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Discovery Health β€” Saver Series

Essential Saver

About this plan

πŸ₯‡ Best suited for families seeking comprehensive cover with everyday healthcare savings.
Principal Member
From
R3,886
per month
Adult Dependant
From
R2,914
per month
Child Dependant
From
R1,556
per month

What's covered

Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health

Waiting periods

General
3 months
Pre-existing conditions
12 months

Essential Saver

Discovery-Health-Essential-Saver

Discovery Health Essential Saver Medical Aid Plan (2026)

Overall, the Discovery Health Medical Scheme Essential Saver Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures for its Family Members. The Essential Saver Medical Aid Plan starts from R3,886 ZAR.  
πŸ”Ž Medical Aid PlanπŸ₯‡ Discovery Health Essential Saver
🌎 International CoverR5 million
πŸ‘€ Main Member ContributionR3,886
πŸ‘₯ Adult Dependent ContributionR2,914
🍼 Child Dependent ContributionR1,556
πŸ” Gap Coverβœ… Yes
πŸŽ—οΈ Oncology Cover R250,000
πŸ’› Extended Cover for OncologyNone
πŸ₯ Hospital CoverUnlimited
😎 Optometry BenefitNone
    Discovery Saver Series for 2026

Discovery Health Medical Scheme Essential Saver - 22 Key Point Quick Overview

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

Essential Saver Overview

Essential Saver overview   The Discovery Health Medical Scheme Essential Saver starts from R3,886 and is part of a series of comprehensive medical scheme plans offered by Discovery Health Medical Scheme. The Essemtial Saver is ideal for those who require basic cover and are healthy and active overall. Gap Cover is available on the Essential 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 Medical Scheme Saver SeriesΒ  offers the following medical aid plans to choose from:   Reimaging your healthcare Essential Delta Core

Essential Saver Contributions and Medical Savings Account

Essential Saver Contributions

Saver plan contributions    
πŸ‘€ Main MemberπŸ‘₯ +1 Adult Dependent🍼 +1 Child Dependent
R3,886R2,914R1,556
 

Essential Saver Medical Savings Account (MSA)

 
πŸ‘€ Main MemberπŸ‘₯ +1 Adult Dependent🍼 +1 Child Dependent
R4,356R 3,264R 1,740
  Discovery Health Saver Contributions and Medical Savings Account

Essential Saver Plan Benefits at a Glance

 
β˜‘οΈ Day-to-Day Cover-
πŸŸ₯ Medical Savings Account (MSA)10% 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.
β˜‘οΈ Hospital Cover-
🟨 Hospitals you may go toAny private hospital that meets Scheme requirements.
🟩 A defined list of procedures in the Day Surgery NetworkPrivate facility for day surgery within the Day Surgery Network.
🟦 Cover for Healthcare Professionals in-hospitalCovered up to 100% of the Discovery Health Rate (DHR)
 

Essential 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 Medical Scheme Emergency Cover covers the following medical services:  
  • βœ… The emergency vehicle (or other medical transport).
  • βœ… The hospital’s account of the incident.
  • βœ… The observations of the physician who admitted you to the hospital.
  • βœ… 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:  
  • βœ… A life-threatening medical condition.
  • βœ… A defined listing of 271 conditions.
  • βœ… 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.Β  In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health Medical Scheme's network.   Once your condition has stabilized, you will be transferred to a hospital or other service providers in the Discovery Health Medical Scheme network, if necessary, according to the scheme’s rules. Discovery Health Medical Scheme 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 Medical Scheme will pay and the actual cost of your treatment.   Furthermore, Discovery Health Medical Scheme will pay according to your plan’s benefits if these criteria are unmet.  

Screening and Prevention

Essential 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:  
  • βœ…Β Screening for kids will assess the child’s growth and development, including weight, height and body mass index measurements,Β blood pressure, and more.
  • βœ…Β Screening for Adults includes blood pressure, blood glucose,Β 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.   READ ALSO:Β Medical Aid Schemes that Cover High Cholesterol

Discovery Health Personal Health Pathway

Personal Healthfund saver series     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.  
🩺 General HealthYou 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 HealthDieticians, biokinetics, or physiotherapists are available for physical well-being evaluations.
🧠 Mental HealthYou have access to a mental health evaluation to promote mental health.
🚺 Women and Men’s HealthYou 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 HealthAs 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.
πŸ“Œ Medical Monitoring DevicesYou have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar.
  Personal health pathways priority series     TheΒ Discovery Health Personal Health Fund for Essential PriorityΒ covers the following: The Personal Health Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider.   Furthermore, the benefit is available to new members in the joining year and subsequent years.Β  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:  
  • βœ…Β Limited toΒ R1,500Β per adult dependent.
  • βœ…Β Limited toΒ R750Β per two-year-old or older child dependent.
  • βœ…Β Limited toΒ R6,000Β per family per year.
  Furthermore, the Personal Health Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.     Personal healthfund sleep actions

