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In-hospital Procedures for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated
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non-Network Specialists: |
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network Specialists: |
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non-Network GPs: |
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network GPs: |
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Hospital Choice: |
- Long stay: Any hospital
- Day procedure: Day Surgery Network
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Day Hospitals: |
- Certain procedures are covered in full at Day Hospital
- Note: You are also covered for certain procedures, like scopes, performed in specialist rooms
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Penalty for using other hospital: |
- non-Network Day hospital: R6,650 co-payment
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Other Co-payments: |
- Mri and CT scans: R3,670 co-payment
- Defined day procedures performed outside of day surgery network: R6,650
- Adenoidectomy, myringotomy (grommets), tonsillectomy, conservative back treatment: R4,550 co-payment
- Arthroscopy, functional nasal procedures, hysterectomy, laparoscopy, hysteroscopy, endometrial ablation: R10,600 co-payment
- Reflux surgery, spinal surgery, joint replacements: R21,800 co-payment
- In-hospital dentistry: co-payment required for some admissions. See dentistry benefit for details
- If any of these are out of hospital: no co-payment
Scopes (Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
No co-payment if:
- Done in doctor's rooms
- Part of confirmed PMB condition
- Patient is under 12yrs
Otherwise
- Day clinic: R4,300 co-payment
- Hospital: R6,900 co-payment, or R5,600 if done by a doctor who is part of "value-based network".
- You must use a facility from Day Surgery Network, or pay an additional R6,650-R6,900
If gastroscopy and colonoscopy are performed in same admission:
- Day clinic: R5,250 co-payment
- Hospital: R8,650 co-payment, or R7,050 if done by a doctor who is part of "value-based network".
- You must use a facility from Day Surgery Network, or pay an additional R8,650
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Specialised Radiology: |
- MRI and CT scans, Part of approved admission: Covered by scheme
- MRI and CT scans, Not part of approved admission R3,670 co-payment
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Supplementary Services: (Physio, etc) |
- Covered in full for professionals with payment arrangement with Discovery
- Otherwise, 100% scheme rate
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Transplants: |
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Dialysis: |
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Exclusions: |
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Alternatives to hospitals: |
- Palliative care at home: Unlimited, as approved
- Physical and virtual 24-hour care for services such as postnatal care, end-of-life care, IV infusions (drips), COVID-19 and wound care.
- Home monitoring device: up to R4,500 per person
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Casualty: |
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Other: |
- International Second Opinion for life-threatening and life-changing condition: members can obtain second opinion from Cleveland Clinic, with a 25% co-payment
- Internal Nerve stimulators: R185,550
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Note: |
- PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
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♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Discovery plans, with costs and brief summary
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Out-of-hospital Procedures for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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- All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
- This can include consults with specialists, blood or other tests, radiology and medicine
- The benefit is paid by the scheme, and not out of your savings account
- If you have no day-to-day funds, you still have cover for PMBs
- Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
- See our Guide to PMBs for more information.
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- If in Self-Payment Gap:
- video call consultations with a network GP,
- unlimited network pharmacy clinic consultations
- unlimited consultations with a network GP when referred by the pharmacy clinic virtual GP .
- Virtual Urgent Care: 4 sessions per family
- Otherwise, from day-to-day benefit
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- GP/Paediatrician/ENT consults: 2 consults, for 0-2yrs
- Child assessment: height, weight, head circumference and health and milestone tracking
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- MRI and CT Scans: R3,670 co-payment , from day-to-day benefit
- Conservative back and neck scans: one scan per spinal and neck region
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- From day-to-day benefits. Includes allied, therapeutic and psychology services. Limited to:
- M =R9,300
- M1 =R14,050
- M2 =R17,450
- M3+ =R21,000
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- External appliances: R28,900 per family from day-to-day benefit
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- R17,050 per family paid from day-to-day benefit
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- PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
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♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Discovery plans, with costs and brief summary
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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
Medication Benefit for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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Chronic: |
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- Schedule 3 and above
- From day-to-day benefit, up to the limits below:
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M= R18,150
M1= R21,500
M2= R25,500
M3+= R31,050
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- From day-to-day benefit
- These do not add up to the annual threshold, and are not paid for from it
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- See "Acute Medicine" benefit
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- See "Acute Medicine" benefit
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- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Discovery plans, with costs and brief summary
|
. |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
|