Note: We are updating 2024 benefits as they are released. Some plans show old benefits until schemes release new plans.

Discovery Essential Core:
in-and-out of hospital benefits (2024)


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Monthly Costs:

Essential Core 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R2,855
  • R2,141
  • R1,146
  • 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 21 yrs old
  • 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:♦️
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
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In-hospital Procedures for 2024:

Discovery: Essential Core
Assume scheme pays all these costs, 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: Any hospital
  • Day procedure: Day Surgery Network
Day Hospitals:
  • Certain procedures are covered in full at Day Hospital
  • Note: You are also covered for certain procedures, like scopes, performed in specialist rooms
Penalty for using other hospital:
  • non-Network Day hospital: R6,650 co-payment
Other Co-payments:
  • Defined day procedures performed outside of day surgery network: R6,650
Scopes (Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
    No co-payment if:
  • Done in doctor's rooms
  • Part of confirmed PMB condition
  • Patient is under 12yrs
    Otherwise
  • Day clinic: R4,300 co-payment
  • Hospital: R7,350 co-payment, or R6,100 if done by a doctor who is part of "value-based network".
  • You must use a facility from Day Surgery Network, or pay an additional R6,650-R7,350
If gastroscopy and colonoscopy are performed in same admission:
  • Day clinic: R5,250 co-payment
  • Hospital: R9,150 co-payment, or R7,600 if done by a doctor who is part of "value-based network".
  • You must use a facility from Day Surgery Network, or pay an additional R9,150-R10,200
Specialised Radiology:
  • MRI and CT scans, part of approved admission: Covered by scheme
  • MRI and CT scans, not part of approved admission: No benefit
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
Transplants:
  • Covered
Dialysis:
  • Covered
Exclusions:
Alternatives to hospitals:
  • Palliative care at home: Unlimited, as approved
    Home-based Hospital Network:
  • Physical and virtual 24-hour care for services such as postnatal care, end-of-life care, IV infusions (drips), COVID-19 and wound care.
  • Home monitoring device: up to R4,500 per person
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
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:♦️
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
.
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.

Out-of-hospital Procedures for 2024:

Discovery: Essential 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.
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:
  • PMBs only
  • Virtual Urgent Care: 4 sessions per family
Childcare:
  • GP/Paediatrician/ENT consults: 2 consults, for 0-2yrs
  • 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
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:♦️
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.

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Medication Benefit for 2024:

Discovery: Essential 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:♦️
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.


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