WHO Outbreak Benefit

  The basket of care includes the following:
  • βœ… COVID-19 vaccines and their administration according to the COVID-19 guidelines of the National Department of Health.
  • βœ… Screening consultations with a network general practitioner (virtual, telephone, or in-person).
  • βœ… COVID-19 PCR and Rapid Antigen screening tests if referred by a qualified medical practitioner.
  • βœ… A set of defined pathology tests for COVID-19-positive individuals.
  • βœ… A predetermined assortment of x-rays and scans for COVID-19-positive individuals.
  • βœ… 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.
  • βœ… When you are admitted to the hospital because of symptoms of COVID-19, you will be covered by the Hospital Benefit of the Essential Saver and, if necessary, the PMBs.
  • βœ… Access to the Long COVID Recovery Program.
  How members of the Essential Saver Plan are covered in terms of Monkeypox:  
  • βœ… The treatment protocol for confirmed cases consists of a diagnostic PCR screening test
  • βœ… 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 DevicesAccess 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 PrescriptionsElectronic prescribing for expedited access to medications.
πŸ’› Home NursesHospital-related care is provided at home by registered nurses.
πŸ’š Medicine Ordering and TrackingOrder and track the delivery of your medication from the dispensary to your door.
πŸ’™ Online CoachesAt-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19.
πŸ’œ Condition-Specific InformationEducational content pertinent to your condition is readily accessible.
  βœ… 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.   βœ… 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.  

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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 Medical Scheme will use your Hospital Benefit to cover any services provided as part of the 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 Medical Scheme 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.
βœ… 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.   βœ… Home Monitoring Devices
  • Suppose you meet the Scheme’s clinical entry criteria. In that case, you have healthcare coverage up to a limit of R4,850 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.
βœ… Home Care CoverYour access to care at home saver care 2026
  • 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.
  • 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.
βœ… 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 Home Care nurse.   READ more: 10 Best Hospital Plans in South Africa

Saver Day-to-Day Benefits

Discovery Health Medical Scheme will cover your medical expenses with funds from your Medical Savings Account (MSA) or Day-to-Day Extender Benefit (DEB).   βœ… The Medical Savings Account (MSA) Discovery Health Medical Scheme 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.   βœ… 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: 2 Consultations Family: 4 Consultations   Furthermore, on Classic Plans, kids <10 years old have two casualty visits annually.     Saver plans Day to Day Benefits

Maternity and Early Childhood Benefit

With the Essential 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.   Maternity Benefit covers the following:βœ… 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.

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βœ… 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 Medical Scheme's prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.     Maternity benefit saver series

Chronic Benefits

The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL).   βœ… Discovery Health Medical Scheme pays for consultations and medicines in the following ways:Chronic Benefits Saver series     You must select a primary care physician from the Discovery Health Medical Scheme Network to manage your chronic conditions.   You must see a Discovery Health Medical Scheme 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 Medical Scheme 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.   βœ… 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 Medical Scheme's Essential Saver Plan provides richer benefits than competitors. However, to gain access to PMBs, certain rules must be followed.   βœ… Medicine covered in terms of the chronic disease list (CDL) You have coverage for all chronic medications on the approved list. Discovery Health Medical Scheme covers you for medications, not on the list up to the Chronic Drug Amount monthly maximum (CDA).   βœ… Essential 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
  • Diabetes Type 1
  • Diabetes Type 2
  • Dysrhythmia
  • Epilepsy
  • Glaucoma
  • Hemophilia

Chronic Medicine

Members can use Discovery Health Health Medical Scheme’s designated service providers (DSPs), MedXpress, and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on chronic medication.Β  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.
βœ… 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.  

Care Programs

Care programmes Core series     Discovery Health Medical Scheme 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.  
πŸ”΄ Discovery Health Disease Prevention ProgramPremier 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.
🟠 Discovery Health Mental Health Care ProgramOnce 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 ProgramYour 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.
🟒 Discovery Health HIV Care ProgramPremier 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.
πŸ”΅ Discovery Health Cardio Care ProgramIf 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.
🟣 Track Your Health via the Discovery Health AppYou 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 Care Programs

Comprehensive Cancer Cover

Oncology programmes and core series     You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.  
πŸŽ—οΈ 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 BenefitAfter 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.
πŸ’› Discovery Health Oncology Innovation BenefitSubject 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 MedicineTo 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.
πŸ₯° Discovery Health Advanced Illness BenefitMembers 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.
 

