Discovery Classic Priority medical aid plan: 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 Priority
2018 costs Gap
In brief: On Classic Priority in 2018:
  • Scheme rate is 200%, and most day-to-day expenses are paid by scheme, or from savings, or from threshold benefit.
  • There is a self payment gap before threshold is reached. The threshold is limited.
  • There are co-payments for certain procedures
  • Discovery does pay for most maternity expenses and some preventative benefits such as mammograms and pap smears
  • You get unlimited cancer cover, with a co-payment after R200,000
  • Cover for cochlear implants included.
  • Travel insurance and international treatment
See full benefits below
For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims from 200% to 500%
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.

Discovery also has its own, seamless, gap cover. You can read about it here.
What’s new in 2018?
    In 2018, Discovery will:
  • Pay for your out of hospital maternity related claims
See below for other changes
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Contributions:
Main: Adult: Child:
Cost 2018: R3,214 R2,534 R1,286
Cost 2017: (R2,968) (R2,337) (R1,187)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: R9,636 R7,596 R3,852
Self Payment: R4,604 R3,074 R808
Above Threshold: R12,080 R8,610 R4,170
Children: Pay for maximum 3 children
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
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IN HOSPITAL PROCEDURES:
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • Covered in full for specialists with payment arrangement with Discovery
  • Otherwise,200% scheme rate
  • Up to 500% of scheme rate
  • 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
Hospital Choice:
  • Unlimited
  • No benefit
Specialised Radiology:
  • If not related to admission: R2,750 co-payment
  • If for conservative back or neck treatment: R3,050 co-payment
  • Co-payment covered in full
  • Up to 500% of scheme rate for service providers
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise,200% scheme rate
  • Up to 500% of scheme rate for service providers
Transplants:
  • Covered
  • Up to 500% of scheme rate for service providers
Co-payments:
  • Scopes: R3,900 co-payment
  • Conservative back treatment: R3, 050
  • Otherwise, 2018: To be confirmed
  • 2017:
    • Adenoidectomy, myringotomy (grommets), tonsillectomy: R2,800 co-payment
    • Arthroscopy, functional nasal procedures, hysterectomy, laparoscopy, hysteroscopy, endometrial ablation: R6,750 co-payment
    • Reflux surgery, spinal surgery, joint replacements: R13,850 co-payment
    • No co-payment if procedure can and is done out-of-hospital
  • Gap covers co-payments for most scopes and a defined list of other procedures. See full list
Alternatives to hospitals:
  • 2018: To be confirmed
  • 2017:
    • 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
    • End of life care: R52,750 per person, per lifetime
    • Cancer: Unlimited palliative care cover for approved care at home
  • No benefit
Casualty:
  • All emergencies are covered
  • 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.
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OUT OF HOSPITAL BENEFITS:
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • If in Self Payment Gap, GP consults and kid casualty visits covered by scheme, if using network provider
  • No benefit
Childcare:
  • If in Self Payment gap, unlimited GP visits and kid casualty visits covered by scheme if using network providers
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • Paid from day-to-day benefit
  • No benefit
General radiology:
  • Paid from day-to-day benefit
  • No benefit
Specialised radiology:
  • Paid from day-to-day benefit
  • No benefit
Supplementary Services: (Physio, etc)
  • 2018: To be confirmed
  • 2017:
    • Paid from day-to-day benefits. Includes allied, therapeutic and psychology services
    Main M1 M2 M3+
    R9,450 R13,350 R17,300 R20,400
  • No benefit
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MATERNITY BENEFITS:
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • Covered at200% scheme rate for specialists
  • Three day visits with midwife if discharged a day early from hospital
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Consultations:
  • $$ 8 consults, paid by scheme
  • $$ Nuchal translucency or Non-Invasive Prenatal Test, paid by scheme
  • $$ Certain blood tests, paid by scheme
  • $$ Five pre- or postnatal classes with registered nurse
  • $$ 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:
  • $$ 2 x ultrasound scans, now paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • Unlimited. After the first R200,000, a 20% co-payment applies
  • Specialised medicine and technology: No benefit, unless PMB
