the ATB is reached, also known as the “Self-Payment Gap.”
📍 Discovery Health Above Threshold Benefit (ATB)	Once the Self-Payment Gap has been filled, Discovery Health will pay claims. However, the following claims will not add up to the ATB or be covered by the ATB: Claims over the annual benefit limit Claims over the DHR Products to enhance your lifestyle Childhood vaccines and immunizations Over-the-counter medicine

The tables below detail how much the Executive plan pays for your day-to-day expenses.

Healthcare Providers and Medicine

🔎 Healthcare Providers and Medicine	What Discovery Health Pays:
🩺 Specialists Discovery Health has arrangements with	Up to the agreed rate
📌 Specialists Discovery Health does not have arrangements with	3x the Discovery Health Rate (300%)
📍 GPS and other healthcare professionals	Up to 100% of the Discovery Health Rate
💊 Preferred Medicine	Up to 100% of the Discovery Health Rate
🅰️ Non-Preferred Medicine	Up to 75% of the DHR if the medicine falls within the 25% preferred equivalent Up to 50% if the medicine is 50%> the preferred equivalent

Medicine

🔎 Members	1️⃣ Single Member	2️⃣ +1 Dependent	3️⃣ 2 Dependents	4️⃣ 3 and More Dependents
Prescribed Medicine (Schedule 3 and higher)	R46,450	R54,450	R62,350	R70,300

OTC Medicine, Childhood vaccines and immunization, lifestyle-enhancing products: Discovery Health will pay claims from the MSA funds. However, these claims will not add up to the Annual Threshold, and neither are they paid from the ATB if the Self-Payment Gap reaches R0

Professional Services

This includes all allied healthcare services, including acousticians, biokinetics, chiropractors, counselors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.

Discovery covers the following:

✅ Main Member only – R27,800
✅ Main and Dependent – R33,450
✅ Main Member and 2 Dependents – R39,150
✅ Main Member and 3 (or more) Dependents – R46,950

In addition, Discovery Health covers the following additional services:

Dental Appliances and orthodontic treatment – R32,600 per person.
Antenatal classes – R2,170 for the family.
Optical – R9,550 per person.
External medical items – R64,200 for the family.
Hearing Aids – R28,200 per family.

Discovery Maternity and Early Childhood Benefit

With the Discovery Health Executive plan, 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.

Discovery Health Maternity Benefit covers the following:

During Pregnancy:

Scans and Screenings
Twelve antenatal consultations with a midwife, GP, or gynecologist.
2 x 2D ultrasound scans
Nuchal translucency test
3D and 4D scans up to the 2D scan rate.
Non-invasive Prenatal Test (NIPT)
One flu vaccination during pregnancy.
Private ward for delivery and cover up to R2,460 per day in a private ward.

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After giving birth, Discovery Health covers the following:

✅ Essential devices up to R5,660 with a 25% co-payment.
✅ GP and Specialist help for up to 2 years.
✅ Postnatal care, including complications during delivery, nutritional assessment, etc.

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Discovery Health prenatal and postnatal care includes:

Five antenatal or postnatal classes.
One Breastfeeding consultation.

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 Chronic Benefit Cover Summarized

🔎 Prescribed Minimum Benefit (PMB) Conditions	Under the Prescribed Minimum Benefits, you can receive treatment for a set of medical conditions (PMBs). The PMBs cover the 27 chronic conditions included in the Chronic Disease List (CDL).
📌 Medicine Cover for the Chronic Disease List	You have cover for all chronic medications on the Scheme’s approved list. Discovery Health will cover you up to the Chronic Drug Amount (CDA) monthly maximum for medications, not on the Scheme’s list.
📍 Medicine Cover for Additional Diseases List (ADL)	Discovery Health provides cover for additional disease list medications (ADL). You are covered for medications up to the monthly CDA. No drug list is applicable.
☑️ Extended Chronic Medicine List	You have cover for an exclusive list of brand-name medications.

Discovery Health Executive Plan 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
📌 Hyperlipidemia
📌 Hypertension
📌 Hypothyroidism
📌 Multiple sclerosis
📌 Parkinson’s disease
📌 Rheumatoid arthritis
📌 Schizophrenia
📌 Systemic lupus erythematosus
📌 Ulcerative colitis
📌 Ankylosing spondylitis
📌 Behςet’s disease
📌 Cystic fibrosis
📌 Delusional disorder,
📌 Dermatopolymyositis
📌 Generalized anxiety disorder
📌 Huntington’s disease
📌 Isolated growth hormone deficiency
📌 Major depression
📌 Muscular dystrophy and other inherited myopathies
📌 Myasthenia gravis
📌 Motor neuron disease
📌 Obsessive-compulsive disorder
📌 Osteoporosis
📌 Paget’s disease
📌 Panic disorder
📌 Polyarteritis nodosa
📌 Post-traumatic stress disorder
📌 Psoriatic arthritis
📌 Pulmonary interstitial fibrosis
📌 Sjogren’s syndrome
📌 Systemic sclerosis

Chronic Medicine

On the Executive Plan, you can get your medication from more than 2,500 pharmacies in the Scheme’s pharmacy network. 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.

