• Benefits, Discovery Plan, prosthetics, Scheme Plans

Discovery Classic Comprehensive: prosthetic benefits (2027)

Contents:

This page has information on: Costs and Prosthetics for Discovery Classic Comprehensive

Terminology:

  • 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 Providers. Where stipulated, you must use 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.
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery:Classic Comprehensive (2027)
Main member: Adult member: Child member:
Total Cost pm:
  • R10,934
  • R10,934
  • R2,181
Savings:
  • R32,796
  • R31,020
  • R6,540
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5,134
  • R6,910
  • R710
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 37640
  • 37640
  • 9140
Children Rates:
  • Under 21yrs
  • Only pay for 3 children
Discovery:Classic Comprehensive (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R10,037
  • R9,492
  • R2,002
Savings:
  • R27,876
  • R26,364
  • R5,568
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R6,934
  • R8,446
  • R1,082
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • R36,290
  • R36,290
  • R8,810
Children Rates:
  • Under 21yrs
  • Only pay for 3 children
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Prosthetics benefits (2027):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: Classic Comprehensive
Assume scheme pays all these costs, unless otherwise stated
Overall Limit:
  • Covered, subject to authorisation
  • Prosthetics required for PMB conditions are always paid in full by scheme, with no co-payment, if you follow the protocols. More info here
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Sub-limits:
  • Shoulder joint prostheses: no limit, unless you use non-network supplier, then R53,500 limit
  • Hip and knee joints surgery: no limit, unless you use non-network supplier, then 80% scheme rate and R33,100 per prosthesis
  • Prosthetic devices used in spinal surgery: no limit, unless you use non-network supplier, then R27,000 limit for first level and R53,950 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
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Note:
  • PMBs: Prescribed Minimum Benefits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs here.
  • DSPs: Designated Service Providers. Where stipulated, you must use 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.
    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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