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 R4,981 ZAR.
| 🔎 Medical Aid Plan | 🥇 Essential Priority |
| 🌎 International Cover | ✅ Yes |
| 👤 Main Member Contribution | R4,981 |
| 👥 Adult Dependent Contribution | R3,917 |
| 🍼 Child Dependent Contribution | R1,989 |
| 🔁 Gap Cover | ✅ Yes |
| 💙 Hospital Cover | Unlimited |
| 💶 Medical Savings Account | ✅ Yes |
| 👶 Maternity Benefits | ✅ Yes |
| 🟦 Pre and Postnatal Care | ✅ Yes |
The Discovery Health Essential Priority starts from R4,981 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
👉 Download the Discovery Health Medical Scheme Priority plan guide for 2025
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R4,981 | R3,917 | R1,989 |
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R8,964 | R7,044 | R3,576 |
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R25,400 | R19,090 | R8,460 |
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R19,370 | R13,820 | R6,770 |
| 🅰️ Essential Priority | – |
| 🅱️ Day-to-Day Cover | – |
| 📌 Medical Savings Account (MSA) | 15% of the monthly contribution |
| 📍 Day-to-Day Extender Benefit | Day-to-day Extender Benefit (DEB) covers essential healthcare services in the our network. |
| 🅰️ Hospital Cover | – |
| 📌 Cover for healthcare professionals in the hospital | Covered up to 100% of the Discovery Health Rate (DHR) |
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:
Any additional approved healthcare provider.
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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:
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.
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 Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.
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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:
| 🟥 General Health | You can access screenings for vision, hearing, dental, and skin conditions as part of your primary care. Additionally, you are eligible for one GP screening consultation |
| 🟧 Physical Health | Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations. |
| 🟨 Mental Health | You have access to a mental health evaluation to promote mental health. |
| 🟩 Women and Men’s Health | You have access to various screening and prevention services for women and men. These include, for instance: Consultation with your doctor for gynecological, prostate, or cardiac issues Bone density analysis |
| 🟦 Children’s Health | 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:
💙How members of the Discovery Health Essential Priority are covered in terms of Monkeypox:
Formulary of supportive medications for pain management.
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.
| 🔴 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. |
✅ 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.
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:
✅ 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
✅ Home Care Cover
✅ Home-based care for follow-up treatment after hospital admission
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 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:
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.
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:
✅ After giving birth:
Discovery Health’s prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.
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:
and many more.
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:
✅ 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 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 Disease Prevention Program | Priority Premier Plus GPs can enroll you in the Disease Prevention Program 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 Program | Your Priority Premier Plus GP can enroll you in the Diabetes Care Program if you receive the Chronic Illness Benefit (CIB) for diabetes. The program covers extra glucometer strips and dietitian and biokinetics visits. A nurse educator can help you manage your condition. |
| 🔁 Discovery Health HIV Care Program | 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 Program | If referred by your Priority Premier Plus GP and enrolled in the Cardio Care Program, 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 Program 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 as an Essential 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 Essential Priority includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
✅ Pre-operative Management Program for major surgeries
✅ The following summarises how Discovery Health pays for approved hospital admissions within the Essential Priority.
✅ Healthcare Providers and Services
✅ Upfront Payments for in-hospital procedures
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✅ Upfront Amounts payable by the member when a procedure below is performed within the Day Surgery Network
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:
✅ 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.
| 🔎 Discovery Health Plan | 🅰️ Day Clinic Account | 🅱️ Hospital Account |
| 1️⃣ Essential Priority | R4,050 | This co-payment will be reduced from R6,500 to R5,300 if performed by a doctor in the Scheme’s value-based network. |
| 2️⃣ If a gastroscopy and colonoscopy are performed during the same admission | – | – |
| 3️⃣ Essential Priority | R4,950 | This co-payment will be reduced from R8,150 to R6,650 if performed by a doctor in the Scheme’s value-based network. |
💙Furthermore, the following will apply to scopes on the Essential Priority:
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.
| 🦻 Cochlear Implants, Auditory Brain Implants, and processors | R230,400 per person per benefit |
| 🧬 Internal Nerve Stimulators | R175,200 per person |
| 🩺 Major Joint Surgery | No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R30,900 per prosthesis per admission. Emergency and trauma surgeries are excluded from the network. |
| 🦾 Shoulder Joint Surgery | If you use a provider outside the network, you can pay up to R45,550 for your prosthesis. |
| 🍹 Alcohol and Drug Rehabilitation | Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission. |
| 🧠 Mental health | Twenty-one days for admissions or 15 out-of-hospital consultations per person for major affective disorders, anorexia, and bulimia, and 12 for acute stress disorder with recent significant trauma. Three days for attempted suicide admissions. Other mental health admissions are 21 days. Network facilities cover all mental health admissions. If you go elsewhere, the Scheme will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account. |
| 📌 Prosthetic Devices used during Spinal Surgery | The preferred prosthesis suppliers have no limit. If you do not use a preferred supplier, the first level is R26,250, and two or more levels are R52,500, limited to one procedure per person per year. The spinal surgery network covers approved spinal surgery admissions. The hospital account will receive up to 80% of the Discovery Health Rate (DHR) for planned admissions outside the Scheme’s network. |
| 🦷 Dental Treatment in the hospital | Dental Limit: 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 R20,300 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. 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-Hospital: Dental admissions require prepaying your hospital or day clinic bill, except for severe dental and oral surgery. Age and treatment location determine this amount. Your Hospital Benefit pays the hospital bill up to 100% of the Discovery Health Rate (DHR). 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. Upfront Payments for Dental Admission: Hospital Account – R7,800 for members 13> and R3,000 for members <13 Day Clinic Account – R5,000 for members 12> and R1,350 for members <13 |
Discovery Health 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 R6,300 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:
Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.
✅ Claims Relating to Traumatic Events
✅ Africa Evacuation Cover
✅ International Travel Benefit
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✅ International Second Opinion Services
✅ Spinal Care Program
✅ In-Room Procedures
✅ Advanced Illness Benefit
Your palliative care treatment plan includes GP consultations.
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.
✅ Exclusions include the following:
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✅ Discovery Health’s waiting periods are as follows:
| 🔎 Medical Aid Plan | 🥇 Essential Priority | 🥈 Fedhealth FlexiFED 4 | 🥉 Bonitas BonComplete Plan |
| 🌎 International Cover | ✅ Yes | None | R10 million |
| 👤 Main Member Contribution | R4,531 | R4,480 | R4,570 |
| 👥 Adult Dependent Contribution | R3,562 | R4,089 | R3,660 |
| 🍼 Child Dependent Contribution | R1,809 | R1,347 | R1,241 |
| 🔁 Gap Cover | ✅ Yes | None | ✅ Yes |
| 💙 Hospital Cover | Unlimited | Unlimited | Unlimited |
| 💶 Medical Savings Account | ✅ Yes | ✅ Yes | ✅ Yes |
| 👶 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟦 Pre and Postnatal Care | ✅ Yes | ✅ Yes | ✅ Yes |
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.
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💙You might also like: Discovery Health Classic Priority
The Essential Priority plan is a mid-level medical aid plan offered by Discovery Health that balances affordability and coverage.
The Essential Priority plan covers hospitalization and specialist consultations. However, it does not include benefits such as dentistry, optical, and chronic medicine coverage.
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.
Yes, the Essential Priority plan has some annual limits on certain benefits, such as GP visits and pathology.
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.
Yes, the Essential Priority plan covers emergency medical care, including ambulance services and emergency treatment in a casualty ward.
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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