Principle Member
From R5327
Dependant Member
From R4189
Child Dependant
From R2127
Essential Priority
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
Principle Member
From R6198
Dependant Member
From R4889
Child Dependant
From R2478
Classic Priority
Silver
Principle Member
From R5857
Dependant Member
From R3152
Child Dependant
From R1224
⚠️ Deferral: Contribution increases are delayed from January to 1 April 2026
Overall, the Discovery Health Priority Series Medical Aid Plans are a series of trustworthy and comprehensive medical aid plans that offers 24/7 medical emergency assistance and daily benefits for its members. The Discovery Health Priority Series Medical Aid Plans start from R5,327 ZAR.
| 🔎 Priority Plan | 1️⃣ Classic Priority | 2️⃣ Essential Priority |
| 👤 Main Member Contribution | R6,198 | R5,327 |
| 👥 Adult Dependent Contribution | R4,889 | R4,189 |
| 💙 Child Dependent Contribution | R2,478 | R2,127 |
| 🌎 International Cover | ☑️ Yes | ☑️ Yes |
| 🔁 Gap Cover | ✅ Yes | ✅ Yes |
| ➡️ Oncology Cover (Maximum ZAR) | R250,000 | R250,000 |
| 💶 Prescribed Minimum Benefits | ☑️ Yes | ☑️ Yes |
| 💻 Screening and Prevention | ✅ Yes | ✅ Yes |
| 💵 Medical Savings Account | ☑️ Yes | ☑️ Yes |
The Discovery Health Priority Series starts from R5,327 and is a series of comprehensive medical insurance plans offered by Discovery Health. The Discovery Priority Series provides an elevated level of cover for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses.
Gap Cover is available on the Discovery Health Priority Series, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.
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| 🔎 Priority Plan | 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| 1️⃣ Classic Priority | R6,198 | R4,889 | R2,478 |
| 2️⃣ Essential Priority | R5,327 | R4,189 | R2,127 |
| 1️⃣ Day-to-Day Cover | 2️⃣ Classic Priority | 3️⃣ Essential Priority |
| 📌 Medical Savings Account (MSA) | 25% of the monthly contribution | 15% of the monthly contribution |
| 📌 Day-to-Day Extender Benefit | The Discovery Health wellness network’s Day-to-Day Extender Benefit (DEB) covers essential healthcare services. You are also covered for child casualty visits. | Day-to-day Extender Benefit (DEB) covers essential healthcare services in the wellness network. |
Hospital Cover:
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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:
All medical schemes are required by the Prescribed Minimum Benefit (PMB) provisions of the Medical Schemes Act 131 of 1998 and its Regulations to cover the costs associated with the diagnosis, treatment, and care of:
Your medical condition must be on the list of Prescribed Minimum Benefit (PMB) conditions to qualify for coverage. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits.
In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health network.
Once your condition has stabilized, you will be transferred to a hospital or other service providers in the 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 unmet.
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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 Personal Health Fund.
The Discovery Health Screening and Prevention covers the following:
Clinical eligibility requirements may apply to these tests:
Vaccines (there may be clinical entry requirements):
The Personal Health Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your individual health requirements.
This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks. Your Personal Health Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.
The Discovery Health Personal health Fund for the Priority Series covers the following:
| 🩺 General Health | You have access to screenings for vision, hearing, dental, and skin conditions as part of your primary care. Additionally, you are eligible for one GP screening consultation |
| 📌 Physical Health | Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations. |
| 🧠 Mental Health | You have access to a mental health evaluation to promote mental health. |
| ☑️ Women and Men’s Health | You have access to various screening and prevention services for women and men. These include, for instance: Consultation with your doctor for gynecological, prostate, or cardiac issues Bone density analysis |
| 👶 Children’s Health | A pediatrician, speech pathologist, or physiotherapist can evaluate your child’s progress toward important developmental milestones as part of a well-child check-up. |
| 🧪 Medical Monitoring Devices | You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar. |
The Personal Health Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider. Furthermore, the benefit is available to new members in the joining year and subsequent years.