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Hospital Benefit

Hospital cover for Saver plansThe Essential Saver includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
  • βœ… You are covered for planned hospital stays.
  • βœ… The funding of newly licensed facilities is subject to Scheme approval.
  • βœ… 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.
  • βœ… 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
  • βœ… 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.
  • βœ… Clinical entry and treatment guidelines govern cover.
How Discovery Health Medical Scheme will pay for approved hospital admissions on the Essential Saver:  
πŸ”΄ The Hospital AccountFull hospital account paid at the agreed rate. Discovery Health will pay 70% of the Discovery Health Rate (DHR) for Scheme-approved hospitals outside the network.
🟠 Upfront payments for a defined list of procedures that are performed outside the Day Surgery NetworkThere is an R7,250 upfront payment.
🟑 A defined list of procedures that are performed in specialist roomsPaid according to the agreed rate where Discovery Health has authorized procedures.
🟒 Specialist with whom Discovery Health has an arrangementThe full account is paid according to the agreed rate.
🟣 Specialists with whom Discovery Health does not have an arrangement, and other healthcare professionalsPaid up to 100% of the Discovery Health Rate (DHR).
πŸ”΅ Radiology and PathologyPaid up to 100% of the Discovery Health Rate (DHR).
πŸ”΄ MRI and CT scansIf it is not related to your admission or for conservative back and neck treatment, we pay the first R4,000 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate. Limited to one scan per spinal and neck region
  βœ… Essential 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.  
πŸŸ₯ Discovery Medical Plan🟦 Day Clinic AccountπŸŸͺ Hospital Account
🟧 Essential SaverR4,650This co-payment will be reduced from R8,000 to R6,650 if performed by a doctor in the Scheme’s value-based network.
🟨 If a gastroscopy and colonoscopy are performed during the same admission--
🟩 Essential SaverR5,700This co-payment will be reduced from R9,950. to R8,250 if performed by a doctor in the Scheme’s value-based network.
  Furthermore, the following will apply to scopes on the Essential Saver:  
  • Scopes performed outside the Day Surgery Network will require an upfront payment of R7,250, except for procedures performed at a hospital outside the Day Surgery Network.
  • Then, the upfront payment will be R8,000.
  • If a gastroscopy and colonoscopy are performed, an up-front fee of R9,850 will be 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.  

Essential Saver Annual Limits

Hospital cover Saver plans with a yearly limit    
🦻 Cochlear Implants, Auditory Brain Implants, and processorsR252,000 per person per benefit.
🧬 Internal Nerve StimulatorsR192,000 per person
🩹 Major Joint SurgeryNo limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R31,850 per prosthesis per admission. Emergency and trauma surgeries are excluded from the network.
🦾 Shoulder Joint SurgeryIf you use a provider outside the network, you can pay up to R48,500 for your prosthesis.
🍹 Alcohol and Drug RehabilitationDiscovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission.
🧠 Mental healthTwenty-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.
βš•οΈ Prosthetic Devices used during Spinal SurgeryThere is no overall limit if you get your prosthesis from our preferred suppliers. If you do not use a preferred supplier, a limit of R21,600 applies for the first level and R43,150 for two or more levels, limited to one procedure per person per year.
🦷 Dental Treatment in the hospitalDental 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 R70,800 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 – R8,950 for members 13> and R3,470 for members <13 Day Clinic Account – R5,750 for members 12> and R1,550 for members <13
 

Essential Saver Cover for Day Surgery Network Procedures

Discovery Health Medical Scheme 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 Medical Scheme will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.   Discovery Health Medical Scheme will cover the costs of doctors, specialists, and other healthcare providers with which the scheme has an arrangement.   In addition, Discovery Health Medical Scheme will pay 100% of the Discovery Health Rate (DHR) on the Essential Saver plan for other healthcare professionals. However, if you visit a facility, not in your plan’s Day Surgery Network, you will be required to pay a co-payment of R7,250.   The following list provides the procedures that can be performed in a Discovery Health Medical Scheme Day Surgery Network:  
  • βœ… Biopsies
  • βœ… Breast Procedures
  • βœ… Ear, nose, and throat procedures
  • βœ… Eye Procedures
  • βœ… Ganglionectomy
  • βœ… Gastrointestinal scopes and procedures
  • βœ… Gynecological Procedures

Essential Saver Extra Benefits

Discovery Health Medical Scheme Essential Saver provides the following additional benefits.   βœ… In-Room Procedures
  • The cover is limited to specialist room procedures.
  • Hospital Benefit covers up to the Scheme-authorised rate.
βœ… 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.
βœ… 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.
βœ… Africa Evacuation Cover
  • Emergency medical evacuations from sub-Saharan African countries to South Africa are covered.
  • Excludes pre-existing conditions.
βœ… 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.
βœ… International Second Opinion Services
  • The Clinic by Cleveland Clinic provides second opinions for life-threatening and life-changing conditions through your specialist.
  • Discovery Health Medical Scheme will pay 100% for second opinions.
Finally, Conservative spinal treatment is out-of-hospital and includes virtual and face-to-face consultations with an appropriately registered allied healthcare professional.  

