Discovery Essential Core medical aid plan: 2020

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

Essential Core
2020 Costs:
Total Cost pm:

Main member:

R2,104

Adult:

R1,577

Child:

R846
Savings (per year):
  • No savings option on this plan



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
IN HOSPITAL PROCEDURES:
Essential Core
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • The Blue Plan gap cover will increase this to 500% scheme rate
network Specialists:
  • Full cover, for contracted specialists
  • The Blue Plan gap cover will increase this to 500% scheme rate
non-Network GPs:
  • Up to 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
network GPs:
  • Full cover, for contracted specialists
  • The Blue Plan gap cover will increase this to 500% scheme rate
Hospital Choice:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment: no benefit
  • Otherwise, 100% scheme rate
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • Covered
Co-payments:
  • Scopes, in-hospital: R5,000 co-payment
  • No co-payment if done in doctor's rooms
  • This applies to gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy
  • In-hospital dentistry: co-payment required for some admissions. See dentistry benefit for details
Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • Terminal care: R68,100 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home
Casualty:
  • Accident and trauma (emergency) related costs covered
  • Both the Blue Plan and Red Plan gap cover will pay up to R20,000 per person for unpaid casualty costs in event of emergency
Other:
  • Cochlear implants: R214,500
  • Internal Nerve stimulators: R147,300
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R157,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R157,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

.
.
OUT OF HOSPITAL BENEFITS (non-PMB):
Essential Core
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Consider getting Primary Health Care (PHC) (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
GP consultations:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Childcare:
Specialists consultations:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Pathology:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
General radiology:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
MATERNITY BENEFITS:
Essential Core
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate for specialists
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
    Discovery pays for:
  • 8 consults, paid by scheme
  • Nuchal translucency or Non-Invasive Prenatal Test, paid by scheme
  • Certain blood tests, paid by scheme
  • Five pre- or postnatal classes with registered nurse
  • One lactation consult
Scans:
    Discovery pays for:
  • 2 x ultrasound scans



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
CANCER (ONCOLOGY):
Essential Core
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • Unlimited. After the first R200,000, a 20% co-payment applies for non-PMB cancers
  • All cancer-related treatments are covered at 100% scheme rate
  • Specialised medicine and technology: No benefit, unless PMB
  • Unlimited palliative care cover for approved care at home



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
DENTISTRY:
Essential Core
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: no benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry:
  • Specialised dentistry: no benefit. This includes claims for orthognathic surgery, dental appliances and their placements
In-Hospital Dentistry: In-hospital:
  • For severe dental and oral surgery, a defined list of procedures is included, with no upfront payment and no overall limit
  • Otherwise, you need to pay a portion of your account upfront:
    • If you are younger than 13, you pay R2,650 for admission to hospital, and R1,200 for admission to a day-clinic
    • If you are 13 and older, you pay R6,800 for admission to hospital, and R4,380 for admission to day-clinic
    • Balance of account is paid by scheme at 100% scheme rate
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • No benefit for orthognathic surgery related accounts



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
MEDICATION:
Essential Core
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary:
Acute (presrcibed) medication:
  • No benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • No benefit
Biological:
  • No benefit, unless PMB level of care



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
OPTOMETRY:
Essential Core
Scheme Benefits: Notes and Links:
Optometry:
Limit:No benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:20% discount on frames and lenses at a network optometrist
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
MENTAL HEALTH:
Essential Core
Scheme Benefits Notes and Links:
In-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: 21 days for admissions or 12 out-of-hospital consultations
  • 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
Out-of-hospital:
  • See above
Trauma:
  • No benefit, unless PMB



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
OTHER BENEFITS:
Essential Core
Scheme Benefits Notes and Links:
General Appliances:
  • Cochlear implants: R223,700
  • Internal nerve stimulators: R153,600
  • Otherwise, from day-to-day benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
  • Covered in full if you use network provider
International Insurance:
  • Up to R5 million per person on each journey for emergency medical costs while outside South Africa
  • Emergency medical evacuations from certain sub-Saharan African countries back to South Africa
Other:
  • Internal nerve stimulators: R153,600
  • Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Essential Core
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered, for 65 yrs+
Pneumonia vaccines:
  • To be confirmed
Biometric Screening:
  • Covered
Child Immunisation: TBC
Pap Smear:
  • Covered, every 3 years
Mammogram:
  • Covered, every 2 years
  • If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
PAS Test:
  • Covered
HIV Test:
  • Covered
Other:
  • Kids' assessment, including height, weight, head circumference and health and milestone tracking



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)
.
.
PROSTHETICS:
Essential Core
Scheme Benefits: Notes and Links:
Overal Limit:
  • Shoulder joint prostheses: no limit, unless you use non-network supplier, in which case R41,700 limit applies
  • Major joints surgery: no limit, unless you use non-network supplier, in which case 80% scheme rate and R30,000 per prosthesis limit applies
  • Spinal surgery: no limit, unless you use non-network supplier, in which case R25,500 limit for first level and R51,000 for two or more levels. Limted to one procedure per person per year.
Sub-limits: .



We’ll check if this is still the best plan for you, and send you a comparison with 3 similar plans. (FREE!)

    Important!
  • Unless specified, assume that all benefits are paid 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