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Discovery Health Saver Series

The Discovery Health Saver Series in South Africa reviewed.

We verified their medical aid plans and reviewed all their features.

This is a complete guide to the Discovery Health Saver Series in South Africa.

In this in-depth guide you’ll learn:

☑️ What is the Discovery Health Saver Series?
☑️ How to compare Discovery’s plans?
☑️ Does Discovery have hospital plans?
☑️ What are Discovery’s contact details?
☑️ Where do you enter the Discovery Login?
☑️ Which GPs are on Discovery’s Saver Network?

So if you’re ready to go “all in” with Discovery’s Health Saver Series in South Africa, this guide is for you.

Let’s dive right in…

Discovery Health Saver Series Summary

Overview

👉 Overall, Discovery Health is a popular medical aid scheme in South Africa, registered with the Council of Medical Schemes (CMS) under FSP No. 18564.

Discovery Health Saver Series Overview

👉 The Discovery Health Saver Series starts from R2,385 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.

📢 Complete below form and receive a free, no obligation quote

Discovery Health Saver Series Contributions 2024

	1️⃣ Main Member	2️⃣ +1 Adult Dependent	3️⃣ +1 Child Dependent
Classic Saver	R4,182	R3,299	R1,676
Classic Delta Saver	R3,342	R2,640	R1,342
Essential Saver	R3,351	R2,514	R1,342
Essential Delta Saver	R2,673	R2,017	R1,072
Coastal Saver	R3,423	R2,574	R1,382

Discovery Health Saver Series Compared

	Classic Saver	Classic Delta Saver	Essential Saver	Essential Delta Saver	Coastal Saver
Prescribed Minimum Benefits (PMB)	✔️	✔️	✔️	✔️	✔️
Screening and Prevention	✔️	✔️	✔️	✔️	✔️
Medical Savings Account	• Main – R10,020 • +1A – R7,908 • +1C – R4,020	• Main – R8,016 • +1A – R6,336 • +1C – R3,216	• Main – R4,008 • +1A – R3,012 • +1C – R1,596	• Main – R3,192 • +1A – R2,412 • +1C – R1,284	• Main – R6,144 • +1A – R4,632 • +1C – R2,484
Maternity Benefits	✔️	✔️	✔️	✔️	✔️
Pre- and Postnatal Care	✔️	✔️	✔️	✔️	✔️
Chronic Conditions	✔️	✔️	✔️	✔️	✔️
Home Care	✔️	✔️	✔️	✔️	✔️
Oncology Cover (Maximum ZAR)	R250,000	R250,000	R250,000	R250,000	R250,000
Extended Cover for Oncology	❌	❌	❌	❌	❌
Hospital Cover	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited
Optometry Benefit	❌	❌	❌	❌	❌
Dentistry Benefit	In-hospital	In-hospital	In-hospital	In-hospital	In-hospital
Advanced Dentistry	❌	❌	❌	❌	❌
Internal Prosthesis	✔️	✔️	✔️	✔️	✔️
External Prosthesis	❌	❌	❌	❌	❌
Mental Healthcare Programme	✔️	✔️	✔️	✔️	✔️
Diabetes Care Programme	✔️	✔️	✔️	✔️	✔️
HIV Care Programme	✔️	✔️	✔️	✔️	✔️
Cardio Care Programme	✔️	✔️	✔️	✔️	✔️
Back and Neck programme	❌	❌	❌	❌	❌
Disease Prevention Programme	✔️	✔️	✔️	✔️	✔️
Cover for Covid-19 and other diseases (WHO Outbreak Benefit)	✔️	✔️	✔️	✔️	✔️
Annual Limit	✔️	✔️	✔️	✔️	✔️
Above Threshold Benefit (ATB)	❌	❌	❌	❌	❌
International Cover	R5 million	R5 million	R5 million	R5 million	R5 million
Main Member Contribution	R4,182	R3,342	R3,351	R2,673	R3,423
Adult Dependent Contribution	R3,299	R2,640	R2,514	R2,017	R2,574
Child Dependent Contribution	R1,676	R1,342	R1,342	R1,072	R1,382
Gap Cover	✔️	✔️	✔️	✔️	✔️

Discovery Health Core Plan Benefits at a Glance

	💊 Classic Core	💊 Classic Delta Core	💊 Essential Core	💊 Essential Delta Core	💊 Coastal Core
➡️ Day-to-Day Cover	Day-to-Day Cover	Day-to-Day Cover	Day-to-Day Cover	Day-to-Day Cover	Day-to-Day Cover
➡️ Medical Savings Account (MSA)	25% of the amount of your monthly contribution	25% of the amount of your monthly contribution	15% of the amount of your monthly contribution	15% of the amount of your monthly contribution	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. • You also have cover for children’s emergency visits.	• The Day-to-Day Extender Benefit (DEB) extends your cover for essential healthcare services in the network daily. • You also have cover for children’s emergency visits.	The Day-to-Day Extender Benefit (DEB) extends your cover for essential healthcare services in the network daily.	The Day-to-Day Extender Benefit (DEB) extends your cover for essential healthcare services in the network daily.	The Day-to-Day Extender Benefit (DEB) extends your cover for essential healthcare services in the network daily.
➡️ Hospital Cover	Hospital Cover	Hospital Cover	Hospital Cover	Hospital Cover	Hospital Cover
➡️ 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	Coastal Day Surgery Network facility for private day surgery
➡️ 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)