  • Unlimited palliative care cover for approved care at home
  • Up to additional 500% of scheme rate to cover shortfall for specialists
  • Full cover for the 20% co-payment
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 Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • 2018: To be confirmed
  • 2017: In-hospital:
    • For severe dental and oral surgery, a defined list of procedures is included, with no upfront payment and no overall limit
    • Otherwise, you need to pay a portion of your account upfront:
      • If you are younger than 13, you pay R2,050 for admission to hospital, and R930 for admission to a day-clinic
      • If you are 13 and older, you pay R5,250 for admission to hospital, and R3,400 for admission to day-clinic
      • Balance of account is paid by scheme at100% scheme rate
    Out-of-hospital:
    • Standard dentistry: from day-to-day benefit
    • Specialised dentistry: from day-to-day benefit, appliances limited to R15,750 per person. This limit includes claims for orthognathic surgery
  • Full cover for in-hospital deductibles
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics:
  • 2018: To be confirmed
  • 2017:
    • All dental appliances, their placement, and orthodontic treatment (including related accounts for orthognathic surgery) paid from day-to-day benefit, up to R15,750 per person
  • No benefit
Maxillo Facial Surgery:
  • See above
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
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MEDICATION:
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • PMBs chronic: paid by scheme
  • No benefit
Acute (presrcibed) medication:
  • 2018: To be confirmed
  • 2017:
    • Schedule 3 and above, from day-to-day benefit, up to the limits below
    Main M1 M2 M3
    R17,200 R20,850 R25,150 R27,450
  • 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: TBC
  • No benefit
On Discharge:
  • See "Acute Medicine" benefit
  • No benefit
Biological:
  • No benefit
n/a
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OPTOMETRY:
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • 2018: To be confirmed
  • 2017:
    • R4,200 per person, including surgery to correct refractive errors, paid from day-to-day benefit
    • 20% discount on frames and lenses at a network optometrist
  • No benefit
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MENTAL HEALTH:
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital: TBC
  • No benefit
Out-of-hospital:
  • 2018: To be confirmed
  • 2017:
    • Major affective disorders, anorexia and bulimia: 15 consultations per person paid by scheme as an alternative to in-hospital treatment
    • Acute stress disorder due to recent significant trauma: 12 consultations per person paid by scheme as an alternative to in-hospital treatment
    • 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+
    R9,450 R13,350 R17,300 R20,400
  • 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 Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • 2018: To be confirmed
  • 2017:
    • External appliances limited to R39,400 per family from day-to-day benefit
    • Cochlear implants: R207,000
  • No benefit
1.1. Hearing Aids:
  • 2018: To be confirmed
  • 2017:
    • R18,300 per family paid from day-to-day benefit
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Covered in full if you use network provider
  • No benefit
HIV:
  • Covered if on the HIV Care program
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • Up to R5 million per person on each journey for emergency medical costs while outside South Africa
  • Up to R500,000 for treatment overseas that is not available in South Africa, with a 20% co-payment
  • Emergency medical evacuations from certain sub-Saharan African countries back to South Africa
  • No benefit
Other:
  • 2018: To be confirmed
  • 2017:
    • Internal nerve stimulators: R142,200
    • Trauma recovery: out-of-hospital claims related to certain traumatic events paid until the end of the year following the event
    • DNA Analysis: paid in full from day-to-day benefit or 50% from above threshold
    • Second opinion from Cleveland Clinic for life-threatening and life-changing conditions. 50% co-payment
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.
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WELLNESS/PREVENTATIVE BENEFITS:
Classic Priority
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered, for 65yrs+
  • No benefit
Pneumonia vaccines:
  • To be confirmed
  • No benefit
Back Rehabilitation Programme: TBC
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation: TBC
  • 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
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2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    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