Discovery Health Essential Priority Plan (🇿🇦 2026)

  Overall, the Discovery Health Essential Priority Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and flexible coverage for its members. The Discovery Health Essential Priority Medical Aid Plan starts from R5,327 ZAR.      

Discovery Health Essential Priority - 22 Key Point Quick Overview

1. ✅ Discovery Health Essential Priority Overview
2. ✅ Discovery Health Essential Priority Contributions, Medical Savings Account, ATB, and Annual Threshold
3. ✅ Discovery Health Priority Plan Benefits Summarised
4. ✅ Discovery Health Essential Priority Benefits and Cover Comprehensive Breakdown
5. ✅ Discovery Health WELLTH Fund
6. ✅ Discovery Health WHO Outbreak Benefit
7. ✅ Discovery Health Connected Care
8. ✅ Discovery Health Hospital At Home
9. ✅ Discovery Health Priority Day-to-Day Benefits
10. ✅ Discovery Maternity and Early Childhood Benefits
11. ✅ Discovery Health Chronic Benefits
12. ✅ Discovery Health Care Programs
13. ✅ Discovery Health Comprehensive Cancer Cover
14. ✅ Discovery Health Hospital Benefit
15. ✅ Discovery Health Annual Limits
16. ✅ Discovery Health Priority Cover for Day Surgery Network Procedures
17. ✅ Discovery Health Priority Additional Benefits
18. ✅ Discovery Essential Priority Value-Added Offers
19. ✅ Discovery Health Essential Priority Exclusions and Waiting Periods
20. ✅ Discovery Health Essential Priority Plan vs Similar Plans from Other Medical Schemes
21. ✅ Our Verdict on Discovery Health Essential Priority
22. ✅ Discovery Health Essential Priority Frequently Asked Questions

Discovery Health Essential Priority Overview

  The Discovery Health Essential Priority starts from R5,327 ZAR and is part of a series of comprehensive medical insurance plans offered by Discovery Health. The Essential Priority Plan is a good option for those prioritizing affordability over a comprehensive range of benefits. The Essential Priority plan provides comprehensive and flexible coverage for medical expenses, with a range of preventative healthcare benefits and unlimited hospital cover.   The Discovery Essential Priority 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 Essential Priority, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.   Discovery Health Priority Series has two plans namely Discovery Health Classic Priority and Discovery Health Essential Priority

Discovery Health Essential Priority Contributions, Medical Savings Account, ATB, and Annual Threshold

Essential Priority Monthly Contributions

     

Essential Priority Medical Savings Account (MSA)

     

Essential Priority Annual Threshold Amount

   

Essential Priority Limited Above-Threshold Benefit Amount (ATB)

   

Discovery Health Priority Plan Benefits Summarised

     

Discovery Health Essential Priority 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.  

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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.

  To qualify for coverage, your medical condition must be on the Prescribed Minimum Benefit (PMB) conditions list. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits. 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.  

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 Personal Health 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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Discovery Health Personal Health Pathway

    The Personal Health Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your individual health requirements.   This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks.   Your Personal Health Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.         The Discovery Health Personal Health Fund for Essential Priority covers the following:   The Personal Health Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider.   Furthermore, the benefit is available to new members in the joining year and subsequent years.  The benefit is available once per lifetime per beneficiary. Cover for eligible healthcare services is limited to the Discovery Health Rate (DHR), subject to the overall benefit maximum.   Your Personal Health Fund maximum is based on the size and composition of your family as stated in your policy:  

• ✅ Limited to R1,500 per adult dependent.
• ✅ Limited to R750 per two-year-old or older child dependent.
• ✅ Limited to R6,000 per family per year.

  Furthermore, the Personal Health 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 Priority and, if necessary, the PMBs.
• ✅ Access to the Long COVID Recovery Program:
• ✅ A six-month support program for members whose COVID-19 symptoms persist beyond 21 days after acute diagnosis.