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 counselling 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 Prescribed Minimum Benefit (PMB) conditions list to qualify for coverage. Furthermore, the necessary treatment must correspond to the remedies 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 specific 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 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 WELLTH Fund

👉 The WELLTH 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 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 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, biokineticists, or physiotherapists are available for physical wellbeing 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. • 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.

How can members get access to the Discovery WELLTH Fund?

👉 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.

Which limits apply to the Discovery WELLTH Fund?

👉 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.

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.
➡️ Access to the Long COVID Recovery Programme:
➡️ A six-month support programme for members whose COVID-19 symptoms persist beyond 21 days after acute diagnosis.
➡️ According to the Scheme’s clinical entry criteria and treatment guidelines, the programme includes the following:
➡️ Up to two specialists and GP consultations.
➡️ A defined basket of pathology tests.
➡️ Allied healthcare professional support.
➡️ A home monitoring device.
➡️ A defined basket of x-rays and scans.

👉 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.

Hospital At Home

👉 Hospital at Home patients receive specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being. They all work together to make your healthcare more efficient and your life safer.

👉 Suppose you have a valid pre-authorization for hospitalization. In that case, Discovery Health will use your Hospital Benefit to cover any services provided as part of Discovery’s Hospital at Home programme.

👉 For those who meet the programme’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 cover 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 also 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.

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.

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	💊 Family
✔️ Saver Plan	Saver Plan	Saver Plan
✔️ Classic and Coastal	3 Consultations	6 Consultations
✔️ Essential	2 Consultations	4 Consultations

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

Discovery Maternity and Early Childhood Benefit

👉 With the Discovery Health Saver Series, you get cover 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 for 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, Discovery Health covers the following:
➡️ Two visits to a GP and Specialist for up to 2 years.
➡️ Postnatal care, including complications during delivery, nutritional assessment, etc.
➡️ Discovery Health prenatal and postnatal care includes:
➡️ Five antenatal or postnatal classes.
➡️ One Breastfeeding consultation.

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 cover 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 cover 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 programmes that assist with managing diabetes, mental health, HIV, and heart-related conditions.

👉 You must be registered with these condition-specific care programmes 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.

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 Programme 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 Hospital Benefit

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

➡️ 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

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 that is not in your plan’s Day Surgery Network, you will be required to pay a co-payment according to the table below.

	💊 Day Surgery Network for Your Plan	💊 Your Out-of-Network Upfront Payment
Classic, Essential, and Coastal	Day Surgery Network	R6,300
Delta Options	Delta Day Surgery Network	R9,650

👉 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

Discovery Core Series Extra Benefits

👉 Discovery Health Saver Series provides the following additional benefits.

In-Room Procedures

➡️ 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 counsellor.

➡️ 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.

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 a wide range of 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.

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

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 cover for pregnancy, and coverage outside South Africa’s borders.

👉 This plan balances in- and out-of-hospital cover that suits most South African budgets.

Frequently Asked Questions

What is the Discovery Health Saver Series?

☑️ In South Africa, Discovery Health offers a selection of medical assistance plans called the Discovery Health Saver Series. These medical aid plans are created to combine comprehensive medical coverage with a savings account element.

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

☑️ Your ability to submit claims under the Discovery Health Saver Series is based on the amount of money that is available in your MSA. Any leftover money will roll over to the following year.

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

☑️ Claim payments can be made by members at cost or at the Discovery Health Rate (DHR). The Scheme will automatically finance the excess from the MSA if the member elects to have their claims paid at cost and the claims total more than the DHR.The member can ask for a special payment if they choose to have their claims paid at the DHR and want to have their claims paid more than the DHR using the money in their MSA that is now available.

What is covered under the Discovery Health Saver Series?

☑️ From the available money in the member’s Medical Savings Account (MSA), the Discovery Health Saver Series pays for routine medical expenses such GP and specialist consultations, medicine (except registered chronic medicine), radiography, and pathology.

How does the savings account component work in the Discovery Health Saver Series?

☑️ Members can save money through the savings account component to pay for ongoing medical costs. Members pay monthly premiums that go into their savings account, and the money they have saved up can be used for a variety of healthcare services, including GP visits, prescription drugs, and preventive care.

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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.