Medical Aid Discovery Health

The main purpose of medical aid is to ensure access to private hospitals when emergencies strikes.

Discovery Health delivers this through:

• Guaranteed, full hospital cover for life-threatening emergencies, including transport.
• Comprehensive, no overall limit cover for hospital admissions in any hospital.
• Discounted premiums for plans that use a listed hospital network.
• Hospital accounts like the theatre, ward, medication, as well as related accounts such as: doctors, anaesthetist, radiology, and pathology are covered.
• Listed in hospital GP and Specialists are paid in full. Others are paid at the Discovery rate or 2 or 3 times that rate depending on the plan you join.
• There are direct payment arrangements with most specialists.
• Benefits for specific day surgery procedures and specialist-room treatments.

Discovery's savings accounts cover day-to-day medical expenses, including GP visits, medication, dentistry, and optometry.

Key features include:

• Savings fund, from which you pay all your day-to-day costs like GP, medicine (except for registered and approved chronic medicine), optometry and dentistry, is provided with certain plans.
• You manage your spending and there are safety nets and extended benefits from listed providers, should you spend all your savings, ensuring you are never out of cover.
• Savings not spent roll over to the next year or can be used to pay for treatments that are not covered, such as certain cosmetic procedures.
• There are comprehensive benefits for maternity and early childhood that cover certain healthcare services before and after birth.
• Benefits include unlimited cover for biokineticists, acousticians, social workers, physiotherapists or chiropractors, psychologists, occupational therapists, speech and language therapists and external medical items, for pre-defined conditions.
• You can enjoy full cover and avoid co-payments when claiming for medicine on the Preferred Medicine List at one of over 2 400 listed pharmacies or by using MedXpress, a convenient medicine ordering service.
• There are also low cost, network plans that have mostly unlimited day-to-day benefits with listed providers.

All plans offer full chronic medicine cover for conditions (some plans up to 49 conditions) as defined by the Prescribed Minimum Benefit Chronic Disease List.

Members benefit from:

• Full chronic medication cover, including generic and non-generic medicines.
• High monthly rand amount for non-listed medicines.
• Allocated consultations, tests, and procedures for both the diagnosis and the ongoing management of the CDL conditions are also paid for.
• Special care programs for diabetes, mental health, HIV, and heart conditions.
• Out-of-hospital conservative care for conditions like dyspepsia, tonsillitis, and spinal care, allowing your doctor manage your condition and improve your health.

You have access to screening and prevention benefits that pay for tests to detect early warning signs of serious illness, so you can get the best care as early as possible.

Discovery covers blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms and/or ultrasounds and prostate screenings at listed providers.

These specific tests do not affect your day-to-day benefits and they should not have any co-payments.

Screening for Kids

covering height, weight, head circumference, health and milestone tracking growth assessment tests, at listed providers.

Screening for Seniors

aged 65 years and older who have cover for age-appropriate screening tests at a GP or defined pharmacy and includes hearing, visual screening and a falls risk assessments.

Discovery Health offers unlimited cancer cover, including high-cost medications and innovative treatments that are not offered by many other medical aids.

Several plans extend this cover to specialist medicines, biologics, and brachytherapy, ensuring members access cutting-edge care.

• Discovery maternity Infertility and Assisted Reproductive Therapy benefits which are an industry first and assists with drug treatment, surgical repair and assisted reproductive techniques.
• Certain out-of-hospital, traumatic event costs, that are paid for the year (and following year) in which the trauma occurred. They include basic dental trauma, dental appliances, prostheses and their placement.
• Superior Healthcare Quality, links you to healthcare providers and facilities that offer quality clinical care programmes designed to optimise your care.
• You have full cover at Centres of Excellence for various conditions like colorectal cancer and back surgery, giving you get the best healthcare for these complicated medical conditions.
• Certain life-changing chronic conditions (like cardiac, oncology and diabetes) need careful management and Health Coaches, who are qualified in a health-related fields such as psychology, nutrition and health coaching, are available to guide and assist members self-managed such conditions.
• International Second Opinion services for life-threatening and life-changing conditions are available from Cleveland Clinic.
• Overseas Treatment benefit, where treatment that is not available in South Africa will be covered.
• International and Africa Evacuation cover for emergency medical evacuations from certain sub-Saharan African countries back to South Africa.
• A WHO Global Outbreak Benefit is available to all members of Discovery Health during a declared outbreak period.
• Hospital at home - an excellent, innovative benefit with safe and effective hospital-level care for medical and surgical conditions that would otherwise require hospitalisation.
• The use of telemedicine and digital healthcare technologies has allowed for effective healthcare done in a patient's home. A personalised care team, including includes doctors and nurses, provide 24 hour clinical support and remote monitoring using Smart Health Devices. Patients are monitored real-time, through devices recording vitals, with an alert notification to providers if urgent intervention is required.
• Discovery has a digital patient community platform which allows members living with chronic illnesses like diabetes, heart disease and long COVID, to connect with and learn from each other, through regular blogs and live Q&A with a panel of local and international medical experts.
• All members get access to several tools and services, like online access to comprehensive information on what treatments, procedures, medical devices and medicines Discovery pay for.

Discovery Health members can also activate Vitality, a science-based wellness program.

By making healthier choices, members earn rewards, such as discounts on fitness, travel, and lifestyle expenses.

Combine this with Discovery Bank, and members enjoy seamless healthcare payments and additional financial rewards.

Discovery Health Medical Scheme members can activate Discovery Pay by downloading the Discovery Bank app and get additional rewards through Vitality Travel, Vitality Money and Discovery Miles.

Discovery Pay Account is a simple and fast way to pay your contacts, health needs and gym all for no additional cost.