The Core Series
The Core Plans offer you cover in hospital
You have access to additional benefits
- Emergency response services nationwide with Discovery 911
- Cover for medical emergencies when you travel overseas, up to R5 million for each person
- Evacuation benefits for medical emergencies when travelling in Africa
Hospital Benefits
We cover you in hospital for emergency and planned hospital admissions. In an emergency, go straight to hospital but call us or get someone to call us within 12 hours. For planned hospital admissions, please call us 48 hours before you go to hospital to confirm your admission.
| Core Series | |
|---|---|
| Overall limit | There is no overall hospital limit on the Core Plans Limits apply to some healthcare services and procedures |
| Choice of hospitals | The Coastal Core Plan* covers you in any private hospital in the coastal provinces |
| Procedures and consultations by specialists participating in direct payment arrangements | We pay in full if you consult a specialist who charges the Premier Rate. If you are on a Classic Plan we cover a wider range of specialists in full. |
| Other healthcare professionals | Classic Core and Classic Delta Core: We pay up to 200% of the Discovery Health Rate Essential Core, Essential Delta Core and Coastal Core: We pay up to 100% of the Discovery Health Rate |
| Radiology and pathology | We cover these expenses in full up to the Discovery Health Rate |
| Endoscopies (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) | You must pay the first R2 200 of your hospital account. We pay the balance of your hospital account and your related accounts from your Hospital Benefit. |
| MRI and CT scans | As part of an approved hospital admission: no overall limit If admitted for conservative back or neck treatment: you must pay the full cost of the scan |
| Dentistry | There is an overall limit of R13 100*** for each person. You must pay the first R1 975 of your hospital account. We pay the balance of the hospital account.** |
| Cochlear implants and auditory brain implants and processors | R126 000 for each person for each benefit |
| Internal nerve stimulators | R96 000 for each person |
| Hip and knee joint prostheses | R31 500 for each prosthesis for each event |
| Prosthetic devices used in spinal surgery | R20 000 for each level, limited to two levels for each procedure, and one procedure for each person each year |
| Mental health benefit | 21 days for each person |
| Alcohol and drug rehabilitation | 21 days for each person |
| Terminal care benefit | R23 400 for each person |
| Dialysis | We cover these expenses in full as long as we have approved your treatment plan and you use a provider in our network |
* On the Coastal Plan you must go to a hospital in one of the four coastal provinces for a planned hospital admission. If you don’t use these hospitals, Discovery Health will pay up to a maximum of 70% of the hospital account and you will need to pay the difference. This does not apply in an emergency.
** You must pay all related accounts. A related account is any approved account for expenses you incur during your hospital stay, other than the hospital account itself.
*** We pro-rate this benefit according to when you join the medical scheme. Your hospital account is subject to this limit.
For more detailed information on how we cover specific healthcare services go to Do We Cover
The benefits described in this section are subject to clinical guidelines and policies.
DiscoveryCare offers specific benefits to help you manage chronic conditions
DiscoveryCare offers specific benefits to help you manage chronic conditions You have flexible cover for chronic diseases. You have full cover for medicine on Discovery Health’s approved medicine list or up to a set amount for medicine not on our list. We pay medicine up to a maximum of the Discovery Health medication rate. We need to approve your chronic condition before it is covered from the Chronic Illness Benefit .
Cover for day-to-day medical benefits
You have access to the following day-to-day benefits:
- A range of preventive healthcare services, including the following group of tests at a Discovery Wellness Network provider: blood glucose, blood pressure, cholesterol and body mass index. The benefit also covers a mammogram, Pap smear, PSA and HIV screening tests. Members from the age of 65 and members registered for certain chronic conditions are also covered for a seasonal flu vaccine from this benefit.
- We also cover endoscopies (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) if done in your doctor’s rooms.
2010 Monthly contributions
| Family size | Classic Core | Essential Core | Coastal Core | Classic Delta Core | Essential Delta Core |
|---|---|---|---|---|---|
| Main member | R1 045 | R898 | R759 | R837 | R718 |
| Adult dependant | R823 | R673 | R569 | R658 | R538 |
| Child * | R418 | R359 | R303 | R334 | R288 |
* We count a maximum of three children when we work out the monthly contribution.
General exclusions
Discovery Health does not cover certain healthcare services. You can find a full list of these exclusions here.
How to join Discovery Health
We market our Discovery Health Plans through independent and accredited financial advisers. If you want a financial adviser to help you choose a Health Plan to suit the needs of your family, please send us your contact details and we will contact you.