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 Care Programmes

Discovery Health will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions. You must be registered with these condition-specific care programs to access additional benefits and services. On a personalized dashboard, you and your Premier Plus GP can identify the next steps to manage your condition and 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.

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 approves your cancer treatment, the Oncology Care Programme covers you. Discovery Health will cover approved cancer treatment for 12 months. Covering R500,000. If your treatment exceeds the cover amount, Discovery Health will cover up to 80% of the additional costs unless the Oncology Innovation and Extended Oncology Benefit cover it. Discovery Health Rate covers 100% of cancer-related healthcare services (DHR). If your doctor charges more, you may have a co-payment.
📍 Discovery Health Oncology Innovation Benefit	The Executive Plan covers the Scheme’s approved innovative cancer drugs. Members must pay 25% of these treatments.
✳️ Discovery Health Extended Oncology Benefit	After your cover maximum is reached, you will be fully covered for a specific set of cancer diagnoses and treatments that fall within the scope of the Scheme.
☑️ Discovery Health – Covering Medicine	To avoid a 20% co-payment, get your approved oncology medicine from a DSP on the Scheme’s medicine list. Ask your doctor if they use the Scheme’s DSPs for your in-room or facility treatment.
✅ Discovery Health advanced Illness Benefit	Members receive comprehensive palliative care. This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services. Your palliative care treatment plan includes GP consultations.

Discovery Hospital Benefit

The Executive plan includes hospitalization coverage. 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.

🔎 Discovery Hospital Benefit	What Discovery Health Pays on the Executive Plan
📌 The Hospital Account	The full account is according to the agreed rate with the hospital. Up to R2,460 per day in a private ward
📍 A Defined List of Procedures that were performed in a specialist’s room	Up to the agreed rate as authorized by Discovery Health
☑️ Specialist where there is a payment arrangement	The entire account, according to the agreed rate
✅ Specialists without a payment arrangement	300% of the Discovery Health Rate (DHR)
🚩 GPs and Other Healthcare Professionals	200% of the Discovery Health Rate (DHR)
✔️ Radiology and Pathology	100% of the Discovery Health Rate (DHR)
📌 MRI and CT scans	Up to the DHR if the scan relates to the hospital admission. The first R3,470 from the day-to-day benefit if it is unrelated, and the balance from the Hospital Benefit according to the DHR. One scan per spinal and neck region in terms of conservative back and neck scans.
📍 Scopes (gastroscopy, colonoscopy, sigmoidoscopy, proctoscopy)	Paid from day-to-day benefits as follows: R4,050 Day Clinic R4,950 Day Clinic if done in the same admission R5,900 co-payment in-hospital, reduced to R4,700 if the doctor performing it forms part of Discovery Health’s value-based network. R7,300 co-payment in-hospital, reduced to R5,950 if the doctor performing it forms part of Discovery Health’s value-based network. The upfront payment will not apply if: Scopes performed in the doctor’s office for a confirmed Prescribed Minimum Benefits (PMB) condition or on children under 12.

Discover 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.
1️⃣ 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.
2️⃣ Dental Treatment in the hospital	Dental Limit: Dental treatment is unlimited. However, all dental appliances, prostheses, placement, and orthodontic treatment (including orthognathic surgery) are paid at 100% of the Discovery Health Rate (DHR). Your daily benefits cover these claims up to R32,600 per person. Since the limit is calculated by counting the remaining months in the year, joining after January will reduce your limit.
3️⃣ 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.
4️⃣ 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 R61,500 per year if clinical entry criteria are met.
5️⃣ 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 covers related bills, including the dentist’s, up to 100% of the Discovery Health Rate (DHR). Specialists receive 300% of the Discovery Health Rate (DHR). Discovery Health will cover preventive care, simple fillings, and root canals from your daily benefits for members 13 years and older.
6️⃣ Dental Treatment in the hospital	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 Executive Plan Extra Benefits

Discovery Health Executive Plan provides the following additional benefits.

Assisted Reproductive Therapy (ART)

Depending on age, the Scheme covers one or two annual ART cycles if you meet its benefit entry criteria.
This benefit covers the following:
Consultations
Ultrasounds
Oocyte retrieval
Embryo transfer and freezing
Lab fees
Medicine
Embryo and sperm storage
This benefit covers egg donation cycles.
Cryopreservation and egg and sperm storage for five years are available to Oncology Programme participants who meet clinical entry criteria.
Discovery Health will pay 75% of the Discovery Health Rate up to R122,000 per person annually.
You must pay up to 25% and any amount over the Discovery Health Rate (DHR).