The benefit is available once per lifetime per beneficiary. Cover for eligible healthcare services is limited to the Discovery Health Rate (DHR), subject to the overall benefit maximum. Your Personal health Fund maximum is based on the size and composition of your family as stated in your policy:
Furthermore, the Personal Health Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.
The basket of care includes the following:
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:
How members of the Discovery Health Priority Series are covered in terms of Monkeypox:
Discovery Health Medical Scheme provides home-based access to health and wellness services. The app 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. |
Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations. Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions. You will not see any changes to your regular benefits because of having cover approved for these gadgets.
Through the app, 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 Priority remote monitoring, point-of-care devices, and individualized coaching consultations to monitor and control their chronic condition in the comfort of their homes.
Hospital at Home patients receives specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being. They all work together to make your healthcare more efficient and your life safer. Suppose you have a valid pre-authorization for hospitalization.
In that case, Discovery Health 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:
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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.
Discovery Health will cover your day-to-day medical expenses with funds from your Medical Savings Account (MSA) or Day-to-Day Extender Benefit (DEB).
Discovery Health pays for the day-to-day medical expenses of its members, such as consultations with GPs and specialists, medicine (excluding registered chronic medicine), radiology, and pathology, from the available funds in the member’s Medical Savings Account (MSA).
Any unused funds will be carried over to the next year. In addition, members can have their claims paid either at the Discovery Health Rate (DHR) or at cost. If the member chooses to have their claims paid at cost and the claims exceed the DHR, the Scheme will automatically fund the excess from the MSA. If the member chooses to have their claims paid at the DHR and wishes to have claims paid more than the DHR from the available funds in their MSA, they can request a special payment.
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Pays for daily benefits after your MSA runs out but before the Annual Threshold. Covers wellness network pharmacy clinic and GP video call consultations. After a video call or pharmacy clinic virtual GP referral, you have unlimited face-to-face network GP consultations. Furthermore, Discovery will cover Discovery Health Rate face-to-face consultations (DHR). Kids under 10 get two casualty visits a year on the Classic plan.
If your MSA expires before you reach your Annual Threshold, you must pay for claims until you reach it. You must keep sending in claims during the SPG so we can track your Annual Threshold.
Over Threshold After your Annual Threshold, the benefit covers daily expenses.
Some claims do not meet your Annual Threshold or ATB payment:
Furthermore, the limited Above Threshold Benefit (ATB) covers daily expenses at the Discovery Health Rate (DHR) or a portion. Benefit limits apply, and any difference between the DHR and the amount claimed.
Any amount over the annual benefit limit or ATB limit must be paid. The tables below illustrate how much we cover your routine healthcare costs under the Priority plans. When you file a claim, the following amounts are added to determine your Annual Threshold.
With the Discovery Health Priority Series, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your baby’s life. This applies from the date of activation of the benefit for each pregnancy and for each child from birth until they are two years old. Discovery Health Maternity Benefit covers the following:
During Pregnancy:
After giving birth, Discovery Health covers the following:
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Discovery Health prenatal and postnatal care includes:
The Discovery Health Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL).
Discovery Health Priority Series Full List of conditions covered:
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Utilize our designated service providers (DSPs), MedXpress and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on your 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 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, and you will be prompted to take your medication and confirm each dose.
