Discovery Classic Comprehensive: 2017 vs 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Classic Comprehensive
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R4,882 R4,618 R974
Cost 2017: (R4,506) (R4,264) (R898)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: R14,640 R13,848 R2,916
Self Payment: R2,150 R2,942 R284
Above Threshold: Unlimited overall, with sublimits for some benefits. Find out more
Children: Pay for maximum 3 children
    In 2018, Discovery will:
  • Pay for your out of hospital maternity related claims
  • No longer pay for pathology test if you are in the self payment gap
See below for other changes
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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: Fusion Gap:
  • Up to 700% scheme rate for specialists and other providers
  • In case of admission related to accident:
    -R300 per day, for days 1-13
    -R600 per day for days 14-20
    -R1,200 per day for days 21-30
  • R350pm per family. More Info or download application below.
Discovery Gap:
  • 400% of scheme rate for specialists only
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
  • This additional benefit can also pay-in for some out-of-hospital expenses related to admission
  • No benefit for co-payments
  • Starts at R90 (single) and R150(family). More Info or contact Discovery below

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Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology:
  • Co-payment: If not related to admission or for conservative back or neck treatment, R2,750 co-payment from day-to-day benefit
  • Sublimit: none
  • Rate: 100% scheme rate
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Discovery Gap:
  • No benefit
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise,200% scheme rate
Fusion Gap:
  • Up to 700% scheme rate for specialists and other providers
Discovery Gap:
  • 400% of scheme rate for specialists only
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
  • This additional benefit can also pay-in for some out-of-hospital expenses related to admission
  • No benefit for co-payments
Transplants:
  • Covered
Fusion Gap:
  • Up to 700% scheme rate for specialists and other providers
Discovery Gap:
  • 400% of scheme rate for specialists only
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
  • This additional benefit can also pay-in for some out-of-hospital expenses related to admission
  • No benefit for co-payments
Co-payments:
  • Scopes, in-hospital: R3,400 co-payment paid from day-to-day benefit
  • This applies to gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy
  • In-hospital dentistry: co-payment required for some admissions. See dentistry benefit for details
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Discovery Gap:
  • No benefit
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: R57,000 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home
  • No benefit
Casualty:
  • Accident and trauma (emergency) related costs covered
Fusion Gap:
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.

Discovery Gap:
  • No additional benefit
Other:
  • Overseas Treatment Benefit: R500,000 for treatment not available in South Africa, with 20% co-payment
  • Specialised medicine and technology: R200,000 per person with a 20% co-payment
  • Cochlear implants: R214,500
  • Internal Nerve stimulators: R147,300
Fusion Gap:
  • If part of oncology treatment, gap will cover the co-payment for the specialised medicine benefit
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.

Discovery Gap:
  • If part of oncology treatment, gap will cover the co-payment for the specialised medicine benefit, up to R100,000
  • Discovery has a Suplementary Gap that pays out for disability, etc.

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OUT OF HOSPITAL BENEFITS:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit at 100% scheme rate
  • If in Self Payment Gap, GP consults and kid casualty visits covered by scheme, if using network provider
  • Out of hospital treatment for conditions that are PMBs is always paid for by the scheme (not out of savings), but according to protocols
  • No benefit


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Childcare:
  • If in Self Payment gap, unlimited network GP visits and 2 kid casualty visits covered by scheme if using network providers
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit at 100% scheme rate, unless Discovery has payment arrangement with specialist
Fusion Gap:
  • Benefits apply to procedures done in doctor's rooms or day clinics if the medical aid pays for precedure from risk (not from savings)
  • R350pm per family. More Info or download application below.
Discovery Gap:
  • An additional benefit (between R2,500 and R20,000) can pay-in for some out-of-hospital expenses related to admission
  • Starts at R90 (single) and R150(family). More Info or contact Discovery below
Pathology:
  • Paid from day-to-day benefit
See above
General radiology:
  • Paid from day-to-day benefit
See above
Specialised radiology:
  • The first R2,750 from day-to-day benefit, balance paid by scheme
  • TBC
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
  • Main M1 M2 M3+
    R16,950 R23,000 R28,050 R32,500
  • 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
Fusion Gap:
  • No benefit

Discovery Gap:
  • R2,500 - R20,000 which can be used for specified out-of hospital expenses related to an admission

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MATERNITY BENEFITS:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • 200% scheme rate
  • Up to R1,880 for private ward
Fusion Gap:
  • Up to 700% scheme rate for specialists and other providers
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth (mother or child):
    -R300 per day, for days 1-13
    -R600 per day for days 14-20
    -R1,200 per day for days 21-30
  • R350pm per family. More Info or download application below.
Discovery Gap:
  • 400% of scheme rate for specialists only
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
  • Starts at R90 (single) and R150(family). More Info or contact Discovery below