Essential Saver Value-Added Offers

  • βœ… 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.
  • βœ… Your plan’s optometrists offer 20% off frames and lenses when you pay immediately.
  • βœ… Expectant parents can cryogenically store their newborn baby’s umbilical cord blood and tissue stem cells at a discounted rate with Netcells’ exclusive offer.
  • βœ… Vitality, the world’s leading science-based wellness program, rewards healthy living. As a result, Discovery Health Vitality members live longer and healthier lives.
  • βœ… 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 Value-Added Offers

Essential Saver Exclusions and Waiting Periods

βœ… 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.
βœ… Discovery Health’s waiting periods could be 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 Saver Exclusions and Waiting Periods

Essential Saver Plan vs Similar Plans from Other Medical Schemes

 
πŸ”Ž Medical Aid PlanπŸ₯‡ Discovery Health Essential Saver πŸ₯ˆ Fedhealth FlexiFED 3 Hospital PlanπŸ₯‰ Momentum Incentive Plan
🌎 International CoverR5 millionEmergency cover while abroad through ER24 AssistR8 million
πŸ‘€ Main Member ContributionR 3,886R3,705 – R4,946R3,362 – R6,030
πŸ‘₯ Adult Dependent ContributionR 2,914R3,398 – R4,531R2,653 – R4,900
🍼 Child Dependent ContributionR1,556R1,314 – R1,753R1,263 – R2,549
πŸ” Gap Coverβœ… YesNot included (available as an add-on)Not included (available as an add-on)
πŸŽ—οΈ Oncology Cover R250,000R360,850R400,000 per treatment cycle (PMB conditions)
πŸ’› Extended Cover for Oncology80% of Discovery Health RateUnlimited cover for PMB conditions (sub-limits apply)20% co-payment after the R400 000 benefit
πŸ₯ Hospital CoverUnlimitedPrivate hospitals, 100% of Fedhealth ratePrivate hospitals, 100% of Momentum rate
😎 Optometry BenefitNoneNetwork provider: Eye test every 2 years, frames & lenses sub-limited to R1,930 per personPaid from savings account
 

Our Verdict on the Discovery Health Medical Scheme Essential Saver

Essential Saver Verdict   This plan is designed to provide affordable coverage for essential healthcare services. The plan has several features that make it an attractive option for those seeking basic medical coverage. However, it also has some drawbacks that potential members should be aware of. One of the key features of the Essential Saver plan is its affordability.   It is one of the most affordable plans offered by Discovery Health Medical Scheme, making it a good option for those who cannot afford more comprehensive coverage. Despite its affordability, the plan still covers essential healthcare services such as hospitalization, chronic medication, and emergency medical care.   Another feature of the Essential Saver plan is its flexible structure. For example, members can choose a hospital network, which can help keep costs down. Members can also choose to add on certain benefits, such as maternity cover or a savings account, which can help to provide additional peace of mind.   However, potential members should be aware of some drawbacks to the Essential Saver plan. Firstly, the plan has limited coverage for out-of-hospital expenses. This means that members may need to pay for certain medical expenses out of their own pocket, which can be costly.   Additionally, the plan has limited coverage for certain procedures, such as MRI and CT scans, which can be a concern for those with existing medical conditions.   You might also consider the following options that Discovery Health Saver SeriesΒ  offer:

Essential Saver Frequently Asked Questions

What is the Essential Saver plan?

The Essential Saver plan is medical aid cover offered by Discovery Health Medical Scheme in South Africa. It is designed to provide affordable coverage for essential healthcare services.  

What does the Essential Saver plan cover?

The plan covers hospitalization, chronic medication, and emergency medical care.  

Is the Essential Saver plan affordable?

Yes, the plan is one of the most affordable plans offered by Discovery Health. This makes it a good option for those who cannot afford more comprehensive coverage. The plan starts at R 3,886.

Does the Essential Saver plan have a hospital network?

Yes, members can choose a hospital network, which can help keep costs down.  

Are there any limitations to the Essential Saver plan?

Yes, the plan has limited coverage for out-of-hospital expenses and certain procedures such as MRI and CT scans.
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