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Discovery Coastal Saver: in-and-out of hospital benefits (2021)

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This page shows the In-hospital, Out-of-hospital and Medicine benefits for Discovery Coastal Saver.

Pricing:

Coastal Saver
Main member: Adult member: Child member:
Total Cost pm: R2,763 R2,078 R1,116
(Pay only for first 3)
Savings: R6,438 R4,842 R2,598
Children Rates:
  • (Pay only for first 3)
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 other benefits:
Inhospital | 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

In-hospital Procedures:

Coastal Saver
non-Network Specialists:
  • Up to 100% scheme rate
network Specialists:
  • Full cover
non-Network GPs:
  • Up to 100% scheme rate
network GPs:
  • Full cover
Hospital Choice:
  • Long stay: Coastal Network
  • Day procedure: Delta Day Surgery
Penalty for using other hospital:
  • Discovery pays 70% cover if you use hospital outside the coastal network.
Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment, R3,130 co-payment from day-to-day benefit
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
Transplants:
  • Covered
Dialysis:
  • Covered in full if you use network provider
Day Hospitals:
  • Private day surgery facility in the Day Surgery Network for certain procedures, or a R5,700 penalty
Co-payments:
  • In-hospital dentistry: co-payment required for some admissions. See dentistry benefit for details
Scopes (Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
  • Day clinic: R3,650 co-payment or R5,700 co-payment if not part of Day Surgery Network
  • Hospital: R6,250 co-payment, or R5,200 if done by a doctor who is part of "value-based network"
If gastroscopy and colonoscopy are performed in same admission:
  • Day clinic: R4,450 co-payment or R5,700 co-payment if not part of Day Network
  • Hospital: R7,800 co-payment, or R6,500 if done by a doctor who is part of "value-based network".
No payment if:
  • done in doctor's rooms
  • as part of confirmed PMB condition
  • patient is under 12yrs
Alternatives to hospitals:
  • Access to Connected Care benefit
  • Terminal care: R70,150 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home
Casualty:
  • Accident and trauma (emergency) related costs covered
Other:
  • International Second Opinion: members can obtain second opinion from Cleveland Clinic, with a 50% co-payment
  • Cochlear implants: R230,400
  • Internal Nerve stimulators: R165,300
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
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones here, but you must consult with your scheme to get the full list.
View other benefits:
Inhospital | 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

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.



Out-of-hospital Procedures:

Coastal Saver
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R6,438 R4,842 R2,598
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:
GP consultations:
  • From day-to-day benefit unless PMB
  • If savings are finished: GP in Premier Plus network, M =2 consults and M+ =4 consults
Childcare:
  • For two years after birth: two visits for baby with GP, Paediatrician or ENT
  • Child assessment, including height, weight, head circumference and health and milestone tracking
Specialists consultations:
  • From day-to-day benefit, unless PMB
Pathology:
  • From day-to-day benefit, unless PMB
General radiology:
  • From day-to-day benefit, unless PMB
Specialised radiology:
  • R3,130 co-payment from day-to-day benefit
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
General Appliances:
  • Cochlear implants: R230,400
  • Internal nerve stimulators: R165,300
  • Otherwise, from day-to-day benefit
1.1. Hearing Aids:
  • From day-to-day benefit
1.2. Wheelchairs:
  • From day-to-day benefit
Note:
  • 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 other benefits:
Inhospital | 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

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 cover:

Coastal Saver
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R6,438 R4,842 R2,598
Chronic:
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • From day-to-day benefit
On Discharge:
  • From day-to-day benefit
Biological:
  • No benefit, unless PMB level of care
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 other benefits:
Inhospital | 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

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.

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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