Discovery Health Medical Scheme Keycare Plan Guide 2022

2022 KEYCARE PLAN
Plus | Core | Start | Start Regional
Taking on every moment

HOME
KEY TERMS
Live healthy KEY FEATURES

AND BENEFITS
in every moment
EMERGENCY
COVER AND PMB
At Discovery Health Medical Scheme,

we are reimagining healthcare so that SCREENING AND
PREVENTION
you can experience quality care with
advanced technology that supports you
CONNECTED
through every life stage because we want CARE
you to live healthy in every moment.

KEYCARE ONLINE
PRACTICE
DAY-TO-DAY
BENEFITS
Read this guide to understand more AND COVER
about your health plan including:
MATERNITY

What to do when you need BENEFITS
to go to a doctor or to a hospital
CHRONIC
How you are covered for preventive
CONDITIONS AND
screening, diagnosis and treatment PROGRAMMES
of medical conditions
COVER FOR

Which benefits you need to apply for and CANCER
if there are any limits for certain benefits
HOSPITAL COVER

Tips on how you can use technology to AND ANNUAL
conveniently manage and access healthcare LIMITS
and all the information you need through

the Discovery app and website DAY SURGERY
EXTRA BENEFITS
CONTRIBUTIONS
The benefits explained in this brochure are provided by Discovery Health Medical Scheme, registration number 1125, administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider.
This brochure is only a summary of the key benefits and features of Discovery Health Medical Scheme plans. In all instances, Discovery Health Medical Scheme Rules prevail. Please consult the Scheme Rules on www.discovery.co.za. When
reference is made in this brochure to ‘we’ in the context of benefits, members, payments or cover, this refers to Discovery Health Medical Scheme. We are continuously improving our communication to you. The latest version of this guide as
EXCLUSIONS
well as detailed benefit information is available on www.discovery.co.za.
01 | Discovery Health Medical Scheme VALUE-ADDED

BENEFITS
HOME
Contents page KEY TERMS
KEY FEATURES
AND BENEFITS
EMERGENCY
COVER AND PMB
SCREENING AND
PREVENTION
CONNECTED
DAY-TO-DAY CARE
KEY TERMS DAY SURGERY
BENEFITS AND COVER
KEYCARE ONLINE
PRACTICE
KEY FEATURES DAY-TO-DAY

MATERNITY BENEFITS EXTRA BENEFITS BENEFITS
AND BENEFITS AND COVER
MATERNITY
BENEFITS
EMERGENCY COVER
CHRONIC CONDITIONS CHRONIC
AND PRESCRIBED CONTRIBUTIONS
AND CARE PROGRAMMES CONDITIONS AND
MINIMUM BENEFITS PROGRAMMES
COVER FOR
CANCER
SCREENING AND
COVER FOR CANCER EXCLUSIONS HOSPITAL COVER
PREVENTION BENEFITS
AND ANNUAL
LIMITS
DAY SURGERY
HOSPITAL COVER
CONNECTED CARE VALUE ADDED OFFERS
AND ANNUAL LIMITS
EXTRA BENEFITS
CONTRIBUTIONS
EXCLUSIONS
02 | Discovery Health Medical Scheme VALUE-ADDED

BENEFITS
HOME
Key Terms KEY TERMS
KEY FEATURES
AND BENEFITS
About some of the terms we use in this document
EMERGENCY
C D
COVER AND PMB
SCREENING AND
PREVENTION
CHRONIC ILLNESS BENEFIT (CIB) DAY-TO-DAY BENEFITS DISCOVERY HEALTH RATE
epending on your chosen plan, you have cover for
D
FOR MEDICINE
he Chronic Illness Benefit (CIB) covers you for a
T CONNECTED
CARE
defined list of chronic conditions. You need to apply a defined set of day-to-day medical expenses such as his is the rate we pay for medicine. It is the Single Exit
T
to have your medicine and treatment covered for your medically appropriate GP consultations, blood tests, Price of medicine plus the relevant dispensing fee.
chronic condition. X-rays or medicine in our KeyCare networks. KEYCARE ONLINE
PRACTICE
DISCOVERY HOME CARE
CONNECTED CARE DEDUCTIBLE
iscovery Home Care is an additional service that offers
D DAY-TO-DAY
BENEFITS
Connected Care is an integrated healthcare ecosystem This is the amount that you must pay upfront to the you quality home-based care in the comfort of your AND COVER
of benefits, services and connected digital capabilities hospital or day clinic for specific treatments/procedures. home for healthcare services like IV infusions, wound
to help you manage your health and wellness. If the upfront amount is higher than the amount charged care, post-natal care and advanced illness care. MATERNITY
for the healthcare service, you will have to pay for the BENEFITS
CO-PAYMENT cost of the healthcare service.
This is an amount that you need to pay towards a healthcare

DESIGNATED SERVICE
E CHRONIC
CONDITIONS AND
PROGRAMMES
service. The amount can vary by the type of covered
healthcare service, place of service or if the amount
PROVIDER (DSP) EMERGENCY MEDICAL CONDITION COVER FOR
the service provider charges is higher than the rate healthcare provider (for example doctor, specialist,
A CANCER
An emergency medical condition, also referred to as an
we cover. If the co-payment amount is higher than allied healthcare professional, pharmacist or hospital) emergency, is the sudden and, at the time, unexpected
the amount charged for the healthcare service, you who we have an agreement with to provide treatment or onset of a health condition that requires immediate
HOSPITAL COVER
AND ANNUAL
will have to pay for the cost of the healthcare service. services at a contracted rate. Visit www.discovery.co.za medical and surgical treatment, where failure to provide LIMITS
or click on Find a healthcare provider on the Discovery medical or surgical treatment would result in serious
COVER app to view the full list of DSPs. impairment to bodily functions or serious dysfunction
DAY SURGERY
of a bodily organ or part or would place the person’s life
over refers to the benefits you have access to and how
C
DISCOVERY HEALTH RATE (DHR) in serious jeopardy.
we pay for these healthcare services such as consultations,
n emergency does not necessarily require a hospital
A EXTRA BENEFITS
medicine and hospitals, on your health plan. his is a rate we pay for healthcare services from
T admission. We may ask you for additional information
hospitals, pharmacies, healthcare professional and to confirm the emergency.
other providers of relevant health services. This rate
CONTRIBUTIONS
may vary depending on the plan you choose.
Connected Care is brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes.
Discovery Home Care is a service provider. Practice 080 000 8000190, Grove Nursing Services (Pty) Ltd registration number 2015/191080/07, trading as Discovery HomeCare. EXCLUSIONS
Find a healthcare provider and the Discovery app are brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes.
03 | Discovery Health Medical Scheme | Key Terms VALUE-ADDED

BENEFITS
HOME
Key Terms KEY TERMS
KEY FEATURES
AND BENEFITS
EMERGENCY
F M
COVER AND PMB
SCREENING AND
PREVENTION
FIND A HEALTHCARE PROVIDER MEDICINE LIST (FORMULARY) Day Surgery Networks
Find a healthcare provider is a medical and provider list of medicine we cover in full for the treatment
A You have full cover for a defined list of procedures CONNECTED
CARE
search tool which is available on the Discovery app of approved chronic condition(s). This list is also in our Day Surgery Network.
or website www.discovery.co.za. known as a formulary.
Medicine Networks KEYCARE ONLINE
H
PRACTICE
Use a pharmacy in our network to get full cover
N and avoid co-payments when claiming for
medicine on the prescribed medicine list.
DAY-TO-DAY
BENEFITS
AND COVER
HEALTHID NETWORKS Regional Networks
MATERNITY
HealthID is an online digital platform that gives your doctor You may need to make use of specific hospitals, The KeyCare Start Regional plan provides cover BENEFITS
fast, up-to-date access to your health information. Once you pharmacies, doctors, specialists or allied healthcare for approved healthcare services in the KeyCare
have given consent, your doctor can use HealthID to access professionals in a network. We have payment Start Regional Network, when referred by the CHRONIC
your medical history, make referrals to other healthcare arrangements with these providers to ensure you KeyCare Online Practice. CONDITIONS AND
get access to quality care at an affordable cost. PROGRAMMES
professionals and check your relevant test results. The KeyCare Start Regional Network consists
By using network providers, you can avoid having of hospitals and healthcare professionals in the
to pay additional costs and co-payments. Limpopo, Mpumalanga and Western Cape regions. COVER FOR
K
CANCER
Hospital Networks Limpopo: Polokwane and Tzaneen

Mpumalanga: Mbombela and Trichardt HOSPITAL COVER
You have chosen a plan with a hospital network, AND ANNUAL
Western Cape: Belville and George
KEYCARE ONLINE PRACTICE make sure you use a hospital in the network
LIMITS
specific to your plan to get full cover.

The KeyCare Online Practice is an integrated healthcare
DAY SURGERY
and referral platform for KeyCare Start Regional Doctor Networks
members to access healthcare services. Visit
www.discovery.co.za or click on KeyCare Online You have full cover for GPs, specialists or allied
healthcare professionals who we have payment EXTRA BENEFITS
Practice on the Discovery app to to access the platform.
arrangements with.
CONTRIBUTIONS
EXCLUSIONS
Find a healthcare provider, the Discovery app and Discovery HealthID are brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes.

BENEFITS
HOME
Key Terms KEY TERMS
KEY FEATURES
AND BENEFITS
EMERGENCY
P R
COVER AND PMB
SCREENING AND
PREVENTION
PAYMENT ARRANGEMENTS o access Prescribed Minimum Benefits (PMBs), there
T RELATED ACCOUNTS
are rules defined by the Council for Medical Schemes
he Scheme has payment arrangements with various
T
(CMS) that apply: ny account other than the hospital account for
A CONNECTED
healthcare professionals and providers to ensure CARE
in-hospital care. This could include the accounts for
that you can get full cover with no co-payments. Your medical condition must qualify for cover and the admitting doctor, anaesthetist and any approved
be part of the defined list of Prescribed Minimum healthcare expenses like radiology or pathology. KEYCARE ONLINE
PRACTICE
PREMIER PLUS GP Benefit (PMB) conditions
Premier Plus GP is a network GP who has contracted

A
with us to provide you with coordinated care and
The treatment needed must match the treatments
in the defined benefits S DAY-TO-DAY
BENEFITS
AND COVER
enrolment on one of our care programmes for You must use designated service providers (DSPs)
defined chronic conditions. in our network. This does not apply in emergencies. SHARIAH COMPLIANT MATERNITY
BENEFITS
Where appropriate and according to the Rules of ARRANGEMENT
PRESCRIBED MINIMUM BENEFITS the Scheme, you may be transferred to a hospital
An arrangement which enables members to have their CHRONIC
(PMB) or other service providers in our network, once CONDITIONS AND
health plan administered in accordance with principles
your condition has stabilised. If you do not use PROGRAMMES
In terms of the Medical Schemes Act of 1998 (Act No. that are Shariah compliant.
a DSP we will pay up to 80% of the Discovery
131 of 1998) and its Regulations, all medical schemes
Health Rate (DHR). You will be responsible for the COVER FOR
have to cover the costs related to the diagnosis,
W
CANCER
difference between what we pay and the actual
treatment and care of:
cost of your treatment.
HOSPITAL COVER
An emergency medical condition AND ANNUAL
If your treatment doesn’t meet the above criteria, LIMITS
A defined list of 271 diagnoses we will pay according to your plan benefits. WHO GLOBAL OUTBREAK BENEFIT
A defined list of 27 chronic conditions. he WHO Global Outbreak Benefit provides cover for
T DAY SURGERY
approved global disease outbreaks recognised by the
World Health Organization (WHO) such as COVID-19
and monkeypox. This benefit provides access to a EXTRA BENEFITS
defined basket of care per disease outbreak, which
includes cover for vaccines (where applicable) and
relevant out-of-hospital treatment. CONTRIBUTIONS
EXCLUSIONS

BENEFITS
HOME
KEY TERMS
Key UNLIMITED COVER FOR

HOSPITAL ADMISSIONS
FULL COVER IN HOSPITAL
FOR SPECIALISTS
KEY FEATURES
AND BENEFITS
Features Unlimited hospital cover in our KeyCare hospital

networks. Cover and network depends on the plan
Guaranteed full cover in hospital for specialists on
the KeyCare networks, and up to 100% of the Discovery
EMERGENCY
COVER AND PMB
you choose. On KeyCare Start Regional you have Health Rate (DHR) for other healthcare professionals.
SCREENING AND
to go to a network hospital in your selected region. Cover and network depends on the plan you choose.
PREVENTION
FULL COVER FOR SCREENING AND CONNECTED

CARE
CHRONIC MEDICINE PREVENTION
Essential cover for chronic medicine on the KeyCare Screening and prevention benefits that cover vital KEYCARE ONLINE
medicine list for all Chronic Disease List (CDL) conditions PRACTICE
tests to detect early warning signs of serious illness.
when you use a designated service provider (DSP).
DAY-TO-DAY
Cover and network depends on the plan you choose.
BENEFITS
DAY-TO-DAY AND COVER
COVER
CONNECTED MATERNITY
Unlimited cover for medically appropriate GP
CARE BENEFITS
consultations, blood tests, X-rays or medicine in our
You have access to remote care at home, including KeyCare networks on KeyCare Plus, KeyCare Start CHRONIC
a Home Monitoring Device Benefit for essential home CONDITIONS AND
and KeyCare Start Regional plans. Cover and network PROGRAMMES
monitoring, home-based care and follow-up treatment depends on the plan you choose.
after an admission and a Home Care Benefit for quality
COVER FOR
care in the comfort of your own home. CANCER
HOSPITAL COVER
EXTENSIVE COVER AND ANNUAL
LIMITS
FOR PREGNANCY
You get comprehensive benefits for maternity and early DAY SURGERY
Shariah compliant arrangement available childhood that cover certain healthcare services before
on all health plans. and after birth.
EXTRA BENEFITS
CONTRIBUTIONS
Vitality is a separate wellness product sold and administered by Discovery Vitality (Pty) Ltd, registration number 1999/007736/07. Limits, terms and conditions apply.
Discovery Home Care is a service provider. Practice 080 000 8000190, Grove Nursing Services (Pty) Ltd registration number 2015/191080/07, trading as Discovery HomeCare.
EXCLUSIONS
06 | Discovery Health Medical Scheme | Key Features and Benefits VALUE-ADDED

BENEFITS
HOME
The benefits on the different KeyCare plans KEY TERMS
KEY FEATURES
AND BENEFITS
The four plan options have differences in benefits, as shown in the table. All other benefits not mentioned in the table are the same across all plan options.
EMERGENCY
COVER AND PMB
Plus Core Start Start Regional
SCREENING AND
Day-to-day cover Day-to-day cover at your chosen KeyCare Specialists are covered up to R4 730 per Day-to-day cover at your chosen KeyCare Day-to-day cover at your chosen KeyCare
PREVENTION
Network GP. Medicine from our medicine person per year. This plan does not offer Start Network GP Start Regional Network GP when referred
list is covered if you use a network any additional day-to-day cover Medicine from our medicine list is covered by the KeyCare Online Practice.
pharmacy if you use a network pharmacy Medicine from our medicine list is covered CONNECTED
Specialists are covered up to R4 730 Two specialist visits up to R2 370 per when prescribed by your chosen KeyCare CARE
per person per year, if you are referred person per year, if you are referred Start Regional Network GP and obtained
by your KeyCare Network GP by your KeyCare Start Network GP from a network pharmacy.
Two specialist visits up to R2 370 per KEYCARE ONLINE
PRACTICE
person per year, if referred by your
KeyCare Start Regional Network GP to a
specialist in the KeyCare Start Regional DAY-TO-DAY
Network. BENEFITS
AND COVER
Non-emergency casualty visits Cover for one casualty visit per person Not covered We cover after-hours care at your chosen We cover after-hours care at your
per year in any casualty unit at a hospital KeyCare Start Network GP or network chosen KeyCare Start Regional Network
MATERNITY
in the KeyCare network provider GP or KeyCare Online Practice
BENEFITS
Unlimited for emergencies
You pay the first R425 of the consultation
CHRONIC
You must get approval before your visit CONDITIONS AND
PROGRAMMES
Chronic medicine prescriptions Your approved chronic medication must Your nominated KeyCare Network GP can Your chronic medicine is covered in We cover your approved chronic medication
be dispensed by your nominated KeyCare prescribe your approved chronic medicine a state facility when you use one of our network
COVER FOR
Network GP, or you must get your and you must get your approved chronic pharmacies or your chosen KeyCare Start
CANCER
approved chronic medicine from medicine from a pharmacy in the network Regional Network GP. Your chosen GP must
a pharmacy in the network prescribe the chronic medicine.
HOSPITAL COVER
Cancer We cover your treatment if it is a Prescribed Minimum Benefit (PMB). Your treatment is covered in a state facility AND ANNUAL
You must use a network provider LIMITS
Chronic Dialysis You must use a network provider once you are registered, or you can go to a state You are covered at a provider in a state facility
facility. If you go elsewhere we will pay 80% of the Discovery Health Rate (DHR) DAY SURGERY
Full Cover Hospital Network We pay up to the Discovery Health Rate (DHR) (100%) We pay the Discovery Health Rate (DHR) We pay the Discovery Health Rate (DHR)
at your chosen KeyCare Start Network at your chosen KeyCare Start Regional
Hospital Network Hospital EXTRA BENEFITS
Partial Cover Hospital Network We pay up to 70% of the hospital account and you must pay the balance No cover for non-emergency admissions
of the account.
CONTRIBUTIONS
If the admission is a Prescribed Minimum Benefit (PMB), we will pay 80%
of the Discovery Health Rate (DHR)
Defined list of procedures Covered at 100% of the Discovery Health Rate (DHR) in the KeyCare Day Covered in the KeyCare Start Day Covered in the KeyCare Start Day EXCLUSIONS
in a Day Surgery Network Surgery Network Surgery Network Surgery Network in your region
07 | Discovery Health Medical Scheme | Key Features and Benefits VALUE-ADDED

BENEFITS
HOME
Emergency Cover KEY TERMS
KEY FEATURES
What is a medical emergency?

AND BENEFITS
EMERGENCY
COVER AND PMB
An emergency medical condition, also referred to as an emergency, is the sudden and unexpected onset of a health condition that requires immediate
medical or surgical treatment. Failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious SCREENING AND
PREVENTION
dysfunction of a bodily organ or part or would place the person’s life in serious jeopardy. An emergency does not necessarily require a hospital
admission. We may ask you or your treating provider for additional information to confirm the emergency.
CONNECTED
CARE
KEYCARE ONLINE
PRACTICE
DAY-TO-DAY
BENEFITS
AND COVER
Emergencies WHAT WE PAY FOR MATERNITY

BENEFITS
ASSISTANCE DURING OR AFTER are covered in full. We pay for all of the following medical services
that you may receive in an emergency:
A TRAUMATIC EVENT CHRONIC
CONDITIONS AND
the ambulance (or other medical transport) PROGRAMMES
You have access to dedicated assistance in the event If you have an emergency,
of a traumatic incident or after a traumatic event. you can go straight to hospital. the account from the hospital
COVER FOR
By calling Emergency Assist you and your family have If you need medically
the accounts from the doctor who admitted CANCER
access to trauma support 24 hours a day. This service equipped transport, you to the hospital
also includes access to counselling and additional
like an ambulance, call the anaesthetist HOSPITAL COVER
benefits for trauma related to gender-based violence. AND ANNUAL
our Emergency Assist.
any other healthcare provider that LIMITS
we approve.
DAY SURGERY
0860 999 911

EXTRA BENEFITS
Click on Emergency Assist

on your Discovery app
CONTRIBUTIONS
The Discovery app is brought to you by Discovery Health (Pty) Ltd;

registration number 1997/013480/07, an authorised financial services
EXCLUSIONS
provider and administrator of medical schemes.
08 | Discovery Health Medical Scheme | Emergency cover and Prescribed Minimum Benefits VALUE-ADDED
BENEFITS
HOME
KEY TERMS
Prescribed Minimum Benefits

KEY FEATURES
AND BENEFITS
EMERGENCY
What are Prescribed Minimum

COVER AND PMB
Benefits?
SCREENING AND
PREVENTION
CONNECTED
CARE
According to the Prescribed Minimum Benefit (PMB) conditions in terms of the Medical
Schemes Act 131 of 1998 and its Regulations, all medical schemes have to cover the costs
KEYCARE ONLINE
related to the diagnosis, treatment and care of: PRACTICE
An emergency medical condition DAY-TO-DAY

BENEFITS
A defined list of 271 diagnoses AND COVER
A defined list of 27 chronic conditions. MATERNITY

BENEFITS
CHRONIC
CONDITIONS AND
To access Prescribed Minimum Benefits (PMBs), there are rules defined by the Council PROGRAMMES
for Medical Schemes (CMS) that apply:

COVER FOR
Your medical condition must qualify for cover and be part of the defined list CANCER
of Prescribed Minimum Benefit (PMB) conditions.
HOSPITAL COVER
The treatment needed must match the treatments in the defined benefits. AND ANNUAL
LIMITS
You must use designated service providers (DSPs) in our network. This does not apply
in emergencies. Where appropriate and according to the Rules of the scheme, you may
DAY SURGERY
be transferred to a hospital or other service providers in our network, once your condition
has stabilised. If you do not use a DSP we will pay up to 80% of the Discovery Health Rate
(DHR). You will be responsible for the difference between what we pay and the actual cost
EXTRA BENEFITS
of your treatment.
If your treatment doesn’t meet the above criteria, we will pay according to your plan benefits.
CONTRIBUTIONS
EXCLUSIONS
09 | Discovery Health Medical Scheme | Emergency cover and Prescribed Minimum Benefits VALUE-ADDED
BENEFITS
HOME
You have access KEY TERMS
to essential
KEY FEATURES
AND BENEFITS
SCREENING FOR KIDS
screening and
This benefit covers growth assessment tests, including EMERGENCY
COVER AND PMB
height, weight, head circumference and health and
milestone tracking at any one of our wellness providers.
prevention
SCREENING AND
PREVENTION
benefits
CONNECTED
CARE
SCREENING FOR ADULTS KEYCARE ONLINE

