Discovery Classic Priority:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Classic Priority. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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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 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
• 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.

In-hospital Procedures (2025):

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

Discovery: Classic Priority
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	network Doctors: paid in full non-network Doctors: 200% scheme rate
Hospital Choice:	Any hospital Day procedure: Day Surgery Network
Penalty for using other hospital:	Use of non-network Day hospital: R7,000 penalty
Co-payments:	Adenoidectomy: R4,800 co-payment Myringotomy: R4,800 co-payment Tonsillectomy: R4,800 co-payment Arthroscopy: R11,100 co-payment Functional Nasal Procedures: R11,100 co-payment Hysterectomy (unless cancer): R11,100 co-payment Laparascopy: R11,100 co-payment Hysteroscopy: R11,100 co-payment Endometrial Ablation: R11,100 co-payment Reflux Surgery: R22,850 co-payment Spinal Surgery: R22,850 co-payment Joint Replacements: R22,850 co-payment 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. Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
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: R4,800 co-payment, paid from day-to-day benefit
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: R7,250 co-payment, or R5,850 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: R9,100 co-payment, or R7,400 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 R9,100 penalty In-rooms, non network doctor: R3,000 co-payment In-rooms, network doctor: No co-payment
Supplementary Services: (Physio, etc)	Covered in full for professionals with payment arrangement with Discovery Otherwise, 200% scheme rate
Transplants:	Covered
Dialysis:	Covered
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!
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.
Casualty/ER:	If in self payment gap : children under 10yrs, two ER consults paid by scheme
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 per person
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

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

Discovery: Classic Priority
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R17,376 R13,704 R6,948 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R8,024 R5,386 R1,512 "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
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	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
Childcare:	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
Specialists consultations:	From day-to-day benefit
Pathology:	From day-to-day benefit
General radiology:	From day-to-day benefit
Specialised radiology:	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
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: R7,250 co-payment, or R5,850 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: R9,100 co-payment, or R7,400 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 R9,100 penalty In-rooms, non network doctor: R3,000 co-payment In-rooms, network doctor: No co-payment
Supplementary Services: (Physio, etc)	From day-to-day benefits. Includes allied, therapeutic and psychology services. Limited to: Main Member= R14,700 Main +1= R20,800 Main +2= R26,900 Main 3+= R31,800
General Appliances:	External appliances: R43,000 per family from day-to-day benefit
1.1. Hearing Aids:	R25,150 per family paid from day-to-day benefit
1.2. Wheelchairs:	See "General Appliances", above
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

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

Discovery: Classic Priority
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R17,376 R13,704 R6,948 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R8,024 R5,386 R1,512 "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
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. .
Acute (prescribed) medication:	Schedule 3 and above From day-to-day benefit , up to the limits below Main Member= R26,850 Main+1= R32,550 Main+2= R59,200 Main+3+= R42,750
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, above
Biological:	PMBs only
View 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.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider