Discovery Health Saver Series Medical Aid Plans(🇿🇦 2025)

Overall, the Discovery Health Saver Series Medical Aid Plans are a series of trustworthy and comprehensive medical aid plans that offers 24/7 medical emergency assistance and day-to-day benefits to up to 3 Family Members. The Discovery Health Saver Series Medical Aid Plans start from R2,898 ZAR.

 

🔎 Saver Option	🥇 Classic Saver	🥈 Classic Delta Saver	🥉 Essential Saver	🏅 Essential Delta Saver	📌 Coastal Saver
🌎 International Cover	R5 million	R5 million	R5 million	R5 million	R5 million
👤 Main Member Contribution	R4,535	R3,624	R3,634	R2,898	R3,797
👥 Adult Dependent Contribution	R3,577	R2,863	R2,725	R2,187	R2,855
💙 Child Dependent Contribution	R1,817	R1,455	R1,455	R1,163	R1,533
🔁 Gap Cover	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes
🦷 Dentistry Benefit	In-hospital	In-hospital	In-hospital	In-hospital	In-hospital
⚕️ Hospital Cover	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited
➡️ Home Care	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes
🍼 Maternity Benefits	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes

 

 

Discovery Health Saver Series – 18 Key Point Quick Overview

1. ☑️ Discovery Health Saver Series Overview
2. ☑️ Discovery Health Saver Series Contributions
3. ☑️ Discovery Health Saver Series Compared
4. ☑️ Discovery Health Core Plan Benefits at a Glance
5. ☑️ Discovery Health Saver Series Benefits and Cover Comprehensive Breakdown
6. ☑️ Discovery Personal Health Pathway
7. ☑️ Discovery Health WHO Outbreak Benefit
8. ☑️ Discovery Health Hospital At Home
9. ☑️ Discovery Health Saver Day-to-Day Benefits
10. ☑️ Discovery  Health Chronic Benefits
11. ☑️ Discovery Care Programmes
12. ☑️ Discovery Health Comprehensive Cancer Cover
13. ☑️ Discovery Health Saver Series Cover for Day Surgery Network Procedures
14. ☑️ Discovery Core Series Extra Benefits
15. ☑️ Discovery Core Series Value-Added Offers
16. ☑️ Discovery Health Saver Series Exclusions and Waiting Periods
17. ☑️ Our Verdict on Discovery Health Saver Series
18. ☑️ Discovery Health Saver Series Frequently Asked Questions

 

Discovery Health Saver Series Overview

The Discovery Health Saver Series starts from R2,898 and is a series of comprehensive medical insurance plans offered by Discovery Health. The Discovery Saver 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 Saver Series, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.

 

The Saver series has the following plans:

• • 👉🏿Discovery Health Essential Saver Plan
  • 👉🏿Discovery Health Essential Delta Saver Plan
  • 👉🏿Discovery Health Coastal Saver Plan
  • 👉🏿Discovery Health Classic Saver Plan
  • 👉🏿Discovery Health Classic Delta Saver Plan

 

💙 Download the discovery-health-medical-scheme-saver-plan-guide 2025

 

 

Discovery Health Saver Series Contributions

🔎 Saver Option	👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
🥇 Classic Saver	R4,535	R3,577	R1,817
🥈 Classic Delta Saver	R3,624	R2,863	R1,455
🥉 Essential Saver	R3,634	R2,725	R1,455
🏅 Essential Delta Saver	R2,898	R2,187	R1,163
➡️ Coastal Saver	R3,797	R2,855	R1,533

 

 

Discovery Health Saver Series Compared

 

🔎 Saver Option	🥇 Classic Saver	🥈 Classic Delta Saver	🥉 Essential Saver	🏅 Essential Delta Saver	📌 Coastal Saver
🌎 International Cover	R5 million	R5 million	R5 million	R5 million	R5 million
👤 Main Member Contribution	R4,535	R3,624	R3,634	R2,898	R3,797
👥 Adult Dependent Contribution	R3,577	R2,863	R2,725	R2,187	R2,855
💙 Child Dependent Contribution	R1,817	R1,455	R1,455	R1,163	R1,533
🔁 Gap Cover	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes
🦷 Dentistry Benefit	In-hospital	In-hospital	In-hospital	In-hospital	In-hospital
⚕️ Hospital Cover	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited
➡️ Home Care	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes
🍼 Maternity Benefits	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes	☑️ Yes

