Discovery Essential Priority:
prosthetic benefits (2024)

This page has information on: Costs and Prosthetics for Discovery Essential Priority We also have information for: In-hospital, Out of hospital, Medicine, Dentistry, Optometry, Maternity, Cancer, Mental Health, Other/Extra Benefits and Wellness and Preventative Find all the open medical aid plans here. Compare any two plans side by side, instantly. Monthly Costs: Essential Priority 2024 prices Main member: Adult member: Child member: Total Cost pm: R4,531 R3,562 R1,809 Only pay for 3 children Savings: R8,136 R6,396 R3,252 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R14,754 R10,814 R4,368 "Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid the self payment gap. R19,370 R13,820 R6,770 Children Rates: Under 21 yrs old Only pay for 3 children Note: Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list. All treatments and procedures are subject to authorisation and protocols All benefits are listed as an indication only. Please verify with your broker and scheme ♦️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 . You'll get the printable guide as well as a weekly newsletter 🙂 Prosthetics benefits (2024): (Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics) Discovery: Essential Priority Overal Limit: Covered, subject to authorisation Prosthetics required for PMB conditions are always paid paid in full by scheme, with no co-payment, if you follow the protocols. More info here Sub-limits: Shoulder joint prostheses: no limit, unless you use non-network supplier, then R45,550 limit applies Hip and knee joints surgery: no limit, unless you use non-network supplier, then 80% scheme rate and R30,900 per prosthesis limit applies Prosthetic devices used in spinal surgery: no limit, unless you use non-network supplier, then R26,250 limit for first level and R52,500 for two or more levels. Limited to one procedure per person per year. Spinal surgery: no limit, unless you use non-network supplier, then 80% scheme rate Note: PMBs: Prescribed Minimum Benfits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs 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 .

Always consult with your broker before making final decisions regarding your healthcare cover.

Important!
• Unless specified, assume that all benefits are paid are paid at 100% scheme rate
• No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
• "Unlimited" benefits are still subject to authorisation, protocols and sublimits
• Assume that all benefits need to be pre-authorised