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.

Specialized Medicine and Technology Benefit

✅ The Specialized Medicine and Technology Benefit covers specific new treatments.
✅ There is a limit of R200,000 per person per year.
✅ This benefit is subject to a 20% co-payment.

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 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.

READ: What is Medical Insurance

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.

Overseas Treatment Benefit

✅ Treatment that is not available within the borders of South Africa is covered.
✅ Up to R750 000 per person is paid for treatment by a licensed healthcare professional.
✅ You also cover 100% of the global fee amount and 80% of the cost above it up to R300 000 at a recognized healthcare provider for in-hospital treatment in South Africa.
✅ Members can pay and claim from Discovery Health when returning to South Africa.
✅ Members must note that this benefit has a 20% co-payment.

Spinal Care Programme

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

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

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 Executive Plan vs. Similar Plans from other Medical Schemes

🔎 Medical Aid Plan	🥇 Discovery Health Executive Plan	🥈 Bonitas Medical Fund BonComprehensive	🥉 Medihelp MedPlus
🌎 International Cover	Up to US$1 million	R10 million	Scheme Tariff
👤 Main Member Contribution	R10,303	R8,217	R10,980
👥 Adult Dependent Contribution	R10,303	R7,749	R10,980
💙 Child Dependent Contribution	R1,969	R1,672	R2,742
📉 Annual Limit	Unlimited	Unlimited	Unlimited
➡️ Oncology Cover	R500,000	R400,000	Unlimited
💶 Prescribed Minimum Benefits	☑️ Yes	✅ Yes	☑️ Yes
💻 Screening and Prevention	✅ Yes	☑️ Yes	✅ Yes
🚑 Hospital Cover	☑️ Yes	✅ Yes	☑️ Yes

Our Verdict on Discovery Health Executive Plan

As the name suggests, the Discovery Health Executive Plan provides the most comprehensive care and benefits for its members. This exclusive plan ensures that members are covered in and out-of-hospital in terms of procedures, diagnosis, and appropriate treatments. Another benefit is that the Discovery Health Executive Plan goes beyond the borders of South Africa and offers international travel and treatment. In addition, the plan has a handy medical savings account to cover day-to-day expenses. Furthermore, while there is a self-payment gap when your MSA is depleted, once you reach the Annual Threshold Benefit, Discovery Health ensures that you are still covered for various treatments, medicines, and procedures.

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Discovery Health Executive Plan Frequently Asked Questions

What happens when I join Discovery Executive Plan while pregnant?

If you join Discovery Executive Plan while pregnant, you will be subject to a three-month general waiting period or a 12-month condition-specific waiting period for existing medical conditions, including pregnancy.

Does Discovery Executive cover DNA testing?

No, Discovery Health does not pay for DNA testing.

Does Discovery Executive pay for Bone Density Testing?

Discovery Executive Plan covers bone density testing, typically one test per qualifying beneficiary annually.

Does Discovery Executive pay for pap smears?

Discovery Executive covers one pap smear per qualifying beneficiary every three years.

Does Discovery Executive Medical Aid cover laser eye surgery?

There is a limit of R9 010 per person for the year. The optometry limit covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye, like excimer laser. Eye tests are not subject to the limit and are paid from the available day-to-day benefits.

Does Discovery Executive pay for mammograms?

Discovery Executive Plan covers one mammogram per member every two years.

What is included in the Executive Plan?

The Discovery Executive Plan typically includes a wide range of benefits, such as in-hospital coverage, day-to-day benefits, chronic medication coverage, and more.

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

How does the Executive Plan compare to other Discovery Health plans?

The Executive Plan is typically one of the more comprehensive plans offered by Discovery Health, offering a higher level of coverage than its other plans. However, the specific benefits and cover levels will vary between the different plans, so it is important to compare them carefully before deciding.

What is the cost of the Executive Plan?

The cost of the Executive Plan will vary based on factors such as your age, location, and the specific plan you have chosen. However, it is usually more expensive than the other plans offered by Discovery Health due to the higher level of coverage it provides. The Executive Plan starts from R10,303 per month.

Can I use any hospital with the Executive Plan?

The Executive Plan typically includes a network of preferred hospitals that you can use. You may also be able to use other hospitals, but this may result in additional out-of-pocket expenses.

Are pre-existing medical conditions covered under the Executive Plan?

Pre-existing medical conditions are typically covered under the Executive Plan, but there may be waiting periods or exclusions for certain conditions.

Can I add family members to my Executive Plan?

Yes, you can usually add family members to your Executive Plan, including your spouse and children.

How do I claim on my Executive Plan?

You can typically claim your Executive Plan by contacting Discovery Health and providing the necessary information and documentation. This may include medical receipts and a claim form. However, the process for making a claim may vary depending on your chosen plan.

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.