 

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

 

 

Discovery Health Core Plan Benefits at a Glance

 

Discovery Health Day-to-Day Care

🔎 Day-to-Day Cover	🥇 Classic Saver	🥈 Classic Delta Saver	🥉 Essential Saver	🏅 Essential Delta Saver	➡️ Coastal Saver
1️⃣ Medical Savings Account (MSA)	20% of the amount of your monthly contribution	20% of the amount of your monthly contribution	10% of the amount of your monthly contribution	10% of the amount of your monthly contribution	15% of the amount of your monthly contribution
2️⃣ Day-to-Day Extender Benefit (DEB)	The Day-to-day Extender Benefit extends your day-to-day cover for essential healthcare services in our network. You also have cover for kids casualty visits.	“The Day-to-day Extender Benefit extends your day-to-day cover for essential healthcare services in our network. You also have cover for kids casualty visits.”	The Day-to-day Extender Benefit extends your day-to-day cover for essential healthcare services in our network.	The Day-to-day Extender Benefit extends your day-to-day cover for essential healthcare services in our network.	The Day-to-day Extender Benefit extends your day-to-day cover for essential healthcare services in our network.

 

Hospital Cover

🔎 Hospital Cover	🥇 Classic Saver	🥈 Classic Delta Saver	🥉 Essential Saver	🏅 Essential Delta Saver	➡️ Coastal Saver
🏥 Hospitals you may go to	Any private hospital that meets Scheme requirements.	The Delta Network’s private hospitals	Any private hospital that meets Scheme requirements.	The Delta Network’s private hospitals	Any private hospital in the four coastal provinces that meets Scheme requirements
☑️ A defined list of procedures in the Day Surgery Network	Private facility for day surgery within the Day Surgery Network.	Private facility for day surgery within the Delta Day Surgery Network	Private facility for day surgery within the Day Surgery Network.	Private facility for day surgery within the Delta Day Surgery Network	Any private hospital in the four coastal provinces approved by the Scheme
💊 Cover for Healthcare Professionals in-hospital	Paid up to 200% of the Discovery Health Rate (DHR)	Paid up to 200% of the Discovery Health Rate (DHR)	Covered up to 100% of the Discovery Health Rate (DHR)	Covered up to 100% of the Discovery Health Rate (DHR)	Covered up to 100% of the Discovery Health Rate (DHR)

 

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Discovery Health Saver Series Benefits and Cover Comprehensive Breakdown

 

Emergency Cover

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

 

Discovery Health Emergency Cover covers the following medical services:

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

 

Prescribed Minimum Benefits

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

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

 

Your medical condition must be on the 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.

 

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.

 

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 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 Personal Health Fund for the Core 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	As a member, you can take advantage of a wellness visit for your children, which includes assessments of their growth and developmental milestones performed by a professional such as an occupational therapist, speech therapist, or physiotherapist.
⚕️ Medical Monitoring Devices	You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar.

The 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 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 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 Core Series and, if necessary, the PMBs.

 

How members of the Discovery Health Saver Series 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, 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 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.

 

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.

 

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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 Saver 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 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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The Day-to-Day Extender Benefit (DEB)

 

The Day-to-day Extender Benefit (DEB) pays for certain benefits after depleting the MSA funds, including the following:

• ✅Video call consultations with network GPs
• ✅Pharmacy clinic consultations
• ✅Unlimited face-to-face consultations with network GPs referred following a video call consultation or by the pharmacy clinic virtual GP.

 

🔎 Saver Plan	🅰️ Single Member	🅱️ Family
➡️ Classic and Coastal	3 Consultations	6 Consultations
➡️ Essential	2 Consultations	4 Consultations

 

The DEB covers face-to-face consultations up to the DHR, and the type of plan determines access to these services.  Furthermore, on Classic Plans, kids who are <10 years old have two casualty visits annually.