PRACTICE
This benefit pays for certain tests that This benefit covers certain tests such as blood glucose,
can detect early warning signs of serious blood pressure, cholesterol, body mass index and HIV DAY-TO-DAY
screening at one of our wellness providers. We also BENEFITS
illnesses. We cover various screening tests AND COVER
cover a mammogram or ultrasound of the breast every
at our wellness providers, for example, blood
two years, a Pap smear once every three years or a HPV
glucose, cholesterol, HIV, Pap smear or HPV test once every five years, PSA test (prostate screening)
MATERNITY
BENEFITS
test for cervical screening, mammograms each year and bowel cancer screening tests every two
and/or ultrasounds and prostate screenings. years for members between 45 and 75 years. These CHRONIC
CONDITIONS AND
tests are paid from the Screening and Prevention Benefit. PROGRAMMES
Consultations that do not form part of Prescribed
Minimum Benefits (PMBs) will be paid from your COVER FOR
available day-to-day benefits. CANCER
HOSPITAL COVER
AND ANNUAL
LIMITS
SCREENING FOR SENIORS
In addition to the screening for adults, members DAY SURGERY
aged 65 years and older have cover for an age
appropriate falls risk screening assessment in our defined
pharmacy network. You may have cover for an additional EXTRA BENEFITS
falls risk assessment when referred to a Premier Plus
GP, depending on your screening test results and if you
meet the Scheme’s clinical entry criteria. CONTRIBUTIONS
EXCLUSIONS
10 | Discovery Health Medical Scheme | Screening and Prevention VALUE-ADDED

BENEFITS
HOME
KEY TERMS
WHAT WE PAY FOR
KEY FEATURES
We cover various screening tests AND BENEFITS
at our wellness providers.

EMERGENCY
COVER AND PMB
These tests are paid from the Screening and
Prevention Benefit. Consultations that do not
SCREENING AND
form part of Prescribed Minimum Benefits PREVENTION
(PMBs) will be paid from your available
day-to-day benefits.
CONNECTED
CARE
ADDITIONAL TESTS
KEYCARE ONLINE
PRACTICE
CLINICAL ENTRY CRITERIA

DAY-TO-DAY
MAY APPLY TO THESE TESTS: BENEFITS
AND COVER
Defined diabetes and cholesterol
screening tests MATERNITY
BENEFITS
Breast MRI or mammogram and once-off
BRCA testing for breast screening CHRONIC
CONDITIONS AND
Colonoscopy for bowel cancer screening
PROGRAMMES
Pap smear or HPV test for cervical screening.
COVER FOR
VACCINES (CLINICAL ENTRY CANCER
CRITERIA MAY APPLY):

HOSPITAL COVER
Seasonal flu vaccine for members who are AND ANNUAL
LIMITS
pregnant, 65 years or older, registered for
certain chronic conditions or healthcare
professionals DAY SURGERY
Pneumococcal vaccine for members over the

age of 65 or those registered for certain
EXTRA BENEFITS
chronic conditions
COVID-19 vaccines are covered from the

WHO Global Outbreak Benefit. Please refer
CONTRIBUTIONS
to page 12 for more information.
Visit www.discovery.co.za to view the detailed
Screening and Prevention Benefit guide. EXCLUSIONS
SCRE E N I N G A ND P R E V E NT I O N 2/ 02
11 | Discovery Health Medical Scheme | Screening and Prevention VALUE-ADDED
BENEFITS
HOME
World Health How you are covered for COVID-19

The basket of care includes: Know your risk
KEY TERMS
Organization
You can understand your risk KEY FEATURES
COVID-19 vaccines and the administration thereof AND BENEFITS
status at any point by completing
in accordance with the National Department of
the COVID-19 risk assessment. The
(WHO) Global
Health COVID-19 guidelines. EMERGENCY
assessment is a set of questions
COVER AND PMB
which determines if you may
Screening consultations with a network GP (either be presenting with symptoms
Outbreak
virtual consultations, telephone or face-to-face). suggestive of COVID-19 disease
SCREENING AND
PREVENTION
or may have been exposed to
COVID-19 infection and need a
Benefit
COVID-19 PCR and Rapid Antigen screening
CONNECTED
tests if referred by an appropriate healthcare consultation with a doctor. The CARE
professional. assessment is available on the
Discovery website or app or by
KEYCARE ONLINE
defined basket of pathology tests for COVID-19
A calling us and following the prompts PRACTICE
The WHO Global Outbreak Benefit is available positive members. to complete the COVID-19 risk
to all members during a declared outbreak assessment. DAY-TO-DAY
BENEFITS
period. The benefit provides cover for defined basket of x-rays and scans for COVID-19
A AND COVER
vaccinations (where applicable) as well as positive members.
a defined basket of care for out-of-hospital MATERNITY
BENEFITS
healthcare services related to outbreak Supportive treatment, including medicine and How you are covered when
diseases such as COVID-19 and monkeypox. a home monitoring device to track oxygen diagnosed with monkeypox CHRONIC
saturation levels for at-risk members who meet CONDITIONS AND
PROGRAMMES
the clinical entry criteria. The basket of care for confirmed cases
Cover is subject to clinical entry criteria and paid up
includes: COVER FOR
to the maximum of the Discovery Health Rate (DHR). You also have cover for:
CANCER

A diagnostic PCR screening test
In-hospital treatment related to COVID-19 for Two consultations with a dermatologist HOSPITAL COVER
approved admissions is covered from the Hospital or GP AND ANNUAL
Benefit based on your chosen health plan and in LIMITS

Supportive medicine formulary for pain
accordance with Prescribed Minimum Benefits
(PMB), where applicable. management.
DAY SURGERY
Access to the Long COVID Recovery Programme:

a six-month support programme for members EXTRA BENEFITS
with COVID-19 symptoms that persist beyond

21 days of diagnosis of acute COVID-19. The
programme includes up to two specialist and CONTRIBUTIONS
GP consultations, a defined basket of pathology
The Discovery app is brought to you by Discovery Health (Pty) Ltd; tests, allied healthcare professional support, a
registration number 1997/013480/07, an authorised financial services home monitoring device and a defined basket of EXCLUSIONS
x-rays and scans, in accordance with the Scheme’s
clinical entry criteria and treatment guidelines.
12 | Discovery Health Medical Scheme | WHO Global Outbreak Benefit VALUE-ADDED
BENEFITS
HOME
Connected Care KEY TERMS
KEY FEATURES
Access quality healthcare from home

AND BENEFITS
EMERGENCY
COVER AND PMB
Discovery Health Medical Scheme gives you access to health and wellness services from the comfort of your home. Connected Care is an integrated
healthcare ecosystem of benefits, services and connected digital capabilities to help you manage your health and wellness. SCREENING AND
PREVENTION
CONNECTED
CARE
KEYCARE ONLINE
PRACTICE
HEALTH MONITORING MEDICINE ORDERING

DEVICES AND TRACKING DAY-TO-DAY
BENEFITS
AND COVER
Access to the latest medical examination and remote Order and track your medicine delivery from
monitoring to enable quality care from home. dispensary to your door.
MATERNITY
BENEFITS
CHRONIC
ELECTRONIC ONLINE CONDITIONS AND
PRESCRIPTIONS COACHES PROGRAMMES
Seamless e-scripting to give you quicker access Personalised coaching consultations to help you better COVER FOR
to your medicine. manage your chronic and acute conditions, including CANCER
COVID-19, from home.

HOSPITAL COVER
AND ANNUAL
LIMITS
HOME
NURSES CONDITION-SPECIFIC
INFORMATION DAY SURGERY
Hospital-related care with home nurses to care
for you at home. Educational content specific to your condition,
at your fingertips. EXTRA BENEFITS
CONTRIBUTIONS
Connected Care is brought to you by Discovery Health (Pty) Ltd;

registration number 1997/013480/07, an authorised financial services Visit www.discovery.co.za to view the detailed
EXCLUSIONS
provider and administrator of medical schemes. Connected Care Benefit guide.
13 | Discovery Health Medical Scheme | Connected Care VALUE-ADDED

BENEFITS
HOME
Your access to Connected Care KEY TERMS
KEY FEATURES
Access to quality care from home

AND BENEFITS
EMERGENCY
COVER AND PMB
Through advanced digital technology and smart health and point-of-care devices, Connected Care enables you and your doctor to access and deliver
healthcare whenever you need it from the comfort of your home. SCREENING AND
PREVENTION
CONNECTED
CARE
KEYCARE ONLINE
PRACTICE
DAY-TO-DAY
BENEFITS
AND COVER
MATERNITY
BENEFITS
CHRONIC
CONDITIONS AND
PROGRAMMES
COVER FOR
CANCER
HOSPITAL COVER
AND ANNUAL
LIMITS
CONNECTED CARE FOR MEMBERS AT HOME CONNECTED CARE FOR MEMBERS
You can connect to doctors through virtual consultations like never before, WITH CHRONIC CONDITIONS
DAY SURGERY
from the comfort of your home. On KeyCare Start Regional you must You and your doctor can manage your chronic condition through
connect with a network doctor through the KeyCare Online Practice. Connected Care in the comfort of your home. You have access to a range
The Home Monitoring Device Benefit gives you access to a range of of digital services linked to remote monitoring devices and personalised EXTRA BENEFITS
essential and registered home monitoring devices for certain chronic coaching consultations, for qualifying members, to help you track and
conditions. You will not have to pay for approved devices. manage your chronic condition from home. On KeyCare Start Regional you
must connect with a network doctor through the KeyCare Online Practice. CONTRIBUTIONS
EXCLUSIONS

BENEFITS
HOME
KeyCare Online Practice

KEYCARE START REGIONAL IS AVAILABLE KEY TERMS
FOR THESE SPECIFIC LOCATIONS

KEY FEATURES
Your access to healthcare on

Tzaneen, Limpopo AND BENEFITS
Polokwane, Limpopo
KeyCare Start Regional

Mbombela, Mpumalanga EMERGENCY
COVER AND PMB
Trichardt, Mpumalanga
SCREENING AND
PREVENTION
KeyCare Start Regional provides cover for healthcare services in selected regions through
the integrated healthcare platform, KeyCare Online Practice. The KeyCare Online Practice
CONNECTED
gives you convenient access to online and face-to-face GP consultations, medicine, basic CARE
Bellville, Western Cape
X-rays, blood tests, specialist referrals and in-hospital treatment. George, Western Cape
KEYCARE ONLINE
PRACTICE
DAY-TO-DAY
BENEFITS
AND COVER
MATERNITY
GP BLOOD BENEFITS
CONSULTATIONS TESTS
CHRONIC
CONDITIONS AND
PROGRAMMES
SPECIALIST COVER FOR

