Hospital Cover from Discovery Health
Discovery Health offers comprehensive hospital cover for planned and emergency procedures. Hospital cover from Discovery Health does not have a limit for cover overall.
The cover consists of payment for the hospital’s fees and payment for health care professionals associated with the procedure.
About Hospital Cover from Discovery Health
The medical scheme covers emergency admissions fully and automatically. Non-emergency procedures need to be authorised upfront.
Discovery will pay for theatre and ward fees at a predetermined rate that they work out in conjunction with the hospital. Hospital cover from Discovery Health is unlimited in general wards.
Coastal Plans and Delta Plans
With the Delta plans, you receive complete coverage as long as the hospital you are admitted to forms part of the Delta Hospital Network.
If the hospital admits you for a non-emergency procedure to a hospital that is not part of this network, you will have to pay R5950 to the hospital on admission. (This falls away in emergency cases.)
With the Coastal plans, they have to hospitalise you in one of the hospitals situated in the provinces with a coastline for non-emergency procedures. Alternatively, you can choose a hospital outside this area and pay 30% of the bill yourself.
Cover for Diagnostic Procedures
This will depend on the process. The medical scheme covers scopes such as colonoscopies. You will need to pay R3400 of the bill, and they will cover the rest.
The medical scheme will cover scans such as CT or MRI scans if they form part of a pre-authorised hospital admission.
All pathology and radiology cover is limited to 100% of the prescribed rates as determined by Discovery.
Coverage for Medical Professionals
They will cover you fully as long as you use a medical professional that has an agreement with Discovery.
The Classic Plans allow the most scope when it comes to specialist consultations. Discovery will pay up to 200% of their laid-out rate for non-network professionals.
On the Coastal and Essential plans, cover for non-network professionals is 100% of the same rate.
If the procedure falls under the Severe Dental and Oral Surgery Benefit, it will be covered in full. You will also not need to make any payments upfront, and there is no annual limit.
For other dentistry that you undergo in the hospital, you will need to pay an upfront amount. This will depend on how old you are and where they are treating you.
Dental appliances will be for your account and so will fees relating to their installation.
Some predefined procedures in the hospital are subject to an annual limit. It is best to check upfront what they do cover and what they don’t cover in this respect.
This is a service that Discovery offers and allows you to receive care at home. You can continue to recuperate at home instead of in the hospital.
Discovery Homecare will dispatch a nurse, or qualified care worker for the following:
- Post-natal care
- Palliative care for terminal patients
- Certain IV infusions
- Care of wounds such as diabetic ulcers, etc.
- Also, short-term care to allow relief for permanent caregivers
For the moment, this service is only available to members who reside in Gauteng.
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