Benefits, Discovery Plan, in-hospital, out-hospital, Scheme Plans

Discovery Classic Priority: in-and-out of hospital benefits (2027)

January 6, 2026

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 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

Discovery:Classic Priority (2027)
	Main member:	Adult member:	Child member:
Total Cost pm:	R6,752	R5,326	R2,700
Savings:	R20,256	R15,972	R8,100
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R9,334	R6,268	R1,760
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	20,830	14,870	7,280
Children Rates:	Under 21yrs Only pay for 3 children

Discovery:Classic Priority (2026)
	Main member:	Adult member:	Child member:
Total Cost pm:	R6,198	R4,889	R2,478
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)	R9,784	R6,706	R2,102
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	R20,080	R14,330	R7,020
Children Rates:	Under 21yrs Only pay for 3 children

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In-hospital Procedures (2027):

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	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Long procedure: any hospital Day procedure: Day Surgery Network
Penalty for using other hospital:	Use of non-network day hospital: R7,550 penalty Defined procedures outside of day hospital: R7,550 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	No co-payments if done in doctor's rooms Adenoidectomy: R5,200 co-payment Conservative back treatment: R5,200 co-payment Myringotomy: R5,200 co-payment Tonsillectomy: R5,200 co-payment Arthroscopy: R11,950 co-payment Functional nasal procedures: R11,950 co-payment Hysterectomy (unless cancer): R11,950 co-payment Laparoscopy: R11,950 co-payment Hysteroscopy: R11,950 co-payment Endometrial ablation: R11,950 co-payment Reflux surgery: R24,600 co-payment Spinal surgery: R24,600 co-payment Joint replacements: R24,600 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: 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, especially if you don't use a DSP for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI and CT scans: R4,155 co-payment, paid from day-to-day benefit MRI and CT scans, for conservative neck or back treatment: R5,200 co-payment, paid from day-to-day benefit	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:	Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy: No co-payment if: Done in network doctor's rooms, or For dyspepsia Part of confirmed PMB condition, or Patient is under 12yrs Otherwise: Day clinic (network): R4,850 co-payment Day clinic (non-network): R7,550 co-payment Hospital: R7,100 co-payment, or R5,650 co-payment if done by a doctor who is part of "value-based network" In-rooms, non-network doctor, single scope: R1,880 co-payment In-rooms, network doctor: no co-payment If gastroscopy and colonoscopy are performed in same admission: Day clinic (network): R5,900 co-payment Day clinic (non-network): R8,750 co-payment Hospital (network): R8,750 co-payment, or R7,100 co-payment if done by a doctor who is part of "value-based network" In-rooms, non-network doctor: R3,220 co-payment In-rooms, network doctor: no co-payment	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	Covered in full for professionals with payment arrangement with scheme Otherwise, 200% scheme rate
Transplants:	Covered
Dialysis:	Covered
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
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. R4,850 per person, paid by scheme 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 Home-based virtual care for the elderly: available for 65yrs+, access to basket of care to manage conditions Virtual chronic care: out-of-hospital basket of care, including monitoring devices and virtual consults
Casualty/ER:	If in self-payment gap: children under 10yrs, two ER consults paid by scheme	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	International Second Opinion for life-threatening and life-changing condition: members can obtain second opinion from MediGuide Internal nerve stimulators: R199,500 per person
PMBs = Prescribed Minimum Benefits (more info) \| DSP = Designated Service Provider

Out-of-hospital Procedures (2027):

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)	R9,784	R6,706	R2,102
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	R20,080	R14,330	R7,020
Other Day-to-Day Funds:	Scheme awards you with money if you complete personalised health and lifestyle actions You need to activate the benefit on the app, and fulfill the personalised pathways These can be things like: get a mammogram, complete a dental checkup etc Personal Health Fund: up to R2,500 per adult and R1,250 for child. Maximum R10,000 per family Personal Health Fund Boost: up to an additional R1,250 per adult, per completed challenge. Maximum two challenges per adult, and R10,000 per family. Challenges take 5-10 weeks to complete, and are meant to build habits The fund money can be used for most out-of-hospital claims

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.

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: four sessions per family, paid by scheme
Otherwise, from day-to-day benefit

GP/Paediatrician/ENT consults: two consults, for children 0-2yrs. Paid by scheme
Child assessment: height, weight, head circumference and health and milestone tracking
If in self-payment gap: two ER consults, for children 0-10yrs, paid by scheme

Gap Cover:
Can pay for child ER visits
(Plans coming soon)

From day-to-day benefit

From day-to-day benefit

From day-to-day benefit

MRI and CT scans: R4,155 co-payment. No co-payment if scan is part of PMB protocol

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy:

No co-payment if:

Done in network doctor's rooms, or
For dyspepsia
Part of confirmed PMB condition, or
Patient is under 12yrs

Otherwise:

Day clinic (network): R4,850 co-payment
Day clinic (non-network): R7,550 co-payment
Hospital: R7,100 co-payment, or R5,650 co-payment if done by a doctor who is part of "value-based network"
In-rooms, non-network doctor, single scope: R1,880 co-payment
In-rooms, network doctor: no co-payment

If gastroscopy and colonoscopy are performed in same admission:

Day clinic (network): R5,900 co-payment
Day clinic (non-network): R8,750 co-payment
Hospital (network): R8,750 co-payment, or R7,100 co-payment if done by a doctor who is part of "value-based network"
In-rooms, non-network doctor: R3,220 co-payment
In-rooms, network doctor: no co-payment

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

From day-to-day benefit. Includes allied, therapeutic and psychology services. Limited to:
- Main member = R15,850
- Main+1 = R22,400
- Main+2 = R29,000
- Main 3+ = R34,250

External appliances: R43,000 per family from day-to-day benefit

R26,150 per family paid from day-to-day benefit
Bone-anchored hearing aids: R155,850 per person
Processor upgrades: R81,050 per person, every three years

See "General Appliances", above

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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 (2027):

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)	R9,784	R6,706	R2,102
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	R20,080	R14,330	R7,020
Other Day-to-Day Funds:	Scheme awards you with money if you complete personalised health and lifestyle actions You need to activate the benefit on the app, and fulfill the personalised pathways These can be things like: get a mammogram, complete a dental checkup etc Personal Health Fund: up to R2,500 per adult and R1,250 for child. Maximum R10,000 per family Personal Health Fund Boost: up to an additional R1,250 per adult, per completed challenge. Maximum two challenges per adult, and R10,000 per family. Challenges take 5-10 weeks to complete, and are meant to build habits The fund money can be used for most out-of-hospital claims

27 PMB conditions: Covered. You can see the full PMB list here.

Schedule 3 and above
From day-to-day benefit, up to the limits below
If you are not on formulary, there can be a 25%-50% co-payment

Main member = R28,950
Main+1 = R35,050
Main+2 = R42,250
Main 3+ = R46,100

From day-to-day benefit
These do not add up to the annual threshold, and are not paid for from it

See "Acute Medicine" benefit

See "Acute Medicine" benefit, above

Oncology Innovation Benefit: certain sub-set of specialised medicine, scheme pays up to 50% of scheme rate

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

More benefits for this plan >>