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Discovery Classic Comprehensive: in-and-out of hospital benefits (2021)

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This page shows the In-hospital, Out-of-hospital and Medicine benefits for Discovery Classic Comprehensive.

Pricing:

Classic Comprehensive
Main member: Adult member: Child member:
Total Cost pm: R6,309 R5,966 R1258
(Pay only for first 3)
Savings: R18,390 R17,394 R3,666
Self Payment Gap:
R3,310 R4,306 R484
Above Threshold: No limit No limit No limit
Children Rates:
  • (Pay only for first 3)
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 other benefits:
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

In-hospital Procedures:

Classic Comprehensive
non-Network Specialists:
  • Up to 200% scheme rate
network Specialists:
  • Full cover
non-Network GPs:
  • Up to 200% scheme rate
network GPs:
  • Full cover
Hospital Choice:
  • Long stay: Choose any hospital
  • Day procedure: Choose from Day Surgery Network
Penalty for using other hospital:
  • If you choose a hospital outside the Day Surgery Network: R5,700 penalty
Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment, R3,130 co-payment
Supplementary Services: (Physio, etc)
  • 200% scheme rate
Transplants:
  • Covered
Dialysis:
  • Covered in full if you use network provider
Day Hospitals:
  • Private day surgery facility in the Day Surgery Network for certain procedures, or a R5,700 penalty
Co-payments: Scopes (Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
  • Day clinic: R3,650 co-payment, or R5,700 co-payment if not part of Day network
  • Hospital: R5,300 co-payment, or R4,250 co-payment if done by a doctor who is part of "value-based network", or R5,700 co-payment if not part of Day network
If gastroscopy and colonoscopy are performed in same admission:
  • Day clinic: R4,450 co-payment or R5,700 if not part of Day network
  • Hospital: R6,600 co-payment, or R5,350 if done by a doctor who is part of "value-based network"or R5,700 co-payment if not part of Day network
No co-payment if:
  • done in doctor's rooms
  • as part of confirmed PMB condition
  • patient is under 12yrs
  • In-hospital dentistry: co-payment required for some admissions. See dentistry benefit for details
Alternatives to hospitals:
  • Access to Connected Care benefit
  • Terminal care: R70,150 per person, per lifetime, for care not related to cancer
  • Cancer: Unlimited palliative care cover for approved care at home
Casualty:
  • Accident and trauma (emergency) related costs covered
  • If in self payment gap: children under 10yrs get two free ER visits
Other:
  • International Second Opinion: members can obtain second opinion from Cleveland Clinic, with a 50% 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
  • Cochlear implants: R230,400
  • Internal Nerve stimulators: R165,300
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
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones here, but you must consult with your scheme to get the full list.
View other benefits:
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.



Out-of-hospital Procedures:

Classic Comprehensive
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R18,390 R17,394 R3,666
Self Payment Gap:
R3,310 R4,306 R484
Above Threshold: No limit No limit No limit
PMBs out of hospital:
  • 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.
General info:
GP consultations:
  • From day-to-day benefit, unless PMB
  • 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.
Childcare:
  • For two years after birth: two visits for baby with GP, Paediatrician or ENT
  • Child assessment, including height, weight, head circumference and health and milestone tracking
Specialists consultations:
  • From day-to-day benefit at up to 100% scheme rate, unless Discovery has payment arrangement with specialist
Pathology:
  • From day-to-day benefit, unless PMB
General radiology:
  • From day-to-day benefit, unless PMB
Specialised radiology:
  • The first R3,130 from day-to-day benefit, balance paid by scheme
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
  • Limited to:
    M M1 M2 M3+
    R20,950 R28,450 R34,700 R40,250
  • 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
General Appliances:
  • External appliances limited to R60,550 per family from day-to-day benefit
  • Cochlear implants: R230,400
1.1. Hearing Aids:
  • R26,600 per family paid from day-to-day benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
Note:
  • 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 other benefits:
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.



Medication cover:

Classic Comprehensive
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R18,390 R17,394 R3,666
Self Payment Gap:
R3,310 R4,306 R484
Above Threshold: No limit No limit No limit
Chronic:
Acute (presrcibed) medication:
  • Schedule 3 and above
  • From day-to-day benefit, up to the limits below
Main M1 M2 M3+
R35,750 R41,950 R48,700 R55,550
Over-the-counter:
  • From day-to-day benefit
  • These do not add up to the annual threshold, and are not paid for from it
Birth Control:
  • See "Acute Medicine" benefit
On Discharge:
  • See "Acute Medicine" benefit
Biological:
  • For a defined list of latest oncology treatments, with a 25% co-payment
  • Otherwise, R200,000 with a 20% co-payment
Note:
  • 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 other benefits:
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.

Important!

  • Unless specified, assume that all benefits 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


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