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 | Priority Premier Plus GPs can enroll you in the Disease Prevention Programme if you have cardiometabolic risk syndrome. GPs, dietitians, and health coaches 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 Priority 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 Priority 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 can help you manage your condition. |
| ✅ Discovery Health HIV Care Programme | Your Priority Premier Plus GP registers you on the HIV program, which includes social worker cover. Confidentiality is guaranteed. Avoid a 20% co-payment by getting your medicine from a DSP. |
| ➡️ Discovery Health Cardio Care Programme | If referred by your Priority Premier Plus GP and enrolled in the Cardio Care Programme, you can receive a defined basket of care and an annual cardiovascular assessment for hypertension, hyperlipidemia, or ischemic heart disease on the Chronic Illness Benefit (CIB). |
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 fully cover PMB cancer treatment 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. The first R250,000 is covered. Discovery Health will cover up to 80% of your treatment costs if they exceed the coverage amount. The scheme network covers cancer treatment on Essential Priority and Dynamic Priority. 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 | Subject to the Scheme’s clinical entry criteria, the Oncology Innovation Benefit covers a subset of innovative cancer medicine. The member must cover 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. |
The Priority Series includes hospitalization cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
The following table summarizes how Discovery Health pays for approved hospital admissions within the Priority Series:
| 🔎 The Hospital Account | The full hospital-agreed account according to a rate agreed with the hospital |
| 📌 Specialist with whom Discovery Health has an arrangement | The entire account, according to the agreed rate |
| 📍 Specialists with whom Discovery Health does not have an arrangement | Classic Plan – up to 200% of the DHR. Essential Plan – up to 100% of the DHR. |
| ☑️ Radiology and Pathology | Up to 100% of the DHR. |
| ✅ Upfront Payment for a defined list of procedures that are performed outside the Day Surgery Network | The member must pay R7,250 upfront |
| 🔍 A defined list of procedures that are performed in a specialist’s room | Covered according to the Scheme-approved rate. |
| 📌 Conservative Back and neck Treatments, adenoidectomy, myringotomy (grommets), and tonsillectomy | The member must pay R5,000 upfront. |
| 📍 Arthroscopy, functional nasal procedures, hysterectomy (except for pre-operatively diagnosed cancer), laparoscopy, hysteroscopy, endometrial ablation | The member must pay R11,500 upfront. |
| ☑️ Nissen fundoplication (reflux surgery), spinal surgery (back and neck), joint replacements | The member must pay R23,700 upfront. |
| ✅ MRI and CT scans | Discovery Health pays the first R4,000 of the scan from the day-to-day benefits. The Hospital Benefit covers up to 100% of the Discovery Health Rate (DHR) scan balance. For conservative back and neck treatment, the member must pay the first R5,000 of the hospital account, and the Hospital Benefit covers the scan balance up to 100% of the DHR. This benefit is limited to one scan per spinal and neck region. |
| 🔎Cataract Surgery at a network provider | Discovery pay the full account at the agreed rate at a network facility for cataract surgery. Discovery pay the hospital account at up to 80% of the Discovery Health Rate at any other facility. |
You are responsible for the following amount depending on where your scope is performed. Your Hospital Benefit will cover the remaining hospital and related charges.
The following will apply to scopes on the Priority Series:
| ☑️ Cochlear Implants, Auditory Brain Implants, and processors | R252,000 per person per benefit |
| 📌 Internal Nerve Stimulators | R192,000 per person |
| ☑️ Major Joint Surgery | No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R31,850 per prosthesis per admission. Emergency and trauma surgeries are excluded from the network. |
| ✅ Shoulder Joint Surgery | If you use a provider outside the network, you can pay up to R50,000 for your prosthesis. |
| ☑️ Alcohol and Drug Rehabilitation | Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission. |
| 📌 Mental health | Twenty-one days for admissions or 15 out-of-hospital consultations per person for major affective disorders, anorexia, and bulimia, and 12 for acute stress disorder with recent significant trauma. Three days for attempted suicide admissions. Other mental health admissions are 21 days. Network facilities cover all mental health admissions. If you go elsewhere, the Scheme will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account. |
| ☑️ Prosthetic Devices used during Spinal Surgery | The preferred prosthesis suppliers have no limit. If you do not use a preferred supplier, the first level is R24,250, and two or more levels are R48,550, 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: Dental treatment is unlimited. However, all dental appliances, prostheses, placement, and orthodontic treatment (including related accounts for orthognathic surgery) are paid at 100% of the Discovery Health Rate (DHR) and up to 200% for anesthetists on the Classic plan. Your daily benefits cover these claims up to R23,400 per person. If you join the Scheme after January, you will not get the full limit because it’s calculated by counting the remaining months in the year. |
| ☑️ Dental Treatment in the hospital | Severe Dental and Oral Surgery In-Hospital: The Severe Dental and Oral Surgery Benefit covers procedures without upfront payment or limit. This benefit requires authorization and Scheme Rules. |
| 📌 Dental Treatment in the hospital | Basic Dental Trauma: The Basic Dental Trauma Benefit covers unexpected dental injuries requiring emergency treatment after an accident. Dental appliances, prostheses, and placement are covered up to R70,800 per person per year if clinical entry criteria are met. Essential Priority and Essential Dynamic Priority do not offer this benefit. |
| ☑️ 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). In addition, your Hospital Benefit covers related bills, including the dentist’s, up to 100% of the Discovery Health Rate (DHR). Anesthetists receive 200% of the Discovery Health Rate (DHR). Members 13 and older must pay for routine conservative dentistry like preventive care, fillings, and root canals. |
| ✅ Dental Treatment in the hospital | Upfront Payments for Dental Admission: Hospital Account – R8,950 for members 13> and R3,470 for members <13 Day Clinic Account – R5,750 for members 12> and R1,550 for members <13 |
Discovery Health 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.
