Discovery Executive medical aid: 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:
Executive
2018 costs Gap
In brief: On Executive in 2018:
  • Scheme rate is 300%, 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.
  • 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 R400,000
  • Cover for cochlear implants included.
  • Generous benefits for travel insurance and international treatment
See full benefits below
For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims from 300% 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?
  • There is a self payment gap in 2018
    In 2018, Discovery will pay for:
  • Second opinion from Cleveland clinic
  • More for overseas treatment not available in SA, and R300,000 for overseas treatment even if treatment is available in SA
  • Specialised radiology, no longer out of savings
  • In-hospital dentistry, no longer out of savings
  • Your out of hospital maternity related claims
  • Up to $1million for travel insurance
See below for more changes.
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Contributions:
Main: Adult: Child:
Cost 2018: R5,950 R5,950 R1,134
Cost 2017: (R5,544) (R5,544) (R1,055)
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: R17,844 R17,844 R3,396
Self Payment: R2,506 R2,506 R454
Above Threshold: Unlimited overall, with sublimits for some benefits. Find out more
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:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • Covered in full for specialists with payment arrangement with Discovery
  • Otherwise, 300% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Unlimited, with a R1,880 cover per day for private ward
  • N/A
Specialised Radiology:
  • 100% scheme rate, from risk. (In 2017, this is paid from day-to-day benefit)
  • Up to 500% of scheme rate for service providers
Supplementary Services: (Physio, etc)
  • 200% scheme rate
  • Up to 500% of scheme rate for service providers
Transplants:
  • Covered
  • Up to 500% of scheme rate for service providers
Co-payments:
  • None
  • No benefit
Alternatives to hospitals:
  • Administration of IV, iron treatments, steroids and immunoglobulins when a hospital admission is not required: covered
  • Care for venous ulcers, diabetic foot ulcers, pressure sores and other moderate to severe wounds for patients who do not require hospital admission: covered
  • End of life care: R52,750 per person, per lifetime
  • Cancer: Unlimited palliative care cover for approved care at home
  • No benefit
Casualty:
  • All emergencies are covered
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit
  • 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 Hospital Benefit
  • No benefit
Supplementary Services: (Physio, etc)
  • 2018: To be confirmed
  • 2017:
    • Paid from day-to-day benefit
    • Limited to:
      M M1 M2 M3+
      R19,750 R23,750 R27,750 R33,350
    • 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
  • No benefit
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MATERNITY BENEFITS:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • Up to R1,880 for private ward
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Consultations:
  • $$ 12 consults, now paid by scheme
  • $$ Nuchal transluency or Non-Invasive Prenatal Test, now paid by scheme
  • $$ 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):
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • Unlimited, subject to sublimit below. After the first R400,000, a 20% co-payment applies
  • Specialised medicine and technology: R200,000 per person with a 20% co-payment
  • Unlimited palliative care cover for approved care at home
  • Up to additional 500% of scheme rate to cover shortfall for specialists
  • Full cover for the 20% co-payments
  • Sublimit increased by R40,000
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • In-hospital: now paid by scheme, with an upfront deductible (to be confirmed).
  • Dental appliances: R26,200 per person
  • Out-of-hospital: paid from day-to-day benefit
  • Full cover for in-hospital deductibles
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics:
  • See above
  • 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:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • PMBs chronic: paid by scheme
  • non-PMBs chronic: additional 23 conditions covered, up to a pre-set limit including an exclusive list of brand medicines.
  • No benefit
Acute (presrcibed) medication:
  • 2018: to be confirmed
  • 2017:
  • Schedule 3 and above
  • Paid from day-to-day benefit, up to the limits below
Main M1 M2 M3+
R33,000 R38,700 R44,300 R49,950
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit
  • These do not add up to the annual threshold, and are not paid for from it
  • No benefit
Birth Control:
  • To be confirmed
  • No benefit
On Discharge:
  • See "Acute Medicine" benefit
  • No benefit
Biological:
  • For a defined list of latest treatments, limited to R200,000 per person, with a 20% co-payment
  • If part of oncology treatment, gap will cover the co-payment
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OPTOMETRY:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • 2018:to be confirmed
  • 2017:
    • R6,800 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:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital:
  • To be confirmed
  • No benefit
Out-of-hospital:
  • 2018:to be confirmed
  • 2017:
    • Major affective disorders, anorexia and bulimia: 15 consultations per person paid by scheme as an alternative to in-hospital treatment
    • Acute stress disorder due to recent significant trauma: 12 consultations per person paid by scheme as an alternative to in-hospital treatment
    • Otherwise, paid from day-to-day benefit. Claims for psychologists and social workers fall into the supplementary benefit sub limit ie:
    M M1 M2 M3+
    R19,750 R23,750 R27,750 R33,350
  • No benefit
Trauma:
  • Offers out of hospital claims for recovery after traumatic events for rest of year, and year after that
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OTHER BENEFITS:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • 2018:to be confirmed
  • 2017:
    • External appliances limited to R58,800 per family from day-to-day benefit
    • Cochlear implants: R207,000
  • No benefit
1.1. Hearing Aids:
  • 2018:to be confirmed
  • 2017:
    • R22,900 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 $1 million per person for emergency costs while travelling outside South Africa, for a period of 90 days. Excludes pre-existing conditions.
  • $$ Second opinion from Cleveland Clinic: now paid for by scheme
  • R750,000 per person for international treatment not available in South Africa, with 20% co-payment
  • $$ R300,000 to cover voluntary in-hospital treatment outside South Africa. This is a new benefit.
  • 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:
Executive
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered, for 65yrs+
  • No benefit
Pneumonia vaccines:
  • To be confirmed
  • No benefit
Back Rehabilitation Programme: TBC
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • To be confirmed
  • No benefit
Pap Smear:
  • Covered, every 3 years
  • No benefit
Mammogram:
  • Covered, every 2 years
  • If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • Kids' assessment, including height, weight, head circumference and health and milestone tracking
  • No benefit
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2017 v 2018 benefits
($$ 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