Home » Medical Aid »

Discovery Health Coastal Saver Medical Aid Plan

Overall, the Discovery Health Coastal Saver Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and unique features to up to 3 Family Members. The Discovery Health Coastal Saver Medical Aid Plan starts from R3,423 ZAR.

🔎 Medical Aid Plan	🥇 Discovery Health Coastal Saver
🌎 International Cover	R5 million
👤 Main Member Contribution	R3,423
👥 Adult Dependent Contribution	R2,574
🍼 Child Dependent Contribution	R1,382
🔁 Gap Cover	✅ Yes
📉 Annual Limit	✅ Yes
🎗️ Oncology Cover	R250,000
💙 Hospital Cover	Unlimited
💶 Medical Savings Account	✅ Yes

Discovery Health Coastal Saver – 22 Key Point Quick Overview

✅ Discovery Health Coastal Saver Overview
✅ Discovery Health Coastal Saver Contributions and Medical Savings Account
✅ Discovery Health Coastal Plan Benefits at a Glance
✅ Discovery Health Coastal Saver Benefits and Cover Comprehensive Breakdown
✅ Discovery Health WELLTH Fund
✅ Discovery Health WHO Outbreak Benefit
✅ Discovery Health Connected Care
✅ Discovery Health Hospital At Home
✅ Discovery Health Saver Day-to-Day Benefits
✅ Discovery Health Maternity and Early Childhood Benefit
✅ Discovery Health Chronic Benefits
✅ Discovery Health Care Programs
✅ Discovery Health Comprehensive Cancer Cover
✅ Discovery Health Hospital Benefit
✅ Discovery Health Coastal Saver Annual Limits
✅ Discovery Health Coastal Saver Cover for Day Surgery Network Procedures
✅ Discovery Health Coastal Saver Extra Benefits
✅ Discovery Health Coastal Saver Value-Added Offers
✅ Discovery Health Coastal Saver Exclusions and Waiting Periods
✅ Discovery Health Coastal Saver Plan vs Similar Plans from Other Medical Schemes
✅ Our Verdict on the Discovery Health Coastal Saver
✅ Discovery Health Coastal Saver Frequently Asked Questions

Discovery Health Coastal Saver Overview

The Discovery Health Coastal Saver starts from R3,423 and is part of a series of comprehensive medical insurance plans offered by Discovery Health. Discovery Health Coastal Saver plan offers unique features and benefits that may appeal to those who live near the coast or frequently visit coastal areas. It is an affordable option for medical aid, but it has some limitations on coverage. Gap Cover is available on the Discovery Health Coastal Saver, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.

The Discovery Health Saver Series offers the following medical aid plans to choose from:

Discovery Health Coastal Saver Contributions and Medical Savings Account

Coastal Saver Contributions

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R3,423	R2,574	R1,382

Coastal Saver Medical Savings Account (MSA)

👤 Main Member	👥 +1 Adult Dependent	🍼 +1 Child Dependent
R6,144	R4,632	R2,484

Discovery Health Coastal Plan Benefits at a Glance

☑️ Day-to-Day Cover	–
🟥 Medical Savings Account (MSA)	20% of the amount of your monthly contribution
🟧 Day-to-Day Extender Benefit (DEB)	The Day-to-Day Extender Benefit (DEB) extends your cover for essential healthcare services in the network daily.
☑️ Hospital Cover	–
🟨 Hospitals you may go to	Any private hospital in the four coastal provinces that meets Scheme requirements
🟩 A defined list of procedures in the Day Surgery Network	Coastal Day Surgery Network facility for private day surgery
🟦 Cover for Healthcare Professionals in-hospital	Covered up to 100% of the Discovery Health Rate (DHR)

POLL: 5 Best Medical Aids under R300

Discovery Health Coastal Saver 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.

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 WELLTH Fund.

The Discovery Health Screening and Prevention covers the following:

✅ Screening for kids will assess the child’s growth and development, including weight, height and body mass index measurements, blood pressure, and more.
✅ Screening for Adults includes blood pressure, blood glucose, HIV, and more. Discovery Health 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.

