Discovery Health Medical Aid Comparison - 2013 Plans
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Discovery Health is by far the biggest medical aid scheme in South Africa and tends to dominate the industry. Their Global Credit Rating is the highest available (AA) and total membership is in excess of 2 million lives. They are an extremely innovative company and introduced a number of new concepts to the industry, including introducing the new generation savings plan schemes.
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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Designed for members in coastal |
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provinces using a Network of |
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Coastal Hospitals |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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No Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 998 |
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Spouse/Adult dependant |
R 748 |
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Per Child (Max 3) |
R 398 |
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| DISCOVERY HEALTH |
| ESSENTIAL DELTA CORE |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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Only from DSP |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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No Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 927 |
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Spouse/Adult dependant |
R 695 |
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Per Child (Max 3) |
R 372 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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No Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,350 |
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Spouse/Adult dependant |
R 1,062 |
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Per Child (Max 3) |
R 539 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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Designed for memebers in coastal |
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provinces |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 4,284 |
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Member+Spouse |
R 7,488 |
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Member+Spouse+Child1 |
R 9,204 |
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Member+Spouse+Child2 |
R 10,920 |
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Member+Spouse+Child3 |
R 12,636 |
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Member+Child 1 |
R 6,000 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,428 |
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Spouse/Adult dependant |
R 1,070 |
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Per Child (Max 3) |
R 574 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 MB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 2,592 |
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Member+Spouse |
R 4,524 |
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Member+Spouse+Child1 |
R 5,556 |
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Member+Spouse+Child2 |
R 6.588 |
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Member+Spouse+Child3 |
R 7,620 |
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Member+Child 1 |
R 3,624 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,442 |
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Spouse/Adult dependant |
R 1,078 |
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Per Child (Max 3) |
R 576 |
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| DISCOVERY HEALTH |
| CLASSIC DELTA SAVER |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit |
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schedule |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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Only from DSP |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 4,344 |
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Member+Spouse |
R 7,764 |
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Member+Spouse+Child1 |
R 9,504 |
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Member+Spouse+Child2 |
R 11,244 |
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Member+Spouse+Child3 |
R 12,984 |
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Member+Child 1 |
R 6,084 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,449 |
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Spouse /Adult |
R 1,141 |
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dependant |
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Per Child (Max 3) |
R 581 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 MB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 5,436 |
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Member+Spouse |
R 9,720 |
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Member+Spouse+Child1 |
R 11,892 |
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Member+Spouse+Child2 |
R 14.064 |
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Member+Spouse+Child3 |
R 16,236 |
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Member+Child 1 |
R 7,608 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Does not apply |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 1,814 |
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Spouse/Adult dependant |
R 1,428 |
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Per Child (Max 3) |
R 725 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Co-payments apply for certain |