MEDICINE CANCER
REFERRALS
HOSPITAL COVER
AND ANNUAL
LIMITS
BASIC IN-HOSPITAL
X-RAYS TREATMENT DAY SURGERY
EXTRA BENEFITS
CONTRIBUTIONS
EXCLUSIONS
15 | Discovery Health Medical Scheme | KeyCare Online practice VALUE-ADDED

BENEFITS
HOME
Connected Care with Discovery Hospital at Home KEY TERMS
KEY FEATURES
AND BENEFITS
Delivering hospital-level care safely and effectively in your home for many medical and surgical conditions for which you would otherwise be
admitted to hospital. If you are admitted to Hospital at Home you have access to enhanced benefits and services, delivered through your personalised
EMERGENCY
care team. Together, these benefits and services give you a seamless healthcare experience, making you healthier, and enhancing and protecting lives. COVER AND PMB
We pay all services offered as part of Discovery’s Hospital at Home programme from your Hospital Benefit, if you have a valid pre-authorisation for
hospitalisation. This unlocks cover for approved devices and healthcare services for those who meet the clinical and benefit criteria. SCREENING AND
PREVENTION
CONNECTED
CARE
24/7 CLINICAL OVERSIGHT FROM A CARE TEAM

KEYCARE ONLINE
Physical and virtual 24-hour care delivery facilitated by a dedicated care team that
PRACTICE
includes doctors, nurses and allied healthcare professionals. Qualifying members
get access to extra Hospital at Home services for a seamless home care delivery DAY-TO-DAY
experience. BENEFITS
AND COVER
N ICAL OVER SIGH
CLI T
24/7 REAL-TIME REMOTE MONITORING SUPPORTED BY MONITOR
OT E IN
MATERNITY
CUTTING-EDGE DIGITAL HEALTHCARE TECHNOLOGIES RE
M G BENEFITS
SPITAL C ARE
Access to a remote monitoring device that automatically transmits information HO
CHRONIC
to a hospital-based care team, 24 hours a day, seven days a week. Healthcare CONDITIONS AND
PROGRAMMES
professionals continually assess your health status, monitor your medical stability,
track treatment compliance and recommend interventions when necessary.
COVER FOR
CANCER
HOSPITAL-LEVEL DIAGNOSTICS AND INTERVENTIONS
HOSPITAL COVER
Access to an improved range of clinical diagnostic procedures and interventions to AND ANNUAL
manage medical or post-surgical hospital-level care in the home. It is supported by LIMITS
extra benefits paid by the Scheme to improve your experience.

DAY SURGERY
Visit www.discovery.co.za to view the

detailed Connected Care Benefit guide. EXTRA BENEFITS
CONTRIBUTIONS
EXCLUSIONS
16 | Discovery Health Medical Scheme | VALUE-ADDED

BENEFITS
HOME
Connected Care for Acute Care at Home KEY TERMS
KEY FEATURES
AND BENEFITS
This includes cover and treatment for COVID-19 and/or follow-up care once discharged. You also have access to the Home Monitoring Device Benefit.
EMERGENCY
COVER AND PMB
SCREENING AND
PREVENTION
H O M E M O N I T O R I N G D E V I C E H O M E - B A S E D C A R E F O R
BENEFIT FOR ESSENTIAL FOLLOW-UP TREATMENT CONNECTED
HOME MONITORING AFTER AN ADMISSION CARE
If you meet the Scheme’s clinical entry criteria, Clinically appropriate conditions such as chronic
KEYCARE ONLINE
you have healthcare cover up to a limit of R4 000 obstructive pulmonary disease, chronic cardiac failure, PRACTICE
per person per year, at 100% of the Discovery Health ischaemic heart disease and pneumonia have access
Rate (DHR), for the monitoring of defined conditions such to enhanced homebased care once discharged from DAY-TO-DAY
as chronic obstructive pulmonary disease, congestive hospital. If you meet the clinical entry criteria you have BENEFITS
AND COVER
cardiac failure, diabetes, pneumonia and COVID-19. cover for bedside medicine reconciliation prior to
admission discharge, a follow-up consultation with a GP
MATERNITY
or specialist, and a defined basket of supportive care BENEFITS
at home that includes a face-to-face consultation and
virtual consultations with a Discovery Home Care nurse. CHRONIC
CONDITIONS AND
PROGRAMMES
H O M E C A R E COVER FOR
BENEFIT CANCER
Discovery Home Care is a service that offers you

HOSPITAL COVER
quality care in the comfort of your own home when AND ANNUAL
LIMITS
recommended by your doctor as an alternative to a
hospital stay. Services include postnatal care, end-of-life
care, IV infusions (drips) and wound care. These services DAY SURGERY
are paid from the Hospital Benefit, subject to approval.

Discovery Home Care is the designated service provider
(DSP) for administration of defined intravenous EXTRA BENEFITS
infusions. Avoid a 20% co-payment by using

Discovery Home Care for these infusions.
CONTRIBUTIONS
Discovery Home Care is a service provider. Practice 080 000 8000190, Grove Nursing Services (Pty) Ltd registration number 2015/191080/07,
trading as Discovery HomeCare.
EXCLUSIONS
Connected Care and the Discovery app are brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised
financial services provider and administrator of medical schemes.

BENEFITS
HOME
Day-to-day Benefits KEY TERMS
KEY FEATURES
AND BENEFITS
You have access to the following day-to-day cover on KeyCare Plus, KeyCare Start and KeyCare Start Regional plans. On KeyCare Start your chosen KeyCare
Start GP must refer you and you must use providers in your chosen KeyCare Start Network. On KeyCare Start Regional you must use the KeyCare Online
EMERGENCY
Practice to access healthcare. Your chosen KeyCare Start Regional GP must refer you for day-to-day cover. COVER AND PMB
SCREENING AND
PREVENTION
Day-to-day cover What we pay

CONNECTED
CARE
You have unlimited cover for medically appropriate GP consultations. When joining, you must choose a GP from the KeyCare, KeyCare Start or KeyCare Start Regional GP
GP visits Network, depending on the plan you choose. You must go to your chosen GP for us to cover your consultations, including some minor procedures. Preauthorisation is
required after your 15th GP visit. On KeyCare Start Regional, GP consultations are covered when referred through the KeyCare Online Practice. KEYCARE ONLINE
PRACTICE
Blood, urine and other We pay for a list of blood, urine and other fluid and tissue tests from a network GP. Your chosen network GP must ask for these tests by filling in a KeyCare
fluid and tissue tests pathology form. DAY-TO-DAY
BENEFITS
AND COVER
Day-to-day medicine We pay for medicine from our medicine list if they are prescribed and/or dispensed by your chosen Network GP depending on the plan you choose.
MATERNITY
Basic X-rays We pay for a list of basic X-rays at a network provider. Your chosen network GP must ask for the X-rays to be done. BENEFITS
On KeyCare Plus, if you need to see a doctor and your chosen GP is not available, each person on your plan can go to any GP for an out-of-network visit. On KeyCare Start CHRONIC
Out-of-network you can go to any KeyCare Network GP for an out-of-network visit. On KeyCare Start Regional you can go to any GP in the KeyCare Start GP Network for an out-of-network CONDITIONS AND
GP visits visit. Out-of-network GP visits are limited to four visits per person on KeyCare Plus and two per person on KeyCare Start and KeyCare Start Regional each year, covered up PROGRAMMES
to the Discovery Health Rate (DHR). We will cover the GP visit, selected blood tests and X-rays, and medicine on our medicine list.
We cover one eye test for each person every two years, but you must go to an optometrist in the KeyCare Optometry Network. The optometrist will have a specific range of COVER FOR
Eye care CANCER
glasses which you can choose from. You can get a set of contact lenses instead of glasses if you choose to. You can get new glasses or contact lenses every 24 months.
Dentistry We cover consultations, fillings and tooth removals at a dentist in our dentist network. Certain rules and limits may apply. HOSPITAL COVER
AND ANNUAL
LIMITS
On KeyCare Plus you have cover for one casualty visit per person per year at any casualty unit at a hospital in the KeyCare network. You must pay the first R425.
You need to get preauthorisation for a casualty visit.
Casualty visits
On KeyCare Start you can go to your chosen KeyCare Start GP or network provider for after-hours care. On KeyCare Start Regional you can go to your chosen KeyCare Start DAY SURGERY
Regional GP or the KeyCare Online Practice for after-hours care.
On KeyCare Plus, we cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical
Medical equipment EXTRA BENEFITS
equipment list, if you get them from a network provider. There is an overall limit of R5 400 for each family. Not covered on the KeyCare Start or KeyCare Start Regional plans.
Specialist cover up to R4 730 on KeyCare Plus and KeyCare Core, and up to two visits up to R2 370 on KeyCare Start and KeyCare Start Regional per person per year.
Your chosen network GP must refer you to a specialist and you need a reference number from us before your consultation with the specialist. On KeyCare Plus,
Specialist Benefit CONTRIBUTIONS
if you need to see a maxillo-facial surgeon, periodontist, ophthalmologist or a specialist for maternity care, you do not need a referral from your GP or a reference
number from us. Out-of-hospital MRI and CT scans are paid up to the Specialist Benefit limit.
Other types
We do not cover other types of healthcare professionals, such as physiotherapists, psychologists, speech therapists, audiologists, homeopaths or chiropractors. EXCLUSIONS
of healthcare
18 | Discovery Health Medical Scheme | Day-to-day Benefits and Cover VALUE-ADDED

BENEFITS
HOME
You have cover for Maternity and Early Childhood KEY TERMS
KEY FEATURES
AND BENEFITS
You get cover for healthcare services related to your pregnancy and treatment for the first two years
of your baby’s life. This applies from the date of activation of the benefit for each pregnancy and for EMERGENCY
each child from birth until they are two years old. COVER AND PMB
SCREENING AND
DURING AFTER YOU PRE- AND PREVENTION
PREGNANCY GIVE BIRTH POSTNATAL CARE

CONNECTED
CARE
KEYCARE ONLINE
ANTENATAL CONSULTATIONS GP AND SPECIALISTS TO HELP We pay for a maximum of five antenatal or postnatal PRACTICE
YOU AFTER BIRTH classes or consultations with a registered nurse up until