Discover more: 5 Best Medical Aids for Pensioners and People over 65

Discovery Health WELLTH Fund

The WELLTH Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your health requirements. This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks. Your WELLTH Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.

The Discovery Health WELLTH Fund for the Coastal Saver 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	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 WELLTH Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider. Furthermore, the benefit is available to new members in the joining year and subsequent years. The benefit is available once per lifetime per beneficiary. Cover for eligible healthcare services is limited to the Discovery Health Rate (DHR), subject to the overall benefit maximum.

Your WELLTH Fund maximum is based on the size and composition of your family as stated in your policy:

✅ Limited to R2,500 per adult dependent.
✅ Limited to R1,250 per two-year-old or older child dependent.
✅ Limited to R10,000 per family.

Furthermore, the WELLTH Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.

Discovery 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 Coastal Saver 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 Coastal Saver 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 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 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 Health’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

Suppose you meet the Scheme’s clinical entry criteria. In that case, you have healthcare coverage up to a limit of R4,250 per person per year at 100% of the Discovery Health Rate (DHR) for monitoring certain conditions like chronic obstructive pulmonary disease, congestive heart failure, diabetes, pneumonia, and COVID-19.
If you meet the clinical entry criteria, the scheme covers up to 75% of the Discovery Health Rate (DHR) for defined point-of-care medical devices. You are responsible for 25% of the total cost of these devices. In addition, you have access to the most advanced remote medical examination device, known as TytoHome.
TytoHome enables you to conduct a medical examination by transmitting throat, ear images, and heart and lung sound to your doctor in real time.

READ more about the 5 Best Hospital Plans with Savings Accounts

✅ Home Care Cover

Discovery Health 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 Health Home Care is the designated service provider (DSP) for intravenous infusion administration. Use Discovery Health 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 Health Home Care nurse.

Free tool: Compare Medical Aid Schemes and Plans in South Africa

Discovery Health Saver Day-to-Day Benefits

Discovery Health will cover your 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.

You might like the 5 Best Limited Day to Day Cover Plans

✅ 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.

The DEB covers face-to-face consultations up to the DHR, and the type of plan determines access to these services.

Single Member: 3 Consultations
Family: 6 Consultations

Furthermore, on Classic Plans, kids <10 years old have two casualty visits annually.

Discovery Health Maternity and Early Childhood Benefit

With the Discovery Health Coastal Saver, 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 pay for a defined list of blood tests to confirm pregnancy.

✅ After giving birth:

Two visits to a GP and Specialist 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). Furthermore, you are protected for 22 additional conditions 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 in the Chronic Disease List (CDL). Furthermore, Discovery Health Health’s Coastal Saver Plan provides richer benefits than competitors. 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 Coastal Saver 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

and many more.

Chronic Medicine

Members can use Discovery Health 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 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.

1️⃣ Discovery Health Disease Prevention Program	Premier Plus GPs can enroll you in the Disease Prevention Program 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.
2️⃣ Discovery Health Mental Health Care Program	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.
3️⃣ Discovery Health Diabetes Care Program	Your 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 may help you manage your condition.
4️⃣ Discovery Health HIV Care Program	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.
5️⃣ Discovery Health Cardio Care Program	If your Premier Plus GP refers you to the Cardio Care Program 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.
6️⃣ Track Your Health via the Discovery Health 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 Health app and be rewarded for achieving your fitness objectives.

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 Prescribed Minimum Benefits (PMB)	PMB cancer treatment is always covered. PMB treatment costs total the cover. Discovery Health will cover PMB cancer treatment even if it exceeds the cover amount.
➡️ Discovery Health Oncology Benefit	After Discovery Health has approved your cancer treatment, the Oncology Care Program covers you. Discovery Health will cover approved cancer treatment for 12 months. Discovery Health covers the first R250,000. Discovery Health will cover up to 80% of additional costs if your treatment exceeds the cover amount. Discovery Health Rate covers up to 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. Members must pay 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.