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procedures |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R200 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 MB Chronic Disease Conditions |
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Subject to scheme formulary |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 6,204 |
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Member+Spouse |
R 11,088 |
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Member+Spouse+Child1 |
R 13,572 |
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Member+Spouse+Child2 |
R 16.065 |
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Member+Spouse+Child3 |
R 18,540 |
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Member+Child 1 |
R 8,688 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 9,170 |
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Spouse/Adult dependant |
R 6,890 |
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Per Child (Max 3) |
R 3,000 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 2,069 |
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Spouse/Adult dependant |
R 1,629 |
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Per Child (Max 3) |
R 828 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R400 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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Specialised medicine & technology |
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benefit R200,000 |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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(Add. 33 Chronic Disease Conditions) |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 8,340 |
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Member+Spouse |
R 16,224 |
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Member+Spouse+Child1 |
R 17,880 |
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Member+Spouse+Child2 |
R 19,536 |
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Member+Spouse+Child3 |
R 21,192 |
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Member+Child 1 |
R 9,996 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 10,375 |
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Spouse/Adult independant |
R 10,375 |
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Per Child (Max 3) |
R 1,950 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 2,780 |
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Spouse/Adult dependant |
R 2,629 |
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Per Child (Max 3) |
R 553 |
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IN HOSPITAL BENEFIT |
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200% Scheme Rate |
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No Overall Annual Limit |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 31,000 |
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Oncology R400 000 thereafter 20% |
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co-payment |
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Internal Prostheses: |
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See detailed benefit schedule |
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Specialised medicine & technology |
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benefit R200,00 |
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CHRONIC MEDICATION BENEFIT |
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100% Scheme Rate |
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27 PMB Chronic Disease Conditions |
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Subject to scheme formulary |
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Add. 33 Chronic Disease Conditions |
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ANNUAL DAY TO DAY BENEFIT
(including savings) |
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100% Scheme Rate |
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Limits per annum: |
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Member |
R 9,252 |
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Member+Spouse |
R 18,000 |
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Member+Spouse+Child1 |
R 19,848 |
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Member+Spouse+Child2 |
R 21,696 |
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Member+Spouse+Child3 |
R 23,544 |
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Member+Child 1 |
R 11,100 |
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Insured Network Benefit |
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ANNUAL THRESHOLD BENEFIT |
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Principal Member |
R 10,375 |
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Spouse/Adult independant |
R 10,375 |
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Per Child (Max 3) |
R 1,950 |
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MONTHLY CONTRIBUTIONS |
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Principal Member |
R 3,086 |
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Spouse/Adult dependant |
R 2,918 |
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Per Child (Max 3) |
R 616 |
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IN HOSPITAL BENEFIT |
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100% Scheme Rate |
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No Overall Annual Limit |
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Network Hospitals to be used |
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Certain procedures only covered at |
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Network Day Clinics |
