Discovery Executive:
in-and-out of hospital benefits, and medication (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Executive. 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: Executive
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	network Doctors: paid in full non-network Doctors: 300% scheme rate non-network GPs: 200% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Any hospital
Penalty for using other hospital:	n/a	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 part of approved admission R4,000 co-payment. No co-payment if scan is part of PMB protocol	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: R6,800 co-payment, or R5,450 co-payment if done by a doctor who is part of "value-based network". 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: R8,400 co-payment, or R6,850 co-payment if done by a doctor who is part of "value-based network". 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, 200% 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:	If in self payment gap : children under 10yrs, two ER consults paid by scheme	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	Private ward: Up to R2,800 per day International Second Opinion for life-threatening and life-changing condition: members can obtain second opinion from Cleveland Clinic, paid by scheme Overseas Treatment Benefit: R750,000 for treatment not available in South Africa, and R300,000 for voluntary in-hospital treatment outside SA. Both options have 20% co-payment Specialised medicine and technology: R200,000 per person with a 20% 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: Executive
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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) R5,156 R5,156 R928 "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: 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 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 2 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
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:	If in Self-Payment Gap, you have access to Extender Benefit: video call consultations with a network GP, network pharmacy clinic consultations face to face consultations with a network GP when referred by the pharmacy clinic or virtual GP Also: Virtual Urgent Care: 4 sessions per family, paid by scheme Otherwise, from day-to-day benefit
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 If in self payment gap : 2 ER consults, for children 0-10yrs, paid by scheme	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	From day-to-day benefit
Pathology:	From day-to-day benefit
General radiology:	From day-to-day benefit
Specialised radiology:	MRI and CT scans: R4,000 co-payment. No co-payment if scan is part of PMB protocol	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: R6,800 co-payment, or R5,450 co-payment if done by a doctor who is part of "value-based network". 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: R8,400 co-payment, or R6,850 co-payment if done by a doctor who is part of "value-based network". 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)	From day-to-day benefits. Includes allied, therapeutic and psychology services. Limited to: Main Member= R32,000 Main +1= R38,450 Main +2= R45,000 Main 3+= R54,000 For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly
General Appliances:	External appliances: R64,200 per family from day-to-day benefit
1.1. Hearing Aids:	R31,250 per family paid from day-to-day benefit Bone-anchored hearing aids: R150,000 per person . Processor upgrades: R78,000 per person, every 3 years
1.2. Wheelchairs:	See "General Appliances", above
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: Executive
Assume scheme pays all these costs, unless otherwise stated
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) R5,156 R5,156 R928 "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: 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 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 2 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
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. non-PMBs: additional 23 conditions covered, up to a pre-set limit including an exclusive list of brand medicines.
Acute (prescribed) medication:	Schedule 3 and above From day-to-day benefit , up to the limits below Main Member= R53,450 Main+1= R62,650 Main+2= R71,700 Main+3+= R80,900
Over-the-counter:	From day-to-day benefit These do not add up to the annual threshold, and are not paid for from it
Birth Control:	See "Acute Medicine" benefit
On Discharge:	See "Acute Medicine" benefit, above
Biological:	For a defined list of latest treatments, R200,000 with a 20% co-payment
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