Discovery Health Hospital Benefit

The Coastal Saver includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by Hospital Benefits.

✅ The cover is provided in any private hospital approved by the Scheme, subject to network requirements for the Coastal Plan.
✅ You are covered for planned hospital stays.
✅ It would help if you used a hospital within your plan’s network on the Coastal Option. 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 Health’s contracted physicians, specialists, and other healthcare professionals. Discovery Health will pay up to 100% for these services.

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.

How Discovery Health will pay for approved hospital admissions on the Coastal Saver:

🟥 The Hospital Account	Full hospital account paid at the agreed rate. For planned admissions to non-Delta Hospital Network hospitals, Delta requires R9,650 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	There is an R6,300 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	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	If it is related to your hospital admission from your Hospital Benefit. Your day-to-day benefits will cover the initial amount of R3,470 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

✅ Coastal Saver 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.

🟥 Medical Aid Plan	🟧 Day Clinic Account	🟨 Hospital Account
🟩 Coastal Saver	R4,050	This co-payment will be reduced from R6,950 to R5,750 if performed by a doctor in the Scheme’s value-based network.
🟦 If a gastroscopy and colonoscopy are performed during the same admission	–	–
🟪 Coastal Saver	R4,950	This co-payment will be reduced from R8,650 to R7,200 if performed by a doctor in the Scheme’s value-based network.

Furthermore, the following will apply to scopes on the Coastal Saver:

✅ Scopes performed outside the Day Surgery Network will require an upfront payment of R6,300, except for procedures performed at a hospital outside the Day Surgery Network.
✅ If a gastroscopy and colonoscopy are performed, a one-time payment of R6,300 is required.

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 Coastal Saver Annual Limits

🦻 Cochlear Implants, Auditory Brain Implants, and processors	R230,400 per person per benefit.
🧬 Internal Nerve Stimulators	R175,200 per person
🩺 Major Joint Surgery	No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R30,900 per prosthesis per admission. Emergency and trauma surgeries are excluded from the network.
🩹 Shoulder Joint Surgery	If you use a provider outside the network, you can pay up to R45,550 for your prosthesis.
🍹 Alcohol and Drug Rehabilitation	Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission.
🧠 Mental health	Twenty-one days for admissions or 15 out-of-hospital consultations per person for major affective disorders, anorexia, and bulimia, and 12 for acute stress disorder with recent significant trauma. Three days for attempted suicide admissions. Other mental health admissions are 21 days. Network facilities cover all mental health admissions. If you go elsewhere, the Scheme will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account.
⚕️ 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: 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). 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. Basic Dental Trauma: The Basic Dental Trauma Benefit covers unexpected dental injuries requiring emergency treatment after an accident. Dental appliances and prostheses and their placement are covered up to R61,500 per year if clinical entry criteria are met. 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). 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). 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 Coastal Saver 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. In addition, Discovery Health will pay 100% of the Discovery Health Rate (DHR) on the Coastal Saver pl for other healthcare professionals.

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

If you visit a facility not in your plan’s Day Surgery Network, you must pay a co-payment of R9,650.

Discovery Health Coastal Saver Extra Benefits

Discovery Health Coastal Saver provides the following additional benefits.

✅ 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.

✅ 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 when the trauma occurs and the year after, you and your dependents on your health plan can receive six counseling sessions per person per year from a psychologist, clinical social worker, or registered counselor.
To qualify, members must apply for this benefit.

✅ Africa Evacuation Cover

Emergency medical evacuations from sub-Saharan African countries to South Africa are covered.
Excludes pre-existing conditions.

✅ International Travel Benefit

While traveling outside South Africa, you are covered for emergency medical costs up to US$1 million per person.
The cover lasts 90 days after leaving South Africa.
This benefit excludes pre-existing conditions.
Suppose the elective treatment is freely available in South Africa and covered by your plan. In that case, Discovery Health might cover it at equivalent local costs.

✅ 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.