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Annual Sub-limits per person: |
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Psychiatric Treatment |
21 days |
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Hospice Care |
R 22,000 |
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Oncology |
PMB |
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|
|
| |
|
|
|
|
|
|
|
|
| |
CHRONIC MEDICATION BENEFIT |
|
| |
100% Scheme Rate |
|
| |
27 PMB Chronic Disease Conditions |
|
| |
Subject to scheme formulary |
|
| |
Only from DSP |
|
| |
|
|
| |
|
|
|
|
|
|
|
|
| |
ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
Does not apply |
|
| |
|
|
|
| |
|
|
|
| |
Specialist benefit limited to R2,550 |
|
| |
per person per annum. Must be |
|
| |
referred by GP |
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
|
| |
ANNUAL THRESHOLD BENEFIT |
|
| |
Does not apply |
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
MONTHLY CONTRIBUTIONS |
|
| |
Income p/m: |
R0 - R6,250 |
|
| |
Principal Member |
R 511 |
|
| |
Spouse /Adult |
R 511 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R129 |
|
| |
|
|
|
| |
Income p/m: |
R6,251 - R8,300 |
|
| |
Principal Member |
R 636 |
|
| |
Spouse /Adult |
R 636 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 158 |
|
| |
|
|
|
| |
Income p/m: |
R8,301+ |
|
| |
Principal Member |
R 982 |
|
| |
Spouse /Adult |
R 982 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 222 |
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
|
|
|
| |
IN HOSPITAL BENEFIT |
|
| |
100% Scheme Rate |
|
| |
No Overall Annual Limit |
|
| |
Network Hospitals to be used |
|
| |
Certain procedures only covered at |
|
| |
Network Day Clinics |
|
| |
Annual Sub-limits per person: |
|
| |
Psychiatric Treatment |
21 days |
|
| |
Hospice Care |
R 22,000 |
|
| |
Oncology |
PMB |
|
| |
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
CHRONIC MEDICATION BENEFIT |
|
| |
100% Scheme Rate |
|
| |
27 PMB Chronic Disease Conditions |
|
| |
Subject to scheme formulary |
|
| |
Only from DSP |
|
| |
|
|
| |
|
|
|
|
|
|
|
|
| |
ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
Does not apply |
|
| |
GP's: |
No Limit from KeyCare |
|
| |
|
Network Providers |
|
| |
Specialists: |
R 2,550 per person |
|
| |
|
from Network Providers |
|
| |
(must be referred by network GP) |
|
| |
Conservative Dentistry: |
|
| |
|
No Limit from KeyCare |
|
| |
|
Network Providers. |
|
| |
|
|
|
| |
|
|
| |
|
|
|
| |
ANNUAL THRESHOLD BENEFIT |
|
| |
Does not apply |
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
MONTHLY CONTRIBUTIONS |
|
| |
Income p/m: R0 - R6,250 |
|
| |
Principal Member |
R 638 |
|
| |
Spouse /Adult |
R 638 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 230 |
|
| |
|
|
|
| |
Income p/m: R6,251 - R8,300 |
|
| |
Principal Member |
R 893 |
|
| |
Spouse /Adult |
R 893 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 250 |
|
| |
|
|
|
| |
Income p/m: R8,301 + |
|
| |
Principal Member |
R 1,330 |
|
| |
Spouse /Adult |
R 1,330 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 356 |
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
|
| |
|
|
| |
IN HOSPITAL BENEFIT |
|
| |
100% Scheme Rate |
|
| |
No Overall Annual Limit |
|
| |
State Hospitals to be used |
|
| |
Access Network hospitals to be used |
|
| |
for emergencies, trauma & childbirth |
|
| |
|
|
| |
Certain procedures only covered at |
|
| |
Network Day Clinics |
|
| |
Annual Sub-limits per person: |
|
| |
Psychiatric Treatment |
21 days |
|
| |
Hospice Care |
R 22,000 |
|
| |
Oncology |
PMB |
|
| |
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
CHRONIC MEDICATION BENEFIT |
|
| |
100% Scheme Rate |
|
| |
27 PMB Chronic Disease Conditions |
|
| |
Subject to scheme formulary |
|
| |
Only from DSP |
|
| |
|
|
| |
|
|
|
|
|
|
|
|
| |
ANNUAL DAY TO DAY BENEFIT
(including savings) |
|
| |
100% Scheme rate |
|
| |
GP's: |
No Limit from KeyCare |
|
| |
|
Network Providers |
|
| |
Specialists: |
R 2,550 per person |
|
| |
|
from Network Providers |
|
| |
(must be referred by network GP) |
|
| |
Conservative Dentistry: |
|
| |
|
No Limit from KeyCare |
|
| |
|
Network Providers. |
|
| |
|
|
|
| |
|
|
| |
|
|
|
| |
ANNUAL THRESHOLD BENEFIT |
|
| |
Does not apply |
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
| |
MONTHLY CONTRIBUTIONS |
|
| |
Income p/m: R0 - R3,900 |
|
| |
Principal Member R450 |
|
|
| |
Spouse /Adult R450 |
|
| |
dependant |
|
| |
Per Child (Max 3) R195 |
|
| |
|
|
| |
Income p/m: R3901 - R6,250 |
|
| |
Principal Member |
R 600 |
|
| |
Spouse /Adult |
R 600 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 215 |
|
| |
|
|
|
| |
Income p/m: R6,251 - R8,300 |
|
| |
Principal Member |
R 865 |
|
| |
Spouse /Adult |
R 865 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 245 |
|
| |
|
|
|
| |
Income p/m: R8,301 + |
|
| |
Principal Member |
R 1,300 |
|
| |
Spouse /Adult |
R 1,300 |
|
| |
dependant |
|
|
| |
Per Child (Max 3) |
R 350 |
|
| |
|
|
|
|
|
|
|
|
For more detailed information on any of the above Discovery Health plans, just click on the name of the relevant plan in the tables above. If you already know what you want, why not make use of our site to download the relevant Medical Aid Application form and then fax it back to us on 0866 200 320. Alternatively, if you would like us to confirm some of the finer details and/or pricing, just fill in our Medical Aid Quote Request form and we will get back to you promptly.
Finally, we invite you to contact us on +27 21 712-8866 at any point in your decision making process for further information on the Discovery Health Medical Aids.
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