Benefits, Discovery Plan, in-hospital, out-hospital, Scheme Plans

Discovery Essential Core: in-and-out of hospital benefits (2027)

January 6, 2026

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Essential 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 Providers. Where stipulated, you must use 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.

Monthly Costs

Discovery:Essential Core (2027)
	Main member:	Adult member:	Child member:
Total Cost pm:	R3,622	R2,718	R1,454
Savings:	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

Discovery:Essential Core (2026)
	Main member:	Adult member:	Child member:
Total Cost pm:	R3,356	R2,517	R1,347
Savings:	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

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In-hospital Procedures (2027):

Discovery: Essential 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: any hospital Day procedure: Day Surgery Network
Penalty for using other hospital:	Use of non-network day hospital: R7,550 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: 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, especially if you don't use a DSP 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 For dyspepsia Part of confirmed PMB condition, or Patient is under 12yrs Otherwise: Day clinic (network): R4,850 co-payment Day clinic (non-network): R7,550 co-payment Hospital: R8,300 co-payment, or R6,900 co-payment if done by a doctor who is part of "value-based network" In-rooms, non-network doctor, single scope: R1,880 co-payment In-rooms, network doctor: no co-payment If gastroscopy and colonoscopy are performed in same admission: Day clinic (network): R5,900 co-payment Day clinic (non-network): R10,350 co-payment Hospital (network): R10,350 co-payment, or R8,550 co-payment if done by a doctor who is part of "value-based network" In-rooms, non-network doctor: R3,220 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 scheme 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. If you opt for hospitalisation instead of recommended home-based care, R5,650 co-payment Monitoring devices: as approved, for chronic and acute conditions. R4,850 per person, paid by scheme 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 Home-based virtual care for the elderly: available for 65yrs+, access to basket of care to manage conditions Virtual chronic care: out-of-hospital basket of care, including monitoring devices and virtual consults
Casualty/ER:	PMB 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 MediGuide Internal nerve stimulators: R199,500 per person
PMBs = Prescribed Minimum Benefits (more info) \| DSP = Designated Service Provider

Out-of-hospital Procedures (2027):

Discovery: Essential 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:	Scheme 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 two 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

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.

PMB only
Virtual Urgent Care: four sessions per family, paid by scheme

GP/Paediatrician/ENT consults: two 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)

PMB only

PMB only

PMB only

PMB only

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy:

No co-payment if:

Done in network doctor's rooms, or
For dyspepsia
Part of confirmed PMB condition, or
Patient is under 12yrs

Otherwise:

Day clinic (network): R4,850 co-payment
Day clinic (non-network): R7,550 co-payment
Hospital: R8,300 co-payment, or R6,900 co-payment if done by a doctor who is part of "value-based network"
In-rooms, non-network doctor, single scope: R1,880 co-payment
In-rooms, network doctor: no co-payment

If gastroscopy and colonoscopy are performed in same admission:

Day clinic (network): R5,900 co-payment
Day clinic (non-network): R10,350 co-payment
Hospital (network): R10,350 co-payment, or R8,550 co-payment if done by a doctor who is part of "value-based network"
In-rooms, non-network doctor: R3,220 co-payment
In-rooms, network doctor: no co-payment

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

PMB only

No benefit

Bone-anchored hearing aids: R155,850 per person
Processor upgrades: R81,050 per person, every three years

No benefit

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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 (2027):

Discovery: Essential 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:	Scheme 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 two 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

27 PMB conditions: Covered. You can see the full PMB list here.

No benefit

No benefit

No benefit

No benefit

Oncology Innovation Benefit: certain sub-set of specialised medicine, scheme pays up to 50% of scheme rate

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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