 

 

Discovery  Health Chronic Benefits

The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL). Furthermore, you are protected for 22 additional conditions listed on the Additional Disease List (ADL).  Discovery Health pays for consultations and medicines in the following ways:

 

• ✅You must select a primary care physician from the Discovery Health Network to manage your chronic conditions.
• ✅You must see a Discovery Health Network physician to receive full coverage for your doctor visits. Use of a non-network primary care physician will incur a 20% co-payment.
• ✅Discovery Health will pay up to the Discovery Health Rate (DHR) for medications purchased at one of the network pharmacies. The DHR for medication consists of the price of the medication and the dispensing fee.

 

Prescribed Minimum Benefit (PMB)

Under the Prescribed Minimum Benefits, you can receive treatment for a set of medical conditions (PMBs). The PMBs cover the 27 chronic conditions included in the Chronic Disease List (CDL).  Furthermore, Discovery Health’s Core plans provide richer benefits than PMBs. However, to gain access to PMBs, certain rules must be followed.

 

Medicine covered in terms of the chronic disease list (CDL)

You have coverage for all chronic medications on the approved list. Discovery Health covers you for medications not on the list up to the Chronic Drug Amount monthly maximum (CDA).

 

Discovery Health Saver Series 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

Members can use Discovery Health’s designated service providers (DSPs), MedXpress, and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on chronic medication.  Through MedXpress, you can order or reorder your medication online and have it delivered to your place of business or residence. Alternatively, you can:

• ✅You can order your medication online and pick it up at a MedXpress Network Pharmacy or
• ✅Fill a prescription as usual at any pharmacy in the MedXpress Network.

 

Medicine Tracker

Furthermore, you can set reminders and prompts to help you take your medication as prescribed and on time. For example, your approved chronic medication will be displayed automatically. You will be prompted to take your medication and confirm each dose.

 

 

Discovery 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 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 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.
➡️ Track Your Health via the Discovery App	You can receive individualized exercise objectives that help you manage your health. If you are at risk for developing cardiovascular disease or diabetes or have been diagnosed with one of these conditions, Discovery Health will provide you with individualized goals. You can track your progress using the Discovery app and be rewarded for achieving your fitness objectives.

 

Discovery Hospital Benefit

The Core Series includes hospitalization cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.

 

• ✅The cover is provided in any private hospital approved by the Scheme, subject to network requirements for Delta options and Coastal plan.
• ✅You are covered for planned hospital stays.
• ✅If you are on the Delta or Coastal option, you must use a hospital within your plan’s network. However, you may visit any private hospital approved by the Scheme for funding on the remaining plans. On all health plans, the funding of newly licensed facilities is subject to Scheme approval.
• ✅Your Hospital Benefit is used to cover planned hospital stays. In addition, Discovery Health will pay for hospitalization-related services, including all healthcare professionals, services, and medications authorized by the Scheme.
• ✅If you utilize Discovery Health’s contracted physicians, specialists, and other healthcare professionals. Discovery Health will pay in full for these services. On Classic plans, Discovery Health will cover up to 200% of the Discovery Health Rate (DHR).
• ✅In contrast, on Essential and Coastal plans, Discovery Health will cover up to 100% of the DHR.

 

Pre-operative Management Programme for major surgeries

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

 

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

🔎 The Hospital Account	Full hospital account paid at the agreed rate. For planned admissions to non-Delta Hospital Network hospitals, Delta requires R10,700 upfront. The Coastal plan requires planned admissions to Coastal-approved hospitals. Discovery Health will pay 70% of the Discovery Health Rate (DHR) for Scheme-approved hospitals outside the coastal network.
📌 Upfront payments for a defined list of procedures that are performed outside the Day Surgery Network	Classic, Essential, and Coastal plans require an R7,000 upfront payment. Delta options require an R10,700 upfront payment.
📍 A defined list of procedures that are performed in specialist rooms	Paid according to the agreed rate where Discovery Health has authorized procedures.
✅ Specialist with whom Discovery Health has an arrangement	The full account is paid according to the agreed rate.
☑️ Specialists with whom Discovery Health does not have an arrangement, and other healthcare professionals	Classic plans are paid up to 200% of the Discovery Health Rate (DHR). Essential and Coastal plans are paid up to 100% of the Discovery Health Rate (DHR).
➡️ Radiology and Pathology	Paid up to 100% of the Discovery Health Rate (DHR).
🔁 MRI and CT scans	MRI and CT scans If it is related to your hospital admission from your Hospital Benefit. Your day-to-day benefits will cover the initial amount of R3,850 for conservative back and neck treatment or non-admission-related expenses. In contrast, your Hospital Benefit will cover the remaining amount up to the Discovery Health Rate (DHR). Restricted to a single scan of the cervical and thoracic regions
📌 Cataract Surgery at a network provider	The full account at the agreed rate at a network facility for cataract surgery. The hospital account at up to 80% of the Discovery Health Rate at any other facility.