We pay for up to eight consultations with your
two years after you have given birth. We pay for one DAY-TO-DAY
gynaecologist, chosen network GP or midwife. Your baby under the age of two years is covered for two BENEFITS
breastfeeding consultation with a registered nurse
AND COVER
visits to a GP, paediatrician or an ear, nose and throat or a breastfeeding specialist.
ULTRASOUND SCANS AND specialist.
To activate these benefits on KeyCare Start, your chosen MATERNITY
SCREENINGS DURING PREGNANCY BENEFITS
network GP must refer you. On KeyCare Start Regional
OTHER HEALTHCARE SERVICES
You are covered for up to two 2D ultrasound scans, you must visit the KeyCare Online Practice and your
CHRONIC
including one nuchal translucency test. 3D and 4D scans You also have access to postnatal care, which includes chosen regional network GP must refer you. CONDITIONS AND
are paid up to the rate we pay for 2D scans. You are a postnatal consultation for complications post delivery PROGRAMMES
Visit www.discovery.co.za to view the detailed
also covered for one chromosome test or Non-Invasive a nutritional assessment with a dietitian and two mental
Maternity Benefit guide.
Prenatal Test (NIPT), if you meet the clinical entry criteria. healthcare consultations with a counsellor or psychologist. COVER FOR
CANCER
To activate these benefits on KeyCare Start your chosen
FLU VACCINATIONS network GP must refer you. On KeyCare Start Regional HOSPITAL COVER
AND ANNUAL
We pay for one flu vaccination during your pregnancy. you must visit the KeyCare Online Practice and your HOW TO GET THE BENEFIT LIMITS
chosen regional network GP must refer you.
You can activate the benefit in any
BLOOD TESTS of these ways: DAY SURGERY
We pay for a defined list of blood tests to confirm

Create your pregnancy or baby profile
your pregnancy.
in the Discovery app or on our website
EXTRA BENEFITS
To activate these benefits on KeyCare Start your chosen at www.discovery.co.za
network GP must refer you. On KeyCare Start Regional
When you register your baby
you must visit the KeyCare Online Practice and your
as a dependant on the Scheme CONTRIBUTIONS
chosen regional network GP must refer you.
EXCLUSIONS
The Discovery app is brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes.
19 | Discovery Health Medical Scheme | Maternity Benefits VALUE-ADDED

BENEFITS
HOME
Chronic Benefits KEY TERMS
KEY FEATURES
You have cover for treatment for ongoing medical conditions (chronic conditions). AND BENEFITS
You have cover for the 27 medical conditions set out in the list of chronic conditions
EMERGENCY
known as the Chronic Disease List (CDL). COVER AND PMB
SCREENING AND
PREVENTION
WHAT IS THIS BENEFIT WHERE TO GET YOUR
CONSULTATIONS AND MEDICINE CONNECTED
The Chronic Illness Benefit (CIB) covers you for CARE
You must nominate a GP in the KeyCare Network to
a defined list of chronic conditions on the Chronic
be your primary care doctor to manage your chronic
Disease List (CDL). KEYCARE ONLINE
conditions. To find a doctor and learn more about the
PRACTICE
nomination process, use www.discovery.co.za, or the
WHAT WE COVER Discovery app.
DAY-TO-DAY
BENEFITS
For more information on our Chronic Care Programmes
PRESCRIBED MINIMUM BENEFIT and enrolment by your KeyCare Premier Plus Network GP
AND COVER
(PMB) CONDITIONS please refer to page 22.

MATERNITY
You have access to treatment for a list of medical BENEFITS
You need to get your approved chronic medicine that
conditions under the Prescribed Minimum Benefits is on the KeyCare medicine list from your network
(PMBs). The PMBs cover the 27 chronic conditions CHRONIC
pharmacies or from your KeyCare Network GP (if he CONDITIONS AND
on the Chronic Disease List (CDL). or she dispenses medicine). If you get your medicine PROGRAMMES
Our plans offer benefits that are richer than PMBs. from anywhere else, you will have to pay 20% of the
To access PMBs, certain rules apply. Discovery Health Rate (DHR) at one of our network COVER FOR
CANCER
pharmacies for medicine.
HOW WE PAY FOR MEDICINE On KeyCare Start, you must use a state facility. HOSPITAL COVER
AND ANNUAL
We pay for medicine up to a maximum of the Discovery On KeyCare Start Regional, you need to get your approved LIMITS
Health Rate (DHR). The DHR for medicine is the price of chronic medicine that is on the KeyCare medicine list from
the medicine and the fee for dispensing it. For medicine one of our network pharmacies or your chosen KeyCare DAY SURGERY
not on our list, we cover you up to the cost of the lowest Start Regional GP. Your chosen regional network GP must
equivalent formulary listed drug. prescribe the chronic medicine.
EXTRA BENEFITS
HOW TO GET THE BENEFIT

You must apply for the Chronic Illness Benefit (CIB). Your chosen network GP must complete the form online CONTRIBUTIONS
or send it to us for approval.
Visit www.discovery.co.za to view the detailed Chronic Illness Benefit (CIB) guide.
EXCLUSIONS
20 | Discovery Health Medical Scheme | Chronic Conditions and Programmes VALUE-ADDED

BENEFITS
HOME
Chronic Benefits KEY TERMS
KEY FEATURES
AND BENEFITS
CHRONIC DISEASE LIST IF YOU NEED CHRONIC EMERGENCY

(CDL) CONDITIONS DIALYSIS COVER AND PMB
We cover these expenses in full if we have

SCREENING AND
approved your treatment plan and you PREVENTION
Chronic conditions covered on all plans use a provider in our network. If you go
elsewhere, we will pay up to 80% of the
CONNECTED
Discovery Health Rate (DHR). CARE
A
Addison’s disease, asthma
KEYCARE ONLINE
MEMBER CARE PROGRAMME PRACTICE
B
Bipolar mood disorder, bronchiectasis
If you are diagnosed with one or more chronic DAY-TO-DAY
C
Cardiac failure, cardiomyopathy, chronic conditions, you might qualify for our Member BENEFITS
AND COVER
obstructive pulmonary disease, chronic Care Programme. We will contact you to confirm
renal disease, coronary artery disease, if you do qualify. The programme offers organised
MATERNITY
Crohn’s disease care to help you to manage your conditions and BENEFITS
to get the best quality healthcare.
D
Diabetes insipidus, diabetes Type 1, CHRONIC
diabetes Type 2, dysrhythmia If you are registered and take part in the CONDITIONS AND
programme, we will pay in full for your PROGRAMMES
E
Epilepsy treatment.
COVER FOR
If you choose not to take part, we will cover
G
Glaucoma
CANCER
the hospital and related accounts up to 80%

H
Haemophilia, HIV, hyperlipidaemia, of the Discovery Health Rate (DHR). HOSPITAL COVER
AND ANNUAL
hypertension, hypothyroidism LIMITS
MEDICINE TRACKER
M
Multiple sclerosis
DAY SURGERY
You can set up reminders and prompts to assist
P Parkinson’s disease you with taking your medicine on time and as
prescribed. Your approved chronic medicine will
R
Rheumatoid arthritis automatically be displayed, and you will then be
EXTRA BENEFITS
prompted to take your medicine and confirm

S
Schizophrenia, systemic lupus
when each dose is taken.
erythematosus CONTRIBUTIONS
Medicine tracker is brought to you by Discovery Health (Pty)

U
Ulcerative colitis Ltd; registration number 1997/013480/07, an authorised
financial services provider and administrator of medical
EXCLUSIONS
schemes.

BENEFITS
HOME
Chronic Care KEY TERMS
Programmes
KEY FEATURES
AND BENEFITS
EMERGENCY
COVER AND PMB
CONDITION-SPECIFIC CARE
PROGRAMMES FOR DIABETES, SCREENING AND
PREVENTION
MENTAL HEALTH, HIV AND
HEART CONDITIONS. CONNECTED
CARE
We cover condition-specific care programmes

KEYCARE ONLINE
that help you to manage diabetes, mental health, PRACTICE
HIV or heart-related medical conditions. You have

to be registered on these condition-specific care DAY-TO-DAY
BENEFITS
programmes to unlock additional benefits and AND COVER
services. You and your KeyCare Premier Plus network

MATERNITY
GP can track progress on a personalised dashboard BENEFITS
to identify the next steps to optimally manage your

condition and stay healthy over time. CHRONIC
CONDITIONS AND
PROGRAMMES
COVER FOR
CANCER
HOSPITAL COVER
AND ANNUAL
LIMITS
DAY SURGERY
EXTRA BENEFITS
CONTRIBUTIONS
EXCLUSIONS

BENEFITS
HOME
TRACK YOUR HEALTH KEY TERMS

MENTAL HEALTH DIABETES CARE
CARE PROGRAMME PROGRAMME You can get personalised health goals that help you to manage
your weight, nutrition and exercise. If you are at risk of developing KEY FEATURES
or you are diagnosed with cardiovascular disease or diabetes, we AND BENEFITS
Once enrolled on the programme by If you are registered on the Chronic Illness
your network psychologist or KeyCare Benefit (CIB) for diabetes, your KeyCare will give you goals tailored to your circumstances. You can track
Premier Plus network GP, you have access Premier Plus network GP can enrol you your progress on the Discovery app and we will reward you for EMERGENCY
COVER AND PMB
to defined cover for the management on the Diabetes Care programme. The meeting your goals.
of major depression. Enrolment on the programme unlocks cover for additional
SCREENING AND
programme unlocks cover for prescribed glucometer strips and consultations with
PREVENTION
medicine, access to either individual or dietitians and biokineticists. You may also
group psychotherapy sessions (virtual and have access to a nurse educator to help
CONNECTED
face-to-face therapy) and additional GP you with the day-to-day management of CARE
consultations to allow your condition.
for effective evaluation, tracking and E CON
CAR SUL KEYCARE ONLINE
ED TP
monitoring of treatment. Qualifying E CT RE PRACTICE
NN M
IE
members will also have access to a relapse CO R
P
prevention programme, which includes
LU
DAY-TO-DAY
S
BENEFITS
GP
additional cover for a defined basket of

AND COVER
care for psychiatry consultations, counseling
CH
sessions and care coordination services.
COA
MATERNITY
BENEFITS
HEALTH
DIETITIAN
CHRONIC
CONDITIONS AND
CARDIO CARE HIV CARE PROGRAMMES
PROGRAMME PROGRAMME
COVER FOR
CANCER
If you are registered on the Chronic If you are registered on the HIV programme
TR
Illness Benefit (CIB) for hypertension, by your KeyCare Premier Plus network HOSPITAL COVER
AC
AND ANNUAL

hyperlipidaemia or ischaemic heart disease, GP, you are covered for the care you
K
YO
I
ST
R IC LIMITS
U
you have access to a defined basket of care need, which includes additional cover HE
AL ET
TH KIN
and an annual cardiovascular assessment, for social workers. You can be assured BI
O
DAY SURGERY
if referred by your KeyCare Premier Plus of confidentiality at all times. You need
network GP and enrolled on the Cardio Care to get your medicine from a designated
programme. service provider (DSP) to avoid a 20%
EXTRA BENEFITS
co-payment.
CONTRIBUTIONS
Click on Track your Health on the Discovery app

Track your health and the Discovery app are brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07,
to activate the programme EXCLUSIONS
an authorised financial services provider and administrator of medical schemes.

