This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Coastal Core.
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: Coastal Network
- 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- Coastal Network hospital: 70% cover
- Use of non--network Day hospital: 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.
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| Specialised Radiology: |
- MRI and CT scans, part of approved admission: Paid by scheme
- MRI and CT scans, not part of approved admission: No benefit
- MRI and CT scans, for conservative back and neck treatment: No 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: R7,700 co-payment, or R6,400 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 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: R9,600 co-payment, or R7,950 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 R9,650 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, 100% 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: |
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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
- 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: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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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 R1,000 per adult and R500 per child. There is a maximum of R4,000 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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- PMBs only
- Virtual Urgent Care: 4 sessions per family, paid by scheme
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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
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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: R7,700 co-payment, or R6,400 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 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: R9,600 co-payment, or R7,950 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 R9,650 penalty
- In-rooms, non network doctor: R3,000 co-payment
- In-rooms, network doctor: No co-payment
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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: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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| Chronic: |
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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
|
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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