  How members of the Discovery Health Essential Priority 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 App and Virtual Benefits

Discovery Health Medical Scheme provides home-based access to health and wellness services. app and virtual benefits is an integrated ecosystem of benefits, services, and digitally connected capabilities designed to assist you in managing your health and wellness.     Care for members at home: Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations. Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions. You will not see any changes to your regular benefits because of having cover approved for these gadgets.   ✅ Care for those with chronic conditions: Through Connected Care, you and your doctor can work together to keep your chronic condition under control while you are at home. Eligible members can use various digital services connected to Priority 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.   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.   ✅ Home Monitoring Devices

• ✅ The Home Monitoring Device Benefit gives you access to a range of essential and registered home monitoring devices for certain chronic and acute conditions. Approved cover for these devices will not affect your day-to-day benefits.

✅ Home Care Cover

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

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

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

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

Discovery Health Priority Day-to-Day Benefits

    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).   ✅ The Medical Savings Account (MSA) 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 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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✅ The Day-to-Day Extender Benefit (DEB) 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.   ✅ The Self-payment Gap (SPG) 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.   ✅ The Above Threshold Benefit (ATB) Over Threshold After your Annual Threshold, the benefit covers daily expenses.   Some claims do not meet your Annual Threshold or ATB payment:  

• ✅ Medicine that you do not need a prescription for (over-the-counter medicine)
• ✅ Childhood vaccines and immunizations
• ✅ Lifestyle-enhancing products
• ✅ Claims more than the Discovery Health Rate (DHR).
• ✅ Claims paid more than annual benefit limits.

  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.    

Discovery Maternity and Early Childhood Benefit

With the Discovery Health Essential Priority, 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 cover predetermined blood tests to confirm your pregnancy.

✅ 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).   ✅ 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.  

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✅ Medicine covered in terms of the chronic disease list (CDL): You have coverage for all chronic medications on the approved list. Discovery Health covers you for medications, not on the list up to the Chronic Drug Amount monthly maximum (CDA).   Discovery Health Essential Priority 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

Chronic Medicine

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 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 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 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.   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 Hospital Benefit

The Essential Priority includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.  

• ✅ This benefit covers the costs associated with hospitalization.
• ✅ The cover is unlimited in any private hospital approved by the Scheme.
• ✅ You are covered for planned hospital stays.
• ✅ You may visit any private hospital approved by the Scheme for funding.
• ✅ On all health plans, funding newly licensed facilities are contingent upon Scheme approval.
• ✅ Certain in-hospital procedures, including those performed by the Day Surgery Network, require an upfront payment.
• ✅ Your Hospital Benefit is used to cover planned hospital stays.
• ✅ Discovery Health will pay for hospitalization-related services, including all healthcare professionals, services, and medications authorized by the Scheme.
• ✅ If you utilize physicians, specialists, and other healthcare professionals with whom Discovery Health agrees, the scheme will pay in full for their services.
• ✅ The scheme will pay up to 200% of the Discovery Health Rate (DHR) for other healthcare professionals.

✅ 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.

✅ The following summarises how Discovery Health pays for approved hospital admissions within the Essential Priority.✅ Healthcare Providers and Services

• ✅ 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: Paid up to 100% of the DHR.
• ✅ Radiology and Pathology: Up to 100% of the DHR.

✅ Upfront Payments for in-hospital procedures

• ✅ 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.

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✅ Upfront Amounts payable by the member when a procedure below is performed within the Day Surgery Network

• ✅ Conservative back and neck treatment, adenoidectomy,myringotomy (grommets), tonsillectomy R5,000.
• ✅ Arthroscopy, functional nasal procedures, hysterectomy (except for pre-operatively diagnosed cancer), laparoscopy, hysteroscopy, endometrial ablation R11,500.
• ✅ Nissen fundoplication (reflux surgery), spinal surgery (back and neck), joint replacements R23,700.