BENEFITS
HOME
You have Comprehensive Advanced

KEY TERMS
Cover for Cancer

Illness Benefit KEY FEATURES
AND BENEFITS
EMERGENCY
fit
COVER AND PMB
You have access to comprehensive cover for cancer treatment.
ne
Be
gy
lo
SCREENING AND
co
PREVENTION
On
Oncology Benefit
m
diu
CONNECTED
Me
CARE
Screening and Prevention KEYCARE ONLINE

PRACTICE
DAY-TO-DAY
BENEFITS
AND COVER
PRESCRIBED MINIMUM BENEFITS (PMB)
ADVANCED ILLNESS BENEFIT MATERNITY
Cancer treatment that is a Prescribed Minimum Benefit (PMB), is always covered in full. On the KeyCare plans we
BENEFITS
cover cancer treatment in our network, or in a state facility if you are on KeyCare Start or KeyCare Start Regional. Members have access to a comprehensive
If you choose to use any other provider, we will only cover up to 80% of the Discovery Health Rate (DHR). palliative care programme. This programme
CHRONIC
offers unlimited cover for approved care at CONDITIONS AND
PROGRAMMES
ONCOLOGY BENEFIT home, care coordination, counselling services
and supportive care for appropriate end-of-life
If you are diagnosed with cancer and once we have approved your cancer treatment, you are covered by COVER FOR
clinical and psychologist services. You also have CANCER
the Oncology Care Programme.
access to a network GP consultation to facilitate
All cancer-related healthcare services are covered up to 100% of the Discovery Health Rate (DHR). You might have your palliative care treatment plan. HOSPITAL COVER
a co-payment if you do not use the designated service provider (DSP) or if your healthcare professional charges AND ANNUAL
LIMITS
above this rate. On the KeyCare plans we cover cancer treatment in our network, or in a state facility if you are
on KeyCare Start or KeyCare Start Regional.
Visit www.discovery.co.za to view DAY SURGERY
If you choose to use any other provider, we will only cover up to 80% of the DHR. the detailed Oncology Benefit guide
HOW WE COVER MEDICINE EXTRA BENEFITS
You need to get your approved oncology medicine on our medicine list from a designated service provider (DSP)
to avoid a 20% co-payment. Speak to your treating doctor to confirm that they are using our DSPs for your medicine
CONTRIBUTIONS
and treatment received in rooms or at a treatment facility.
EXCLUSIONS
24 | Discovery Health Medical Scheme | Cover for Cancer VALUE-ADDED

BENEFITS
HOME
Hospital KEY TERMS
benefit
KEY FEATURES
AND BENEFITS
WHAT IS THE BENEFIT? What we pay

EMERGENCY
This benefit pays the costs when you are admitted We pay for planned hospital stays from your Hospital
If you need
COVER AND PMB
into hospital. Benefit. We pay for services related to your hospital
stay, including all healthcare professionals, services and
to be admitted
SCREENING AND
medicine authorised by the Scheme for your hospital
WHAT WE COVER PREVENTION
stay. If you use doctors, specialists and other healthcare
to hospital
Unlimited cover in private hospitals approved by the professionals that we have an agreement with, we will
CONNECTED
Scheme, subject to the KeyCare network requirements. pay for these services in full. We pay up to the Discovery CARE
The network depends on the plan you choose. On Health Rate (DHR) for other healthcare professionals.
KeyCare Start Regional you have to go to a network
You can avoid co-payments by: KEYCARE ONLINE
The KeyCare plans offer cover for hospital hospital in your selected region. The funding of newly PRACTICE
G
oing to a hospital in the network
stays. There is no overall limit for the licensed facilities is subject to approval by the Scheme,
on all health plans. of hospitals for your plan
Hospital Benefit. DAY-TO-DAY
BENEFITS
You have cover for planned stays in our KeyCare U
sing healthcare professionals that AND COVER
hospital networks. we have a payment arrangement with.

MATERNITY
BENEFITS
If you have to go to hospital, we will HOW TO GET THE BENEFIT
View hospitals in the KeyCare Hospital
pay your hospital expenses. There is
Networks using Find a healthcare provider CHRONIC
no overall hospital limit for the year Get your confirmation first on the Discovery app CONDITIONS AND
on any of the plans. However, there PROGRAMMES
Contact us to confirm your hospital stay before you
are limits to how much you can claim are admitted (this is known as preauthorisation).
COVER FOR
for some treatments.
Where to go CANCER
Contact us in good time before you have

You have cover for planned admissions in a defined
to go to hospital. We will let you know HOSPITAL COVER
network. For planned admissions at hospitals outside AND ANNUAL
what you are covered for. If you do not LIMITS
these KeyCare networks, you either have to pay the full
contact us before you go, you may be
amount or a portion of the hospital account.
responsible for some of the costs.
DAY SURGERY
PRE-OPERATIVE MANAGEMENT PROGRAMME FOR MAJOR SURGERIES

EXTRA BENEFITS
For a defined list of surgeries such as colorectal surgery, coronary artery bypass graft, radical prostatectomy
and mastectomy, you have cover for a pre-operative assessment with a nurse, a consultation (face-to-face,
virtual or telephonic) with your treating healthcare professional and specific laboratory, pathology and
CONTRIBUTIONS
radiology tests where required.
Find a healthcare provider and the Discovery app are
brought to you by Discovery Health (Pty) Ltd; registration Cover is subject to accordance with the Scheme’s clinical entry criteria and treatment guidelines.
number 1997/013480/07, an authorised financial services
EXCLUSIONS
25 | Discovery Health Medical Scheme | Hospital Cover and Annual Limits VALUE-ADDED
BENEFITS
HOME
Hospital Cover KEY TERMS
KEY FEATURES
AND BENEFITS
The KeyCare Plans offer unlimited hospital cover.
EMERGENCY
COVER AND PMB
The table below shows how we pay for your approved hospital admissions:
SCREENING AND
Plus Core Start Start Regional PREVENTION
Full Cover Hospital Network We pay up to the Discovery Health Rate (DHR) (100%). Covered in full at your chosen KeyCare Covered in full at your chosen KeyCare
Start Network Hospital. Start Regional Network Hospital
CONNECTED
You can use any approved hospital in the KeyCare Network. You need to go to your chosen KeyCare You need to go to your chosen KeyCare CARE
Start Network Hospital. If you do not use Start Regional Network hospital. If you
your chosen hospital in the networks, you do not use your KeyCare Start Regional
will have to pay all the costs. This does not Network hospital, you will have to pay all the KEYCARE ONLINE
PRACTICE
apply in an emergency. costs. This does not apply in an emergency.
Partial Cover Hospital Network We pay up to 70% of the hospital account and you must pay the balance of the No cover for non-emergency admissions. DAY-TO-DAY
account. If the admission is a Prescribed Minimum Benefit, we will pay 80% of the BENEFITS
Discovery Health Rate (DHR). AND COVER
Defined list of procedures Covered in the KeyCare Day Surgery Network. Covered in the KeyCare Start Day Surgery Covered in the KeyCare Start Regional Day
in a Day Surgery Network Network. Surgery Network MATERNITY
BENEFITS
Defined list of procedures Up to the agreed rate where authorised by the Scheme.
performed in specialist rooms
CHRONIC
Non-network hospitals We will not pay the hospital and related accounts if you are admitted to a non-network hospital for a planned procedure. If the admission is a Prescribed Minimum Benefit CONDITIONS AND
PROGRAMMES
(PMB), we will pay 80% of the Discovery Health Rate (DHR).
Specialists and healthcare Full cover. Full cover at a contracted provider in Full cover at a contracted provider in your
COVER FOR
professionals in our network your KeyCare Start Network Hospital. KeyCare Start Regional Network Hospital CANCER
Specialists and healthcare The Discovery Health Rate (DHR). If they charge more, you must pay We will pay the Discovery Health Rate (DHR) for providers at your KeyCare Start and
professionals not in our network the balance of the account. KeyCare Start Regional hospital who we do not have a payment arrangement with, HOSPITAL COVER
you must pay the balance of the account. AND ANNUAL
LIMITS
X-rays and blood tests Up to the Discovery Health Rate (DHR).
(radiology and pathology accounts)
DAY SURGERY
Cover for scopes (gastroscopy, Prescribed Minimum Benefit (PMB) cover in the KeyCare Day Surgery Network. Prescribed Minimum Benefit (PMB) Prescribed Minimum Benefit (PMB)
colonoscopy, sigmoidoscopy Authorised scopes done in the doctor’s rooms will be covered from your Hospital cover in the KeyCare Start Day Surgery cover in the KeyCare Start Regional Day
and proctoscopy) Benefit. Network. Authorised scopes done in Surgery Network. Authorised scopes
the doctor’s rooms will be covered done in the doctor’s rooms will be EXTRA BENEFITS
from your Hospital Benefit. covered from your Hospital Benefit.
Alcohol and drug rehabilitation We pay for 21 days of rehabilitation per person per year. Three days per approved admission per person for detoxification.
CONTRIBUTIONS
Mental health 21 days for admissions or up to 15 out-of-hospital consultations per person for major affective disorders, anorexia and bulimia, and up to 12 out-of-hospital consultations
for acute stress disorder accompanied by recent significant trauma. Three days per approved admission for attempted suicide.
21 days for other mental health admissions.
EXCLUSIONS
All mental health admissions are covered in full at a network facility. If you go elsewhere, we will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account.
26 | Discovery Health Medical Scheme | Hospital Cover and Annual Limits VALUE-ADDED
BENEFITS
HOME
KEY TERMS
KEY FEATURES
AND BENEFITS
Cover for procedures EMERGENCY

COVER AND PMB
in the Day Surgery Network SCREENING AND

PREVENTION
CONNECTED
We cover specific procedures that can be done in the Day Surgery Network. CARE
KEYCARE ONLINE
PRACTICE
ABOUT THE BENEFIT WHAT WE PAY DAY-TO-DAY

BENEFITS
We cover certain planned procedures in a day surgery We pay these services from your Hospital Benefit. AND COVER
facility. A day surgery may be inside a hospital, in a day We pay for services related to your hospital stay,
MATERNITY
clinic or at a standalone facility and the network depends including all healthcare professionals, services and
BENEFITS
on the plan you choose. medicine authorised by the Scheme.
If you use doctors, specialists and other healthcare CHRONIC

HOW TO GET THE BENEFIT professionals that we have a payment arrangement
CONDITIONS AND
PROGRAMMES
View the list of day surgery procedures on the next with, we will pay for these services in full.
page. You must contact us to get confirmation of your COVER FOR
CANCER
procedure (called preauthorisation). WHEN YOU NEED TO PAY
If you go to a facility that is not in your plan’s Day HOSPITAL COVER
AND ANNUAL
Surgery Network, you will have to pay the full account.
LIMITS
DAY SURGERY
View all Day Surgery Network facilities using EXTRA BENEFITS

