Discovery Coastal Core:
in-and-out of hospital benefits (2025)

What's on this page:

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Coastal Core.

Monthly Costs (2025)

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

Coastal Core 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R3,011
  • R2,259
  • R1,196
  • Only pay for 3 children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Children Rates:
  • Under 21yrs
  • Only pay for 3 children
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 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.

.

In-hospital Procedures (2025):

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

Discovery: Coastal Core
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • Covered in full
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Covered in full
Hospital Choice:
  • Long stay: Coastal Network
  • Day procedure: Day Surgery Network
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
Penalty for using other hospital:
  • Use of non- Coastal Network hospital: 70% cover
  • Use of non--network Day hospital: R7,000 penalty
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.
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
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
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
Transplants:
  • Covered
Dialysis:
  • Covered
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.
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:
  • PMBs only

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
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
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.

.

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: Coastal Core
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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:
  • 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
GP consultations:
  • PMBs only
  • Virtual Urgent Care: 4 sessions per family, paid by scheme
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
Specialists consultations:
  • PMBs only
Pathology:
  • PMBs only
General radiology:
  • PMBs only
Specialised radiology:
  • PMBs only
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
Supplementary Services: (Physio, etc)
  • PMBs only
General Appliances:
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Note:
  • 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
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.

Medication Benefit (2025):

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

Discovery: Coastal Core
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Chronic: .
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • No benefit
Biological:
  • PMBs only
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 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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