 

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 the scopes of the Saver Series:

• ✅ Where a scope is performed in a facility outside of the Day Surgery Network an upfront payment of R7,000 will apply, except if performed in a hospital outside the Day Surgery Network where an upfront payment of R7,700 will apply.
• ✅Where both a gastroscopy and colonoscopy are performed the upfront payment of R9,600 will apply. For Delta options, the out-of-network upfront payment of R10,700 will apply.
• ✅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.

 

Discover Annual Limits

📌 Cochlear Implants, Auditory Brain Implants, and processors	R244,000 per person per benefit
📍 Internal Nerve Stimulators	R185,550 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 R20,950, and two or more levels are R41,900, limited to one procedure per person per year. The spinal surgery network covers approved spinal surgery admissions. The hospital account will receive up to 80% of the Discovery Health Rate (DHR) for planned admissions outside the Scheme’s network.
🦷 Dental Treatment in the hospital	Dental Limit: No overall dental limit. However, your Medical Savings Account pays 100% of the Discovery Health Rate (DHR) for dental appliances, prostheses, orthodontic treatment, and orthognathic surgery (MSA).
🪥 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 and prostheses and their placement are covered up to R68,250 per year if clinical entry criteria are met.
📍 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). The benefit covers related bills, including the dentist’s, up to 100% of the Discovery Health Rate (DHR). Anesthetists receive 200% of Discovery Health Rate on Classic plans (DHR).
✔️ Dental Treatment in the hospital	Upfront Payments for Dental Admission: Hospital Account – R8,650 for members 13> and R3,350 for members <13 Day Clinic Account – R5,550 for members 12> and R1,500 for members <13

 

💙You might like the 5 Best Medical Aids under R500 

 

 

Discovery Health Saver Series Cover for Day Surgery Network Procedures

Discovery Health will provide cover for certain day surgery procedures. A day surgery may take place in a hospital, a day clinic, or an independent facility. Furthermore, these services are covered by your Hospital Benefit.  Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.

 

Discovery Health will cover the costs of doctors, specialists, and other healthcare providers with which the scheme has an arrangement. For other healthcare professionals, Discovery Health will pay 200% of the Discovery Health Rate (DHR) on Classic and 100% on Essential and Coastal plans.  If you visit a facility, not in your plan’s Day Surgery Network, you will be required to pay a co-payment according to the table below.

 

🔎 Medical Aid Plan	1️⃣ Day Surgery Network for Your Plan	2️⃣ Your Out-of-Network Upfront Payment
☑️ Classic, Essential, and Coastal	Day Surgery Network	R7,000
☑️ Delta Options	Delta Day Surgery Network	R10,700

 

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
• ✅Simple superficial lymphadenectomy
• ✅Skin procedures
• ✅Urological procedures

 

And much more.

 

 

Discovery Saver Series Extra Benefits

Discovery Health Saver Series provides the following additional benefits.

 

In-Room Procedures

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

 

Advanced Illness Benefit

• ✅Members receive comprehensive palliative care.
• ✅This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services.
• ✅Your palliative care treatment plan includes GP consultations.

 

Claims relating to Traumatic Events

• ✅Trauma Recovery Extender Benefit covers out-of-hospital trauma claims.
• ✅The Trauma Recovery Extender Benefit pays claims for the rest of the year and the year after.
• ✅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.

 

International Second Opinion Services

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

 

Spinal Care Programme

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

 

 

Discovery Core Series Value-Added Offers

• ✅Healthy Care at Clicks or Dis-Chem offers discounts on various 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 Saver Series 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.