Find a healthcare provider on the Discovery app.
CONTRIBUTIONS
Find a healthcare provider and the Discovery app are brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07,
EXCLUSIONS
an authorised financial services provider and administrator of medical schemes.
27 | Discovery Health Medical Scheme | Day Surgery VALUE-ADDED

BENEFITS
HOME
List of procedures covered in the Day Surgery Network KEY TERMS
KEY FEATURES
The following is a list of procedures to be performed in our Day Surgery Network. AND BENEFITS
B G Repair bunion or toe deformity

EMERGENCY
Treatment of simple closed fractures and/or
Biopsies Ganglionectomy COVER AND PMB
dislocations, removal of pins and plates.
Skin, subcutaneous tissue, soft tissue, muscle, Gastrointestinal Subject to individual case review
SCREENING AND
bone, lymph, eye, mouth, throat, breast, cervix, PREVENTION
Gastrointestinal scopes (oesophagoscopy, R
vulva, prostate, penis, testes
gastroscopy, colonoscopy, sigmoidoscopy,
Breast Procedures proctoscopy, anoscopy) Removal of foreign body CONNECTED
CARE
Mastectomy for gynaecomastia Anorectal procedures (treatment Subcutaneous tissue, muscle, external
of haemorrhoids, fissure, fistula) auditory canal under general anaesthesia
Lumpectomy (fibroadenoma) KEYCARE ONLINE
Gynaecological Procedures S PRACTICE
E
Diagnostic Dilatation and Curettage Simple superficial lymphadenectomy
Ear, nose and throat Procedures DAY-TO-DAY
Endometrial ablation BENEFITS
Skin Procedures AND COVER
Tonsillectomy and/or adenoidectomy
Diagnostic Hysteroscopy
Debridement
Repair nasal turbinates, nasal septum
Colposcopy with LLETZ MATERNITY
Removal of lesions BENEFITS
Simple procedures for nose bleed
Examination under anaesthesia (dependent on site and diameter)
(extensive cautery)
O Simple repair of superficial wounds CHRONIC
Sinus lavage CONDITIONS AND
PROGRAMMES
Scopes (nasal endoscopy, laryngoscopy) Orthopaedic Procedures U
middle ear procedures (mastoidectomy, Arthroscopy, arthrotomy (shoulder, elbow, knee, Urological COVER FOR
myringoplasty, grommets) ankle, hand, wrist, foot, temporomandibular joint),
CANCER
Cystoscopy
Eye Procedures arthrodesis (hand, wrist, foot)
Male genital procedures (circumcision, repair HOSPITAL COVER
Minor joint arthroplasty (intercarpal, carpometacarpal AND ANNUAL
Cataract surgery of penis, exploration of testes and scrotum, LIMITS
and metacarpophalangeal, interphalangeal joint
Corneal transplant orchiectomy, epididymectomy, excision hydrocoele,
arthroplasty)
excision varicocoele, vasectomy)
Treatment of glaucoma Tendon and/or ligament repair, muscle debridement,
DAY SURGERY
Other eye procedures (removal of foreign body, fascia procedures (tenotomy, tenodesis, tenolysis,
conjunctival surgery (repair laceration, pterygium), repair/reconstruction, capsulotomy, capsulectomy, Some of these procedures are not covered on the KeyCare
EXTRA BENEFITS
glaucoma surgery, probing & repair of tear synovectomy, excision tendon sheath lesion, plans. See page 32 for a list of extra exclusions on the
ducts, vitrectomy, retinal surgery, eyelid surgery, KeyCare Plans.
fasciotomy, fasciectomy). Subject to individual
strabismus repair) case review
CONTRIBUTIONS
EXCLUSIONS
28 | Discovery Health Medical Scheme | Day Surgery VALUE-ADDED

BENEFITS
HOME
Extra benefits on your plan KEY TERMS
KEY FEATURES
AND BENEFITS
You get the following extra benefits to enrich your cover.
EMERGENCY
COVER AND PMB
INTERNATIONAL SECOND IN ROOMS
OPINION SERVICES PROCEDURES
SCREENING AND
PREVENTION
Through your specialist, you have access to second You have cover for a defined list of procedures
opinion services from Cleveland Clinic for life-threatening performed in specialist rooms. Cover is up to the
and life-changing conditions. We cover 50% for the cost agreed rate, where authorised by the Scheme, CONNECTED
CARE
of the second opinion service. from your Hospital Benefit.
KEYCARE ONLINE
CLAIMS RELATED TO ADVANCED ILLNESS PRACTICE
TRAUMATIC EVENTS BENEFIT

DAY-TO-DAY
The Trauma Recovery Extender Benefit extends your BENEFITS
Members have access to a comprehensive palliative care AND COVER
cover for out-of-hospital claims related to certain programme. This programme offers unlimited cover for
traumatic events. Claims are paid from the Trauma approved care at home, care coordination, counselling MATERNITY
Recovery Extender Benefit for the rest of the year in services and supportive care for appropriate end-of-life BENEFITS
which the trauma occurred, as well as the year after clinical and psychologist services. You also have access
the event occurred. You and your dependants on your to a GP consultation to facilitate your palliative care CHRONIC
CONDITIONS AND
health plan have access to six counselling sessions per treatment plan. PROGRAMMES
person per year by a psychologist, clinical social worker
or registered counsellor, for the year in which the COVER FOR
trauma event occurred and the year after. You need CANCER
to apply for this benefit.

HOSPITAL COVER
AND ANNUAL
LIMITS
DAY SURGERY
EXTRA BENEFITS
CONTRIBUTIONS
The Clinic by Cleveland Clinic online medical second opinion programme is brought to you by Discovery Health (Pty) Ltd; registration number
EXCLUSIONS
1997/013480/07, an authorised financial services provider and administrator of medical schemes.
29 | Discovery Health Medical Scheme | Extra Benefits VALUE-ADDED

BENEFITS
HOME
KEY TERMS
KEY FEATURES
AND BENEFITS
Your contributions EMERGENCY

COVER AND PMB
SCREENING AND
JANUARY 2022 – SEPTEMBER 2022 PREVENTION
CONNECTED
KeyCare income bands Main member Adult Child* CARE
KeyCare Plus
KEYCARE ONLINE
13 801+ R2 595 R2 595 R695 PRACTICE
8 551 – 13 800 R1 758 R1 758 R495

DAY-TO-DAY
0 – 8 550 R1 279 R1 279 R464 BENEFITS
AND COVER
KeyCare Core
MATERNITY
13 801+ R1 916 R1 916 R435
BENEFITS
8 551 – 13 800 R1 253 R1 253 R310
CHRONIC
0 – 8 550 R1 005 R1 005 R260 CONDITIONS AND
PROGRAMMES
KeyCare Start
13 801+ R2 536 R2 536 R688 COVER FOR

CANCER
9 151 – 13 800 R1 629 R1 629 R637
HOSPITAL COVER
0 – 9 150 R968 R968 R583
AND ANNUAL
LIMITS
KeyCare Start Regional
13 801+ R2 190 R2 190 R670

DAY SURGERY
9 151 – 13 800 R1 405 R1 405 R620
0 – 9 150 R930 R930 R560

EXTRA BENEFITS
We count a maximum of three children when we calculate your monthly contributions. For any additional children, cover is free.
*
**
Income verification will be conducted for the lower income bands. Income is considered as: the higher of the main member’s or registered
spouse or partner’s earnings, commission and rewards from employment; interest from investments; income from leasing of assets or property; CONTRIBUTIONS
distributions received from a trust, pension and/or provident fund; receipt of any financial assistance in terms of any statutory social assistance
programme.
EXCLUSIONS
30 | Discovery Health Medical Scheme | VALUE-ADDED

BENEFITS
HOME
KEY TERMS
KEY FEATURES
AND BENEFITS
Your contributions EMERGENCY

COVER AND PMB
SCREENING AND
OCTOBER 2022 – DECEMBER 2022 PREVENTION
CONNECTED
KeyCare income bands Main member Adult Child* CARE
KeyCare Plus
14 401+ R2 801 R2 801 R750 KEYCARE ONLINE

PRACTICE
8 951 – 14 400 R1 897 R1 897 R535
DAY-TO-DAY
0 – 8 950 R1 380 R1 380 R502 BENEFITS
AND COVER
KeyCare Core
14 401+ R2 068 R2 068 R470 MATERNITY

BENEFITS
8 951 – 14 400 R1 352 R1 352 R336
0 – 8 950 R1 084 R1 084 R284 CHRONIC

CONDITIONS AND
PROGRAMMES
KeyCare Start
14 401+ R2 737 R2 737 R744 COVER FOR

CANCER
9 551 – 14 400 R1 758 R1 758 R689
0 – 9 550 R1 044 R1 044 R637 HOSPITAL COVER

AND ANNUAL
KeyCare Start Regional LIMITS
14 401+ R2 190 R2 190 R670

DAY SURGERY
9 551 – 14 400 R1 405 R1 405 R620
0 – 9 550 R930 R930 R560

EXTRA BENEFITS
We count a maximum of three children when we calculate your monthly contributions. For any additional children, cover is free.
*
**
Income verification will be conducted for the lower income bands. Income is considered as: the higher of the main member’s or registered
spouse or partner’s earnings, commission and rewards from employment; interest from investments; income from leasing of assets or property; CONTRIBUTIONS
distributions received from a trust, pension and/or provident fund; receipt of any financial assistance in terms of any statutory social assistance
programme.
EXCLUSIONS
31 | Discovery Health Medical Scheme | Contributions VALUE-ADDED

BENEFITS
HOME
EXTRA EXCLUSIONS SPECIFIC KEY TERMS
Exclusions
TO KEYCARE PLANS
In addition to the general exclusions that apply to all KEY FEATURES
AND BENEFITS
plans, KeyCare plans do not cover the following, except
where stipulated as part of a defined benefit or under
Healthcare services that are the Prescribed Minimum Benefits (PMBs). EMERGENCY
COVER AND PMB
not covered on your plan 01 | H

ospital admissions related to,
among others: SCREENING AND
PREVENTION
Dentistry
Nail disorders CONNECTED

Skin disorders, including benign growths and CARE
lipomas

Investigations KEYCARE ONLINE
Discovery Health Medical Scheme has certain exclusions. We do not pay for healthcare services PRACTICE