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Consultations:
  • 12 consults, now paid by scheme
  • Nuchal translucency or Non-Invasive Prenatal Test, now paid by scheme
  • Up to R5,000 for registered devices (breast pumps, etc) with 25% co-payment
  • Certain blood tests, now paid by scheme
  • Five pre- or postnatal classes with registered nurse, now paid by scheme
  • For two years after birth: two visits for baby with GP, Paediatrician or ENT; one six week post-birth consult with midwife, GP or gynae; one nutritional assessment; two mental health consults; one lactation consult
  • No benefit
Scans:
  • 2 x ultrasound scans, now paid by scheme
  • No benefit

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CANCER (ONCOLOGY):
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • Unlimited, subject to sublimit below. After the first R400,000, a 20% co-payment applies for non-PMB cancers
  • All cancer-related treatments are covered at 100% scheme rate
  • Specialised medicine and technology, defined list: R200,000 per person with a 20% co-payment
  • Unlimited palliative care cover for approved care at home
Fusion Gap:
  • Full cover for the 20% co-payments
  • R350pm per family. More Info or download application below.

Discovery Gap:
  • Provides up to R100,000 per year to cover shortfalls on approved cancer-related claims once you have reached oncology threshold
  • Starts at R90 (single) and R150(family). More Info or contact Discovery below
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.

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DENTISTRY:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
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 R2,200 for admission to hospital, and R1,000 for admission to a day-clinic
    • If you are 13 and older, you pay R5,650 for admission to hospital, and R3,650 for admission to day-clinic
    • Balance of account is paid by scheme at200% scheme rate for anaesthetists and 100% scheme rate for other accounts.
Out-of-hospital:
  • Standard dentistry: from day-to-day benefit
  • Specialised dentistry: from day-to-day benefit, limited to R26,200 per person. This limit includes claims for orthognathic surgery, dental appliances and their placements
Fusion Gap:
  • Up to 700% scheme rate for specialists and 600% for other in-hospital providers
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
  • R350pm per family. More Info or download application below.
Discovery Gap:
  • 400% scheme rate for specialists
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
  • No benefit for co-payments)
  • Starts at R90 (single) and R150(family). More Info or contact Discovery below

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Orthodontics:
  • See above
  • No benefit
Maxillo Facial Surgery:
  • See above
Fusion Gap:
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Discovery Gap:
  • See above

OR

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No benefit

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Acute (presrcibed) medication:
  • Schedule 3 and above
  • Paid from day-to-day benefit, up to the limits below
  • If you are in the Self Payment Gap, Discovery will still pay for the medicine, up to the limits below
Main M1 M2 M3
R28,850 R33,900 R39,350 R44,900
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit
  • These do not add up to the annual threshold, and are not paid for from it
  • No benefit
Birth Control:
  • 2018: To be confirmed
  • No benefit
On Discharge:
  • See "Acute Medicine" benefit
  • No benefit
Biological:
  • For a defined list of latest treatments, limited to R200,000 per person, with a 20% co-payment
  • If part of oncology treatment, gap will cover the co-payment

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OPTOMETRY:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • R5,000 per person, including surgery to correct refractive errors, paid from day-to-day benefit
  • 20% discount on frames and lenses at a network optometrist
  • No benefit

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MENTAL HEALTH:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
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
  • No benefit

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Out-of-hospital:
  • See above
  • Otherwise, paid from day-to-day benefit. Claims for psychologists and social workers fall into the supplementary benefit sub limit ie:
M M1 M2 M3+
R16,950 R23,000 R28,050 R32,500
  • No benefit
Trauma:
  • Offers out of hospital claims for recovery after traumatic events for rest of year, and year after that

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OTHER BENEFITS:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • External appliances limited to R58,800 per family from day-to-day benefit
  • Cochlear implants: R214,500
  • No benefit

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1.1. Hearing Aids:
  • R23,700 per family paid from day-to-day benefit
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Covered in full if you use network provider
  • No benefit
HIV:
  • Covered if on the HIV Care program
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • Up to R5 million per person for emergency costs while travelling outside South Africa, for a period of 90 days. Excludes pre-existing conditions.
  • R500,000 per person for international treatment not available in South Africa, with 20% co-payment
  • No benefit
Other:
  • Internal nerve stimulators: R147,300
  • Trauma recovery: out-of-hospital claims related to certain traumatic events paid until the end of the year following the event
  • DNA Analysis: paid in full from day-to-day benefit or 50% from above threshold
  • Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policyholder was not at fault: Gap will provide all legal assistance, fully covered.

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WELLNESS/PREVENTATIVE BENEFITS:
Classic Comprehensive
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered, for 65 yrs+ or pregnant women
  • No benefit

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Pneumonia vaccines:
  • To be confirmed
  • No benefit
Back Rehabilitation Programme:
  • To be confirmed
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • From day-to-day benefit
  • No benefit
Pap Smear:
  • Covered, every 3 years
  • No benefit
Mammogram:
  • Covered, every 2 years
  • If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • Kids' assessment, including height, weight, head circumference and health and milestone tracking
  • No benefit

OR

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit: .
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Sub-limits:
  • Shoulder joint prostheses: no limit, unless you use non-network supplier, in which case R40,000 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 R25,000 limit for first level nd R51,000 for two or more levels. Limted to one procedure per person per year.
  • An additional R40,000 per sublimit, per event

OR

    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