Endoscopies
What are endoscopies?
Endoscopies – also called scopes – are used to investigate certain medical and surgical conditions such as gastric ulcers, reflux and infections. When we refer to endoscopies and how we cover them, we only refer to four diagnostic endoscopies which include gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy. These are all used to investigate the digestive system. Scopes may also be used to investigate other body systems. All such endoscopies/ scopes fall outside of this benefit.
Cover for gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy.
Please call us to confirm your benefits at least 48 hours before having this procedure.
Where the scope is performed in your doctor’s rooms we refer to this as “out-of-hospital”
Where the scope is performed in hospital, payment for this healthcare service is based on your health plan
Executive Plan
In-hospital
The hospital account is covered in full. We pay all related accounts from the Medical Savings Account. Once you reach your Annual Threshold, we pay these accounts from the Above Threshold Benefit.
Out-of-hospital
We pay all related accounts from the Medical Savings Account or Above Threshold Benefit
Comprehensive Series
In-hospital
We pay the first R1 750 of your hospital account from your available day-to-day benefits.
We pay the balance of the hospital account and your related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit to these health services. Discovery Health pays these claims without using your day-to-day benefits.
Priority Series
In-hospital
The first R1 975 of your hospital account is a deductible which you need to pay. We pay the balance of the hospital account and your related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit on these health services. The deductible does not apply and Discovery Health pays these claims without using your day-to-day benefits.
Saver Series
In-hospital
The first R2 200 of your hospital account is paid from your Medical Savings Account as long as you have money available. We pay the balance of the hospital account and all related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit to these health services. Discovery Health pays these claims without using your Medical Savings Account
Core Series
In-hospital
You must pay the first R2 200 of your hospital account. We pay the balance of the hospital account and all related accounts from the Hospital Benefit.
Out-of-hospital
There is no overall limit to these health services. Discovery Health pays these claims.
KeyCare Series
In-hospital
The claims are paid from the Hospital Benefit.
Out-of-hospital
These claims are paid from the Hospital Benefit
