Discovery Executive: cancer, maternity and mental health (2027)

This page has information on: Costs, Maternity, Oncology, Mental Health for Discovery Executive

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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

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

Cancer/ Oncology benefits (2027):

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

Discovery: Executive
Assume scheme pays all these costs, unless otherwise stated
Overall cancer coverage (in and out of hospital):	R500,000, then 20% co-payment applies for non-PMB treatment Extended Oncology Benefit: certain medicine and treatment is funded without a co-payment, even after R500,000 is reached Oncology Innovation Benefit (certain specialized medicine): scheme pays up to 70% of scheme rate Palliative care: Unlimited cover for approved care at home Note: Most cancers are PMBs, and treatment is paid in full by scheme. More info here Most schemes require use of specific providers (DSPs) for oncology treatment.	Gap Cover: Can cover the penalty in full (Plans coming soon)

Maternity benefits (2027):

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

Discovery: Executive
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:	300% scheme rate Up to R2,900 per day for private ward Usually covered for 2 nights for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.	Gap Cover: Can cover most shortfalls (Plans coming soon)
Consultations:	Oncology Innovation Benefit (certain specialized medicine): scheme pays up to 70% of scheme rate
Scans:	two ultrasound scans
Note:	If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don't have medical aid.

Mental Health benefits (2027):

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

Discovery: Executive
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:	Main Member: Adult: Child: Savings: R34,284 R34,284 R6,552 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R8,286 R8,286 R1,528 "Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid the self payment gap. Unlimited Unlimited Unlimited 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 R3,000 per adult and R1,500 for child. Maximum R12,000 per family Personal Health Fund Boost: up to an additional R1,500 per adult, per completed challenge. Maximum two challenges per adult, and R12,000 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
FYI:	Mental Health PMB conditions are covered for in and out of hospital treatment, even on "hospital" plans. For a full list see here. Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts. Scheme will pay this in full, if you use a DSP.
In-hospital:	Major affective disorders, anorexia and bulimia: 21 days for admissions or 15 out-of-hospital consultations Attempted suicide or detoxification: three days admission Other mental health admissions: 21 days in-hospital Alcohol and drug rehab: 21 days in-hospital All admissions are covered in full at a network facility, or at 80% scheme rate at a non-network facility	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Out-of-hospital:	Major affective disorders, anorexia and bulimia: 21 days for admissions or 15 out-of-hospital consultations Acute stress disorder accompanied by recent significant trauma: 12 out-of-hospital consultations Otherwise, paid from day-to-day benefit. Claims for psychologists and social workers fall into the supplementary benefit ie: Main member = R33,500 Main+1 = R39,950 Main+2 = R46,750 Main 3+ = R56,100
Other:	Traumatic event claims: six counselling sessions per person per year, for the year in which the trauma event occurred and the year after

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.