Discovery Essential Delta Saver 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:
Essential Delta Saver
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,758 R1,325 R705
Cost 2017: (R1,634) (R1,230) (R655)
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: R3,156 R2,376 R1,260
Children: Pay for maximum 3 children
    In 2018, Discovery will:
  • Pay for your out of hospital maternity related claims
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:
Essential Delta Saver
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:
  • 300% 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 R165 (single) and R395(family). More Info or contact Discovery below

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Hospital Choice: Fusion Gap:
  • R12,800 per person per year for use of a non-network hospital
Discovery Gap:
  • No benefit
Specialised Radiology:
  • Co-payment: If not related to admission 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, 100% scheme rate
Fusion Gap:
  • Up to 700% scheme rate for specialists and other providers
Discovery Gap:
  • 300% of scheme rate for specialists only
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
Transplants:
  • Covered
Fusion Gap:
  • Up to 700% scheme rate for specialists and other providers
Discovery Gap:
  • 300% of scheme rate for specialists only
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
Co-payments:
  • Scopes, in-hospital: R4,200 co-payment paid from day-to-day benefit
  • No co-payment if done in doctor's rooms
  • 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: TBC Fusion Gap:
  • 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:
  • Discovery has a Suplementary Gap that pays out for disability, etc.

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OUT OF HOSPITAL BENEFITS:
Essential Delta Saver
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • GP in Premier Plus network: M =2 consults and M+ =4 consults if your savings are depleted. Face-to-face or video call.
  • Otherwise, paid from day-to-day benefit
  • No benefit


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Childcare:
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
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 R165 (single) and R395(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:
  • Paid from day-to-day benefit
  • TBC
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
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:
Essential Delta Saver
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • Covered at 100% scheme rate for specialists
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 R160 (single) and R395(family). More Info or contact Discovery below

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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):
Essential Delta Saver
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • Unlimited. After the first R200,000, a 20% co-payment applies for non-PMB cancers
  • All cancer-related treatments are covered at 100% scheme rate
  • Specialised medicine and technology: No benefit, unless PMB
  • 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 R160 (single) and R395(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:
Essential Delta Saver
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 at 100% scheme rate
Out-of-hospital:
  • Standard dentistry: from day-to-day benefit
  • Specialised dentistry: from day-to-day benefit. This includes claims for orthognathic surgery, dental appliances and their placements
Fusion Gap:
  • Up to 600% scheme rate for specialists
  • 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:
  • 300% scheme rate for specialists
  • Additional R2,500-R20,000 for specialist costs not fully covered by this
  • No benefit for co-payments)
  • Starts at R160 (single) and R395(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:
Essential Delta Saver
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No benefit

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Acute (presrcibed) medication:
  • Paid from day-to-day benefit
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit
  • No benefit
Birth Control:
  • Paid from day-to-day benefit
  • No benefit
On Discharge:
  • Paid from day-to-day benefit
  • No benefit
Biological: TBC
  • No benefit

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OPTOMETRY:
Essential Delta Saver
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Paid from day-to-day benefit
  • 20% discount on frames and lenses at a network optometrist
  • No benefit

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MENTAL HEALTH:
Essential Delta Saver
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, from day-to-day benefit
  • 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:
Essential Delta Saver
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • 2018: To be confirmed
  • 2017:
    • Cochlear implants: R207,000
    • Otherwise, from day-to-day benefit
  • No benefit

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1.1. Hearing Aids:
  • Paid from day-to-day benefit
  • No benefit
1.2. Wheelchairs:
  • Paid from day-to-day benefit
  • 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:
  • Internal nerve stimulators: R147,300
  • 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:
Essential Delta Saver
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered, for 65 yrs+
  • No benefit

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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

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

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    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