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

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Essential Delta Core. 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 (2026):

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

Discovery: Essential Delta Core
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	network Doctors: paid in full non-network Doctors: 100% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Long Procedure: Delta Network Day procedure: Delta Day Surgery Network
Penalty for using other hospital:	Use of non-network hospital: R11,100 penalty Use of non-network Day hospital: R11,100 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
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. 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.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI and CT scans, part of approved admission: Covered by scheme MRI and CT scans, not related to admission: No cover MRI and CT scans, for conservative neck or back treatment: No cover	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 Part of confirmed PMB condition, or Patient is under 12yrs Otherwise: Day clinic: R4,650 co-payment Hospital: R8,000 co-payment, or R6,650 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 R11,100 penalty In-rooms, non network doctor: R1,800 co-payment In-rooms, network doctor: No co-payment If gastroscopy and colonoscopy are performed in same admission: Day clinic: R5,700 co-payment Hospital: R9,950 co-payment, or R8,250 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 R11,100 penalty In-rooms, non network doctor: R3,100 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 Discovery Otherwise, 100% 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 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:	PMBs only	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 Cleveland Clinic, with a 25% co-payment Internal Nerve stimulators: R192,000 per person
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2026):

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

Discovery: Essential Delta Core
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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. Other Day-to-Day Funds: Discovery 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 R1,000 per adult and R500 for child. Maximum R4,000 per family. Personal Health Fund Boost: Up to an additional R500 per adult, per completed challenge. Maximum 2 challenges per adult, and R4,000 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
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:	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	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	PMBs only
Pathology:	PMBs only
General radiology:	PMBs only
Specialised radiology:	PMBs only	Gap Cover: Can pay 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 Part of confirmed PMB condition, or Patient is under 12yrs Otherwise: Day clinic: R4,650 co-payment Hospital: R8,000 co-payment, or R6,650 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 R11,100 penalty In-rooms, non network doctor: R1,800 co-payment In-rooms, network doctor: No co-payment If gastroscopy and colonoscopy are performed in same admission: Day clinic: R5,700 co-payment Hospital: R9,950 co-payment, or R8,250 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 R11,100 penalty In-rooms, non network doctor: R3,100 co-payment In-rooms, network doctor: No co-payment	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	PMBs only
General Appliances:	No benefit
1.1. Hearing Aids:	Bone-anchored hearing aids: R150,000 per person . Processor upgrades: R78,000 per person, every 3 years
1.2. Wheelchairs:	No benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2026):

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

Discovery: Essential Delta Core
Assume scheme pays all these costs, unless otherwise stated
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. Other Day-to-Day Funds: Discovery 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 R1,000 per adult and R500 for child. Maximum R4,000 per family. Personal Health Fund Boost: Up to an additional R500 per adult, per completed challenge. Maximum 2 challenges per adult, and R4,000 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
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. .
Acute (prescribed) medication:	No benefit
Over-the-counter:	No benefit
Birth Control:	No benefit
On Discharge:	No benefit
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