Functional nasal surgery
related to the following, except where stipulated as part of a defined benefit or under the Prescribed
E
lective caesarean section, except if
Minimum Benefits (PMBs). For a full list of exclusions, please visit www.discovery.co.za. DAY-TO-DAY
medically necessary BENEFITS
AND COVER
Surgery for oesophageal reflux and hiatus hernia
Back and neck treatment or surgery
MEDICAL CONDITIONS THE GENERAL EXCLUSION LIST INCLUDES: MATERNITY
Knee and shoulder surgery BENEFITS
DURING A WAITING Reconstructive treatment and Injuries sustained or healthcare Arthroscopy
PERIOD surgery, including cosmetic services arising during travel CHRONIC
Joint replacements, including but not limited CONDITIONS AND
If we apply waiting periods procedures and treatments to or in a country at war to hips, knees, shoulders and elbows PROGRAMMES
because you have never belonged Otoplasty for bat ears, port- Experimental, unproven Cochlear implants, auditory brain implants
to a medical scheme or you have wine stains and blepharoplasty or unregistered treatments COVER FOR
and internal nerve stimulators (this includes
CANCER
had a break in membership of (eyelid surgery) or practices procedures, devices, processors and hearing aids)
more than 90 days before joining Breast reductions or enlargements Search and rescue. H
ealthcare services that should be done out of HOSPITAL COVER
Discovery Health Medical Scheme, and gynaecomastia hospital and for which an admission to hospital AND ANNUAL
you will not have access to the We also do not cover the LIMITS
Obesity is not necessary
Prescribed Minimum Benefits complications or the direct or
Endoscopic procedures
(PMB) during your waiting Infertility indirect expenses that arise from DAY SURGERY
periods. This includes cover for Frail care any of the exclusions listed above,
except where stipulated as part 02 | C
orrection of hallux valgus (bunion)
emergency admissions. If you Alcohol, drug or solvent abuse
of a defined benefit or under the and Tailor’s bunion (bunionette)
had a break in cover of less than EXTRA BENEFITS
Wilful and material violation Prescribed Minimum Benefits (PMBs).
90 days before joining Discovery 03 | R
emoval of varicose veins
of the law
Health Medical Scheme, you 04 | R
efractive eye surgery
Wilful participation in war, terrorist CONTRIBUTIONS
may have access to Prescribed
activity, riot, civil commotion, 05 | N
on-cancerous breast conditions
Minimum Benefits (PMBs) during
rebellion or uprising
waiting periods. 06 | H
ealthcare services outside South Africa.
EXCLUSIONS
32 | Discovery Health Medical Scheme | Exclusions VALUE-ADDED

BENEFITS
HOME
Exclusive access to KEY TERMS
value-added offers
KEY FEATURES
AND BENEFITS
EMERGENCY
COVER AND PMB
Our members have exclusive access to value-added offers
outside of the Discovery Health Medical Scheme benefits and Rules. SCREENING AND
Go to www.discovery.co.za to access these value-added offers. PREVENTION
CONNECTED
SAVINGS ON PERSONAL AND FAMILY CARE ITEMS CARE
You can sign up for Healthy Care to get savings on a vast range of personal and family
care products at any Clicks or Dis-Chem. Healthy Care items include a list of baby care, KEYCARE ONLINE
PRACTICE
dental care, eye care, foot care, sun care and hand care products, as well as first aid and
emergency items and over-the-counter medicine.
DAY-TO-DAY
BENEFITS
AND COVER
SAVINGS ON STEM CELL BANKING
You get access to an exclusive offer with Netcells that gives expectant parents MATERNITY
BENEFITS
the opportunity to cryogenically store their newborn baby’s umbilical cord blood
and tissue stem cells for potential future medical use, at a discounted rate.
CHRONIC
CONDITIONS AND
PROGRAMMES
ACCESS TO VITALITY TO GET HEALTHIER
You have the opportunity to join the world’s leading science-based wellness COVER FOR
CANCER
programme, Vitality, which rewards you for getting healthier. Not only is a healthy
lifestyle more enjoyable, it is clinically proven that Vitality members live healthier,
HOSPITAL COVER
longer lives. AND ANNUAL
LIMITS
ACCESS SUPPORT FROM ONLINE PATIENT COMMUNITIES

DAY SURGERY
Discovery Health has partnered with myHealthTeam, a global leader in facilitating highly
effective online patient communities. This gives members living with diabetes and heart
disease and those impacted by long COVID access to a digital community of patients EXTRA BENEFITS
living with the same illness to help them manage their condition.
CONTRIBUTIONS
Vitality is not part of Discovery Health Medical Scheme. Vitality is a separate wellness product, sold and
administered by Discovery Vitality (Pty) Ltd, registration number 1999/007736/07. Limits, terms and conditions
apply. myHealthTeam and Healthy Care are brought to you by Discovery Vitality (Pty) Ltd, registration number
1997/007736/07, an authorised financial services provider. Netcells is brought to you by Discovery Health (Pty) Ltd,
EXCLUSIONS
registration number 1997/013480/07, an authorised financial services provider.
33 | Discovery Health Medical Scheme | Value-added Benefits VALUE-ADDED

BENEFITS
HOME
If you have KEY TERMS
a complaint
KEY FEATURES
AND BENEFITS
EMERGENCY
COVER AND PMB
Discovery Health Medical Scheme WHA T T O DO I F YOU HA VE A COM P L A I N T :
is committed to providing you with SCREENING AND
the highest standard of service and 01 | TO TAKE YOUR QUERY FURTHER PREVENTION
your feedback is important to us. If you have already contacted Discovery Health Medical Scheme and feel that your query has still not been resolved,
The following channels are available please complete our online complaints form on www.discovery.co.za. We would also love to hear from you if we
CONNECTED
CARE
for your complaints. have exceeded your expectations.
KEYCARE ONLINE
02 | TO CONTACT THE PRINCIPAL OFFICER PRACTICE
If you are still not satisfied with the resolution of your complaint after following the process in Step 1 you are able
DAY-TO-DAY
to escalate your complaint to the Principal Officer of the Discovery Health Medical Scheme. You may lodge a query BENEFITS
or complaint with Discovery Health Medical Scheme by completing the online form on www.discovery.co.za or by AND COVER
e-mailing principalofficer@discovery.co.za.
MATERNITY
BENEFITS
03 | TO LODGE A DISPUTE
CHRONIC
If you have received a final decision from Discovery Health Medical Scheme and want to challenge it, you may lodge
CONDITIONS AND
a formal dispute. You can find more information of the Scheme’s dispute process on www.discovery.co.za. PROGRAMMES
04 | TO CONTACT THE COUNCIL FOR MEDICAL SCHEMES COVER FOR

CANCER
Discovery Health Medical Scheme is regulated by the Council for Medical Schemes. You may contact the Council
at any stage of the complaints process, but we encourage you to first follow the steps above to resolve your complaint HOSPITAL COVER
AND ANNUAL
before contacting the Council directly. Contact details for the Council for Medical Schemes: Council for Medical LIMITS
Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion 0157 |
complaints@medicalschemes.co.za | 0861 123 267 | www.medicalschemes.co.za
DAY SURGERY
EXTRA BENEFITS
CONTRIBUTIONS
EXCLUSIONS
34 | Discovery Health Medical Scheme | Complaints VALUE-ADDED

BENEFITS
HOME
KEY TERMS
KEY FEATURES
AND BENEFITS
EMERGENCY
COVER AND PMB
SCREENING AND
PREVENTION
CONNECTED
CARE
KEYCARE ONLINE
PRACTICE
DAY-TO-DAY
BENEFITS
AND COVER
MATERNITY
BENEFITS
CHRONIC
CONDITIONS AND
PROGRAMMES
COVER FOR
CANCER
HOSPITAL COVER
AND ANNUAL
LIMITS
DAY SURGERY
Download the Discovery app
EXTRA BENEFITS
Discovery Health Medical Scheme is regulated by the Council for Medical Schemes.
The benefits explained in this brochure are provided by Discovery Health Medical Scheme, registration number 1125, administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07,
an authorised financial services provider and administrator of medical schemes. This brochure is only a summary of the key benefits and features of Discovery Health Medical Scheme plans, awaiting CONTRIBUTIONS
formal approval from the Council for Medical Schemes. In all instances, Discovery Health Medical Scheme Rules prevail. Please consult the Scheme Rules on www.discovery.co.za. When reference is
made to ‘we’ in the context of benefits, members, payments or cover, in this brochure this is reference to Discovery Health Medical Scheme.
EXCLUSIONS
RCK_91663DH_03/10/2022_V1
VALUE-ADDED
BENEFITS

Discovery Health Medical Scheme Keycare Plan Guide 2022

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2022 KEYCARE PLAN

Plus | Core | Start | Start Regional

Taking on every moment

Live healthy KEY FEATURES

At Discovery Health Medical Scheme,

you to live healthy in every moment.

and all the information you need through

01 | Discovery Health Medical Scheme VALUE-ADDED

Contents page KEY TERMS

KEY FEATURES DAY-TO-DAY

02 | Discovery Health Medical Scheme VALUE-ADDED

Key Terms KEY TERMS

CO-PAYMENT cost of the healthcare service.

This is an amount that you need to pay towards a healthcare

03 | Discovery Health Medical Scheme | Key Terms VALUE-ADDED

Key Terms KEY TERMS

Hospital Networks Limpopo: Polokwane and Tzaneen

specific to your plan to get full cover.

04 | Discovery Health Medical Scheme | Key Terms VALUE-ADDED

Key Terms KEY TERMS

 Premier Plus GP is a network GP who has contracted

05 | Discovery Health Medical Scheme | Key Terms VALUE-ADDED

Key UNLIMITED COVER FOR

Features Unlimited hospital cover in our KeyCare hospital

FULL COVER FOR SCREENING AND CONNECTED

06 | Discovery Health Medical Scheme | Key Features and Benefits VALUE-ADDED

The benefits on the different KeyCare plans KEY TERMS

07 | Discovery Health Medical Scheme | Key Features and Benefits VALUE-ADDED

Emergency Cover KEY TERMS

What is a medical emergency?

Emergencies WHAT WE PAY FOR MATERNITY

0860 999 911

Click on Emergency Assist

The Discovery app is brought to you by Discovery Health (Pty) Ltd;

Prescribed Minimum Benefits

What are Prescribed Minimum

An emergency medical condition DAY-TO-DAY

A defined list of 27 chronic conditions. MATERNITY

for Medical Schemes (CMS) that apply:

You have access KEY TERMS

SCREENING FOR ADULTS KEYCARE ONLINE

10 | Discovery Health Medical Scheme | Screening and Prevention VALUE-ADDED

at our wellness providers.

CLINICAL ENTRY CRITERIA

CRITERIA MAY APPLY):

Pneumococcal vaccine for members over the

World Health How you are covered for COVID-19

Access to the Long COVID Recovery Programme:

with COVID-19 symptoms that persist beyond

Connected Care KEY TERMS

Access quality healthcare from home

HEALTH MONITORING MEDICINE ORDERING

COVID-19, from home.

Connected Care is brought to you by Discovery Health (Pty) Ltd;

13 | Discovery Health Medical Scheme | Connected Care VALUE-ADDED

Your access to Connected Care KEY TERMS

Access to quality care from home

14 | Discovery Health Medical Scheme | Connected Care VALUE-ADDED

KeyCare Online Practice

FOR THESE SPECIFIC LOCATIONS

Premier Plus GP is a network GP who has contracted

An emergency medical condition DAY-TO-DAY

A defined list of 27 chronic conditions. MATERNITY

Pneumococcal vaccine for members over the