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

Discovery Health Coastal Saver 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 Health 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 Coastal Saver 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 Health’s waiting periods are as follows:

During your waiting periods, you will not have access to the Prescribed Minimum Benefits (PMBs) if you are subject to waiting periods due to never having belonged to a medical scheme or a break in membership of more than 90 days before joining Discovery Health Medical Scheme, including emergency admission cover.
If you had less than a 90-day break in cover before enrolling in Discovery Health Medical Scheme, you might be eligible for Prescribed Minimum Benefits (PMBs) during waiting periods.

Discovery Health Coastal Saver Plan vs Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 Discovery Health Coastal Saver	🥈 Medshield MediPlus Compact	🥉 Bestmed Pace 1
🌎 International Cover	R5 million	Only Organ Transplants	R500,000 – R3 million
👤 Main Member Contribution	R3,423	R3,768	R4,620
👥 Adult Dependent Contribution	R2,574	R2,688	R3,245
🍼 Child Dependent Contribution	R1,382	R846	R1,166
🔁 Gap Cover	✅ Yes	None	None
📉 Annual Limit	✅ Yes	Unlimited Hospital Cover	Several limits and sub-limits
🎗️ Oncology Cover	R250,000	R282,350	100% of the scheme tariff
💙 Hospital Cover	Unlimited	Unlimited	Unlimited
💶 Medical Savings Account	✅ Yes	None	✅ Yes

Our Verdict on the Discovery Health Coastal Saver

The Discovery Health Coastal Saver plan is a medical aid option offering unique features and benefits. Unlike other Discovery Health plans, the Coastal Saver plan offers its network of healthcare providers, which can result in lower costs and more streamlined processes. This can be particularly beneficial for those living near the coast or frequently visiting coastal areas. One of the key benefits of the Coastal Saver plan is its affordability. It is one of the cheapest options available through the Discovery Health Medical Scheme, making it a good choice for those on a tight budget.

However, it is important to note that this affordability comes with some limitations on coverage. For example, the plan has lower annual limits and higher co-payments, meaning members may need to pay for certain medical expenses out of their own pocket. Another key difference between the Coastal Saver and Discovery Health plans is that they only cover up to 100% of the Discovery Health Rate. This means that if a member chooses to see a healthcare provider who charges more than the Discovery Health Rate, they will need to pay the difference themselves. However, the plan still offers good coverage for essential healthcare services such as hospitalization, chronic medication, and emergency medical care.

You might also consider the following options that Discovery Health Saver Series offer:

Discovery Health Coastal Saver Frequently Asked Questions

What is the Coastal Saver plan’s network of healthcare providers?

The Coastal Saver plan offers its network of healthcare providers, which can result in lower costs and more streamlined processes. This network is focused on healthcare providers located near the coast.

What kind of medical expenses does the Coastal Saver plan cover?

The Coastal Saver plan covers essential healthcare services such as hospitalization, chronic medication, emergency medical care, specialist consultations, radiology, pathology, and preventive healthcare services.

Are there any limits on the cover with the Coastal Saver plan?

Yes, the Coastal Saver plan has lower annual limits and higher co-payments than other Discovery Health plans. Unfortunately, this means that members may need to pay for certain medical expenses out of their own pocket.

Does the Coastal Saver plan cover maternity benefits?

Yes, the Coastal Saver plan covers some maternity benefits, but these are subject to annual limits.

Does the Coastal Saver plan offer a personal savings account?

Yes, the Coastal Saver plan is part of Discovery’s range of savings plans with a Medical Savings Account (MSA) according to each member’s membership level.

Are there any sub-limits on the Coastal Saver plan?

Yes, the plan has sub-limits for certain benefits, such as consultations with specialists and certain diagnostic tests.

What is the difference between the Coastal Saver plan and other Discovery Health plans?

The Coastal Saver plan differs from other Discovery Health plans in that it offers its own network of healthcare providers, has lower annual limits and higher co-payments, and only covers up to 100% of the Discovery Health Rate.

Can I choose to see a healthcare provider who charges more than the Discovery Health Rate?

Yes, you can choose to see a healthcare provider who charges more than the Discovery Health Rate, but you will need to pay the difference yourself.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.