This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Classic Comprehensive.
In-hospital Procedures (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
| 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 Surgery Network
- Possible penalty for use of non-network hospital. See below
- Note: You are also covered for certain procedures, like scopes, performed in specialist rooms
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| Penalty for using other hospital: |
- Use of non-Day Surgery Network: R7,000 penalty
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| Other Co-payments: |
- Scopes: Co-payment required if done outside of network doctor's rooms. See "Scopes" benefit, below.
- Dental: Co-payment required for some dental admissions. See "Dental Benefit".
- MRI and CT scans: Co-payment required in some cases.
- Medicine and Treatment: Some co-payments apply for certain services and treatments, eg specialised medicine. See specific benefits for details.
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| Specialised Radiology: |
- MRI and CT scans, part of approved admission: Covered by scheme
- MRI and CT scans, not related to admission: R3,850 co-payment, paid from day-to-day benefit
- MRI and CT scans, for conservative neck or back treatment: R3,850 co-payment, paid from day-to-day benefit
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| Scopes: |
Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy:
No co-payment if:
- Done in network doctor's rooms, or
- Part of confirmed PMB condition, or
- Patient is under 12yrs
Otherwise:
- Day clinic: R4,500 co-payment
- Hospital: R6,550 co-payment, or R5,250 co-payment if done by a doctor who is part of "value-based network".
- You must use a hospital from Day Surgery Network, or pay an additional R7,000 penalty
- In-rooms, non network doctor: R1,750 co-payment
- In-rooms, network doctor: No co-payment
If gastroscopy and colonoscopy are performed in same admission:
- Day clinic: R5,500 co-payment
- Hospital: R8,100 co-payment, or R6,600 co-payment if done by a doctor who is part of "value-based network".
- You must use a hospital from Day Surgery Network, or pay an additional R8,100 penalty
- In-rooms, non network doctor: R3,000 co-payment
- In-rooms, network doctor: No co-payment
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| Supplementary Services: (Physio, etc) |
- Covered in full for professionals with payment arrangement with Discovery
- Otherwise, 200% scheme rate
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| Transplants: |
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| Dialysis: |
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| Exclusions: |
Exclusions:
- Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
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| Alternatives to hospitals: |
- Hospital at home: Used in case of early hospital release, or as an alternative to admission. Includes physical and virtual care, monitoring devices and access to procedures and interventions to manage care at home.
- Monitoring devices: As approved, for chronic and acute conditions
- Palliative care at home: Unlimited, as approved
- Home Care As an alternative to hospital admission. Services such as postnatal care, end-of-life care, IV infusions (drips), and wound care.
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| Casualty: |
- If in self payment gap: children under 10yrs, two ER consults paid by scheme
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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
- Overseas Treatment Benefit: R500,000 for treatment not available in South Africa, with 20% co-payment
- Specialised medicine and technology: R200,000 per person with a 20% co-payment
- Internal Nerve stimulators: R185,550 per person
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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:
In-hospital |
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.
Find all other open medical aid plans here.
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Out-of-hospital Procedures (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, 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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- Discovery provides a Personal Health Fund for day-to-day expenses, over and above any other day-to-day benefit.
- You accumulate money into this fund by completing certain health check and milestones
- You can accumulate a maximum of R2,500 per adult and R1,250 per child. There is a maximum of R10,000 per family that can be acumulated.
- Once allocated, this money can be used to pay for almost any day-to-day expenses
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If in Self-Payment Gap, you have access to Extender Benefit:
- video call consultations with a network GP,
- network pharmacy clinic consultations
- face to face consultations with a network GP when referred by the pharmacy clinic or virtual GP
Also:
- Virtual Urgent Care: 4 sessions per family, paid by scheme
- Otherwise, from day-to-day benefit
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- GP/Paediatrician/ENT consults: 2 consults, for children 0-2yrs. Paid by scheme.
- Child assessment: height, weight, head circumference and health and milestone tracking
- If in self payment gap: 2 ER consults, for children 0-10yrs, paid by scheme
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- MRI and CT Scans: R3,850 co-payment , from day-to-day benefit
- Conservative back and neck scans: one scan per spinal and neck region
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| Scopes: |
Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy:
No co-payment if:
- Done in network doctor's rooms, or
- Part of confirmed PMB condition, or
- Patient is under 12yrs
Otherwise:
- Day clinic: R4,500 co-payment
- Hospital: R6,550 co-payment, or R5,250 co-payment if done by a doctor who is part of "value-based network".
- You must use a hospital from Day Surgery Network, or pay an additional R7,000 penalty
- In-rooms, non network doctor: R1,750 co-payment
- In-rooms, network doctor: No co-payment
If gastroscopy and colonoscopy are performed in same admission:
- Day clinic: R5,500 co-payment
- Hospital: R8,100 co-payment, or R6,600 co-payment if done by a doctor who is part of "value-based network".
- You must use a hospital from Day Surgery Network, or pay an additional R8,100 penalty
- In-rooms, non network doctor: R3,000 co-payment
- In-rooms, network doctor: No co-payment
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- From day-to-day benefits. Includes allied, therapeutic and psychology services. Limited to:
- Main Member= R24,600
- M+1= R33,450
- M+2= R40,750
- M3+= R47,300
- For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly
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- External appliances: R64,200 per family from day-to-day benefit
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- R31,250 per family paid from day-to-day benefit
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- See "General Appliances", above
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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:
In-hospital |
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.
Find all other open medical aid plans here.
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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 (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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| Chronic: |
- non-PMBs: additional 23 conditions covered, up to a pre-set limit including an exclusive list of brand medicines.
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- Schedule 3 and above
- From day-to-day benefit, up to the limits below
- Main Member= R42,050
- Main+1= R49,300
- Main+2= R57,250
- Main+3+= R65,250
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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, above
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- For a defined list of latest treatments, R200,000 with a 20% co-payment
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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
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View all the other benefits for this plan:
In-hospital |
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.
Find all other open medical aid plans here.
|
| . |
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.
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