 

Also take note of new Members 35 years or older may be subject to late-joiner penalties on Discovery Health Medical Aid Plans. 

 

 

Our Verdict on Discovery Health Saver Series

The Discovery Health Saver series offers comprehensive day-to-day coverage from the medical savings account, allowing members to manage their spending. Furthermore, the Day-to-Day Extender Benefit (DEB) provides extensive cover for essential healthcare services.

 

Furthermore, Discovery Health Saver members have access to full coverage for chronic medicine, screening, and prevention, extensive coverage for pregnancy, and cover outside South Africa’s borders. This plan balances in- and out-of-hospital cover that suits most South African budgets.

 

You might also like the following service Discovery has to offer:

• 👉🏿Discovery Health Vitality
• 👉🏿Discovery Health Smart Series
• 👉🏿Discovery Health Priority Series
• 👉🏿Discovery Health KeyCare Series
• 👉🏿Discovery Health Executive Plan
• 👉🏿Discovery Health Core Series
• 👉🏿Discovery Health Comprehensive Series

 

Discovery Health Saver Series Frequently Asked Questions

What is covered under the Discovery Health Saver Series?

The Discovery Health Saver Series covers day-to-day medical expenses, such as GP and specialist consultations, medicine (excluding registered chronic medicine), radiology, and pathology, from the available funds in the member’s Medical Savings Account (MSA). The Day-to-day Extender Benefit (DEB) also pays for certain benefits after depleting the MSA funds.

 

How do I pay for my claims under the Discovery Health Saver Series?

Members can pay their claims 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.

 

Is the Discovery Medical Saver Series affordable?

Yes, the Discovery Medical Saver Series plans are designed to provide comprehensive health cover at an affordable cost.

 

Are there waiting periods for the Discovery Medical Saver Series plans?

Yes, there are waiting periods for certain benefits under the Discovery Medical Saver Series plans.

 

Does the Discovery Medical Saver Series cover chronic medication?

Yes, the Discovery Medical Saver Series plans offer chronic medicine benefits.

 

Can I add dependents to my Discovery Medical Saver Series plan?

Yes, you can add dependents such as spouses and children to your Discovery Medical Saver Series plan.

 

Does the Discovery Medical Saver Series offer day-to-day benefits?

Yes, the Discovery Medical Saver Series plans offer day-to-day benefits, although the extent of these benefits varies depending on the plan.

 

Does the Discovery Medical Saver Series offer hospitalization cover?

Yes, all of the Discovery Medical Saver Series plans offer hospitalization cover.

 

Does the Discovery Medical Saver Series cover emergency medical expenses?

Yes, the Discovery Medical Saver Series plans cover emergency medical expenses, including ambulance services and emergency room visits.

 

Can I change my Discovery Medical Saver Series plan?

Yes, you can change your Discovery Medical Saver Series plan during the annual open enrollment period.

 

How do I know if a specific medication or treatment is covered under my Discovery Medical Saver Series plan?

You can check the plan guide or contact Discovery Health’s customer service to confirm whether a specific medication or treatment is covered under your plan.

 

Is there a limit to the number of claims I can make under the Discovery Health Saver Series?

The number of claims you can make under the Discovery Health Saver Series depends on the available funds in your MSA. Any unused funds will carry over to the next year.

 

How does the Day-to-day Extender Benefit (DEB) work?

The DEB pays for certain benefits after the MSA funds have been depleted. This includes video call consultations with network GPs, pharmacy clinic consultations, and unlimited face-to-face consultations with network GPs referred following a video call consultation or by the pharmacy clinic virtual GP. The DEB covers face-to-face consultations up to the Discovery Health Rate (DHR).

 

How do I check my Discovery Medical Aid Savings?

You can check your Discovery Medical Aid Savings on the Discovery app or website. Alternatively, you can contact Discovery Health via the website (chatbot) or the email address or telephone number provided.

 

Does Discovery Medical Aid give cash back to members?

Through your Discovery Life Plan, you could earn additional cash rewards with the Double PayBack Benefit. This returns up to 100% of your premiums in cash. With Discovery Life, living a healthy lifestyle pays off.