If you utilize physicians, specialists, and other healthcare professionals with whom Discovery Health will have a payment arrangement, Discovery Health will cover the full cost of these services.
Furthermore, if you go to a facility not part of the Day Surgery Network, you must pay R7,250 upfront. If any of these procedures are on the list of hospital admission procedures with an upfront payment, the higher of the two upfront payments will apply.
The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:
Exclusions include the following:
Discovery Health’s waiting periods are as follows:
| 🔎 Priority Plan | 🥇 Classic Priority | 🥈 Essential Priority |
| 👤 Main Member Contribution | R6,198 | R5,327 |
| 👥 Adult Dependent Contribution | R4,889 | R4,189 |
| 💙 Child Dependent Contribution | R2,478 | R2,127 |
| 🌎 International Cover | ✅ Yes | ✅ Yes |
| 🔁 Gap Cover | ☑️ Yes | ☑️ Yes |
| Hospital Cover | Unlimited | Unlimited |
| 🏥 Oncology Cover (Maximum ZAR) | R250,000 | R250,000 |
| 🏠 Home Care | ✅ Yes | ✅ Yes |
| 🍼 Maternity Benefits | ☑️ Yes | ☑️ Yes |
The Discovery Health Priority Series provides essential care for those with specific needs. There is unlimited hospital coverage and coverage for several in-hospital treatments and procedures.
In addition, the medical aid savings account ensures that members are covered for day-to-day expenses. Members also have coverage when they go beyond the borders of South Africa, and they can expect access to extensive care programs, the Discovery WELLTH fund, comprehensive coverage for chronic medicine, and 27 CDLs.
You might also like the following service Discovery has to offer:
The Discovery Medical Aid Priority Plan offers a range of benefits, including comprehensive in-hospital cover, chronic medication benefits, preventative care benefits, and cover for major medical events such as cancer treatment and organ transplants.
Members of the Discovery Medical Aid Priority Plan can access healthcare services through a network of providers, including hospitals, doctors, and specialists. The plan also offers telemedicine services, which allow members to consult with healthcare professionals remotely.
Yes, members of the Discovery Medical Aid Priority Plan can add their dependents, including spouses and children, to their coverage. Additional fees may apply for each dependent added to the plan.
The Discovery Medical Aid Priority Plan is only available to members of Discovery Health. To become a member, individuals need to apply and meet the eligibility criteria, which may include a health assessment.
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The Discovery Medical Aid Priority Plan provides cover for pre-existing conditions, subject to waiting periods and certain terms and conditions. Members should consult their plan documentation for more information.
There is a limit of R6 850 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.
Yes, members of the Discovery Medical Aid Priority Plan can change their coverage level as their needs change. However, changes may be subject to waiting periods and other terms and conditions. Members should consult their plan documentation for more information.
Yes, with a Discovery Health Priority Plan, you can choose your doctor or specialist. However, you may need to choose a provider within the Discovery Health network to ensure maximum coverage.
A Discovery Health Priority Plan refers to a specific type of medical aid plan offered by Discovery Health. In contrast, a Discovery Health Priority Series refers to a set of plans within the Priority Plan range, each with its own unique benefits and coverage options.
The specific benefits included in a Discovery Health Priority Plan will depend on the individual plan chosen. However, some common benefits Discovery Health Priority Plans offer include access to private hospitals, GP visits, specialist consultations, diagnostic services, and prescribed minimum benefits (PMBs).
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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