Discovery Essential Saver medical aid plan: 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.

Essential Saver
2018 Costs:
Total Cost pm:

Main member:

R2,203

Adult:

R1,652

Child: (Pay only for first 3)

R883
Savings Account (yr): R3,960 R2,964 R1,584
2019 Costs:
Total Cost pm:

Main member:

R2400
(8.94%)

Adult:

R1,800

Child: (Pay only for first 3)

R962
Savings: R4,320 R3,240 R1,728
In brief (2018):
  • Scheme rate is 100%, and most day-to-day expenses are from savings.
  • 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
  • Travel insurance and international treatment
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below
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IN HOSPITAL PROCEDURES:
Essential Saver
Scheme Benefits: Gap Benefits:
Specialists:
  • 100% scheme rate
  • Network specialists covered in full
  • You or gap cover pay the balance, if any
AskAdam Gap
  • Gap tops up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Discovery Gap:
  • Up to 300% of scheme rate for specialists only
  • 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) for this plan. More Info or contact Discovery below
Hospital Choice:
  • Choose any hospital
  • No benefit
Specialised Radiology:
  • If not related to admission or for conservative back or neck treatment, R2,750 co-payment from day-to-day benefit
AskAdam Gap:
  • Co-payment benefit pays the co-payments
Discovery Gap:
  • No benefit
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 100% scheme rate
AskAdam Gap
  • Gap tops up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
Discovery Gap:
  • R2,500-R20,000 for some outstanding costs not covered by scheme
Transplants:
  • Covered
AskAdam Gap
  • Gap tops up to 500% the scheme rate for in-hospital specialists, GPs and other medical professionals
Discovery Gap:
  • 300% of scheme rate for specialists only
  • Additional R2,500-R20,000 for some outstanding costs not covered by scheme
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
AskAdam Gap:
  • Co-payment benefit pays the co-payments
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 extra benefit available
Casualty:
  • Accident and trauma (emergency) related costs covered
AskAdam Gap:
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid

Discovery Gap:
  • No additional benefit
Other: TBC
  • N/A
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Essential Saver
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: R3,960 R2,964 R1,584
General info: AskAdam
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
Discovery Gap:
  • Additional R2,500-R20,000 for some outstanding costs not covered by scheme, related to hospital admissions
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
Childcare:
  • No extra benefit available
Specialists consultations:
  • Paid from day-to-day benefit
AskAdam Gap:
  • No benefit
Discovery Gap:
  • An additional benefit (between R2,500 and R20,000) can pay-in for some out-of-hospital expenses related to admission
Pathology:
  • Paid from day-to-day benefit
AskAdam Gap:
  • No benefit
Discovery Gap:
  • An additional benefit (between R2,500 and R20,000) can pay-in for some out-of-hospital expenses related to admission
General radiology:
  • Paid from day-to-day benefit
AskAdam Gap:
  • No benefit
Discovery Gap:
  • An additional benefit (between R2,500 and R20,000) can pay-in for some out-of-hospital expenses related to admission
Specialised radiology:
  • Paid from day-to-day benefit
  • No benefit
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
AskAdam Gap:
  • No benefit
Discovery Gap:
  • An additional benefit (between R2,500 and R20,000) can pay-in for some out-of-hospital expenses related to admission
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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MATERNITY BENEFITS:
Essential Saver
Scheme Benefits Gap benefits
Hospital stay:
  • Covered at 100% scheme rate for specialists
AskAdam Gap:
  • Pays up to 500% scheme rate for specialists, GPs and other medical professionals, in-hospital only
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
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
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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CANCER (ONCOLOGY):
Essential Saver
Scheme Benefits Gap benefits
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
AskAdam Gap
  • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, the gap cancer benefit will cover costs authorised but not paid by your medical scheme (up to the R150,000 per person per year gap limit) More info

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
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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DENTISTRY:
Essential Saver
Scheme Benefits Gap benefits
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
AskAdam Gap:
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
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
Orthodontics:
  • See above
  • No extra benefit available
Maxillo Facial Surgery:
  • See above
  • See above
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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MEDICATION:
Essential Saver
Scheme Benefits Gap benefits
Chronic:
  • No benefit
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
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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OPTOMETRY:
Essential Saver
Scheme Benefits Gap benefits
Optometry:
  • Paid from day-to-day benefit
  • 20% discount on frames and lenses at a network optometrist
AskAdam Gap
  • Pays shortfalls and co-payments for in-hospital or day-clinic treatment approved by scheme
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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MENTAL HEALTH:
Essential Saver
Scheme Benefits Gap benefits
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 extra benefit available
Out-of-hospital:
  • See above
  • Otherwise, from day-to-day benefit
  • No extra benefit available
Trauma:
  • Offers out of hospital claims for recovery after traumatic events for rest of year, and year after that
  • No extra benefit available
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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OTHER BENEFITS:
Essential Saver
Scheme Benefits Gap benefits
General Appliances:
  • 2018: To be confirmed
  • 2017:
    • Cochlear implants: R207,000
    • Otherwise, from day-to-day benefit
  • No benefit
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 extra benefit available
HIV:
  • Covered if on the HIV Care program
  • No benefit
Emergency Transport:
  • Discovery 911
  • 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
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More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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WELLNESS/PREVENTATIVE BENEFITS:
Essential Saver
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered, for 65 yrs+
  • 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
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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PROSTHETICS:
Essential Saver
Scheme Benefits Gap benefits
Overal Limit:
  • 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.
AskAdam
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits: . AskAdam
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
More info on AskAdam gap covers
Apply for AskAdam gap cover online

No need to print or sign forms!


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