  If the procedure can be performed outside the hospital, such as in the doctor’s office, you will not be required to pay the hospital in advance.   If any of these procedures are on the list of day surgery procedures, you must pay the greater of the two upfront amounts if the procedure is performed outside the Day Surgery Network.   ✅ 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.
• ✅ The member must pay the first R5,000 of the hospital account for conservative back and neck treatment.
• ✅ 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.

✅ 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.     Furthermore, the following will apply to scopes on the Essential Priority:  

• ✅ R7,500. This co-payment will reduce to R6,050 if the scope is performed by a doctor who is part of the Scheme’s value-based network.
• ✅ R9,450. This co-payment will reduce to R7,650 if scopes are performed by a doctor who is part of the Scheme’s value-based network.

  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

     

Discovery Health Priority 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.   Utilise physicians, specialists, and other healthcare professionals with whom Discovery Health will have a payment arrangement. Discovery Health will cover up to 100% 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:  

• ✅ Biopsies
• ✅ Breast Procedures
• ✅ Ear, nose, and throat procedures
• ✅ Eye Procedures
• ✅ Ganglionectomy
• ✅ Gastrointestinal scopes and procedures
• ✅ Gynecological Procedures
• ✅ Orthopedic Procedures
• ✅ Removal of a foreign body

  Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.    

Discovery Health Priority Additional Benefits

✅ 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 R5 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.

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✅ 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 75% for second opinions.

✅ Spinal Care Program

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

✅ In-Room Procedures

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

Discovery Essential Priority 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 Priority 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.

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✅ 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.

Medical Aid Comparisons : Discovery Health Essential Priority Plan vs Similar Plans from Other Medical Schemes

     

Our Verdict on Discovery Health Essential Priority

  The Essential Priority plan offered by Discovery Health Medical Scheme is a mid-level option that balances affordability and coverage. However, this plan has some notable features and drawbacks that should be considered when deciding which health plan to choose.   One of the primary benefits of the Essential Priority plan is that it is more affordable than the Classic plan offered by Discovery Health. However, this affordability comes at the cost of fewer benefits and some limitations on coverage.   For example, while the plan covers hospitalization and specialist consultations, it does not include benefits such as dentistry, optical, and chronic medicine cover. This means that individuals who require these types of benefits may need to seek additional cover or pay for them out-of-pocket. Another limitation of the Essential Priority plan is that Discovery Health only pays up to 100% of the Discovery Health Rate for in-hospital treatment.   In contrast, the Classic plan covers all costs in full. This means that individuals may need to pay the difference between the Discovery Health Rate and the actual cost of treatment out of their own pockets. Additionally, this plan has some annual limits on certain benefits, such as GP visits and pathology.   You might also like: Discovery Health Priority Series You might also like: Discovery Health Classic Priority

Discovery Health Essential Priority Frequently Asked Questions

What is the Essential Priority plan from Discovery Health?

The Essential Priority plan is a mid-level medical aid plan offered by Discovery Health that balances affordability and coverage.  

What benefits does the Essential Priority plan cover?

The Essential Priority plan covers hospitalization and specialist consultations. However, it does not include benefits such as dentistry, optical, and chronic medicine coverage.  

What is the difference between the Essential Priority plan and the Classic plan?

The Essential Priority plan is more affordable than the Classic plan. However, it provides fewer benefits and has some limitations on coverage. On the other hand, the Classic plan is more comprehensive and covers a wider range of benefits.  

Does the Essential Priority plan have annual limits on certain benefits?

Yes, the Essential Priority plan has some annual limits on certain benefits, such as GP visits and pathology.  

Does the Essential Priority plan cover chronic medication?

No, the Essential Priority plan does not include chronic medicine coverage. If you require this benefit, you may need to seek additional cover or pay it out of pocket.  

Does the Essential Priority plan cover emergency medical care?

Yes, the Essential Priority plan covers emergency medical care, including ambulance services and emergency treatment in a casualty ward.