Discovery Gap Cover

Why choose Discovery Health?

Discovery Health was founded by Adrian Gore in 1992. He had a vision of providing affordable healthcare to all South Africans. The success of Discovery Health is due to their ability of offering a value-driven, fully integrated spectrum of products, incorporating the healthcare needs of each individual. As a medical aid, Discovery Health offers comprehensive cover, it is well priced, it has a great credit rating and it has a reputation for paying claims. It has won awards as the best medical aid in South Africa.

Realistically, many clients are equally happy with a multitude of other South African medical aids. However, if the medical aid is integrated with Vitality then Discovery is the best option available in the industry. Through Vitality, Discovery Health offers members innovative solutions that reduces their health risks and makes them healthier. This contributes to their shared-value insurance business module.

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In keeping the above strategy, PvB & Associates strive toward maintaining these values with each of the individual products offered.

Navigating the healthcare system can be a complex task. Members need a partner to navigate the healthcare system as well as the healthcare providers. This includes all aspects of the member’s healthcare experience, from managing their claims to finding the right provider. This delivers better and sustainable healthcare for all members. We provide information, advice, and invaluable service to our clients with our expertise and an excellent offering of the Discovery brand of products.

Plan Choices:

Discovery offers wide range of medical aids in order to meet you and family’s needs. The 23 plans all offer private healthcare cover and range from affordable KeyCare cover to the extensive in-hospital and day-to-day benefits of the Executive Plan:

  • Affordable medical cover
  • Specified network providers for both in-hospital and out-of-hospital treatment

  • The most cost-effective in-hospital cover
  • Essential chronic medicine cover plus limited day-to-day cover
  • Specified network hospital providers

  • Value-for-money hospital plan
  • Unlimited private hospital cover and essential cover for chronic medicine
  • No day-to-day cover

  • The most economical in-hospital cover
  • Essential chronic medicine cover
  • Day-to-day benefits through a Medical Savings Account

  • Cost-effective in-hospital cover
  • Eessential chronic medicine cover
  • Day-to-day benefits with a limited Above Threshold Benefit.

  • Comprehensive cover for in-hospital (200%)
  • Day-to-day cover with extended chronic medicine cover
  • Unlimited Above Threshold Benefit

  • Comprehensive cover for in-hospital (300%)
  • Day-to-day cover with extended chronic medicine cover
  • Unlimited Above Threshold Benefit

Click this link to download our summary of Discovery’s medical aid plans

We at PvB understand that everyone has different health needs. We also agree that the plan choices are complicated, and that the Discovery website provides you with an overload of information. Through our proven Medical Aid Analysis Tool, let us show you how we can provide you with the best medical aid cover for you and your family.

Discovery Health FAQ’s

Below are some of the frequently asked questions we receive about the Discovery Health options. If you need to know more about Discovery’s Medical Aid Schemes or have any questions that you don’t see listed below, please speak to one of our consultants.

The medical aid gives the member a fixed amount of money at the beginning of the year, which goes into a “savings” account linked to your medical aid premium. This portion of your premium is repaid to the medical aid on a monthly basis. and is calculated by the medical aid as per the specific plan of the member. The member may use these funds in the savings account to pay for any services that are not done in the hospital. These include medication, doctor’s visits, basic dentistry, and basic eye tests, and obtaining glasses or visiting a dentist. Any positive money left over in this savings account at the end of the year is carried over to the next year. You will never lose the money in your savings account, and it accrues interest as well. If you decide to leave the scheme, any positive savings will either be paid out directly into your bank account or transferred to the new scheme that you join, after 4 months. (According to legislation, you have 4 months to submit claims after the date of service).

The Above Threshold Benefit gives you extra coverage when your claims add up to a set amount called the Annual Threshold if you are on an Executive, Comprehensive, or Priority plan.

The Self Payment Gap is created when you have used the funds in your Medical Savings Account before your expenses add up to the Annual threshold. During this time, you will need to pay for your day to day expenses from your own pocket.

This is an additional contribution amount imposed on someone who was not a member of any South African medical, which is calculated from the age of 35. You decided to join at a later stage in life when you are more likely to need expensive cover from a medical scheme.

This is the period during which contributions are payable without the member being entitled to any benefits.

  1. A general waiting period of up to three months.
  2. A condition-specific waiting period of 12 months.

Why is a medical aid outside of South Africa not recognized in SA?

South African legislation currently does not recognize medical aid coverage outside the country. You need to be a member of a registered South African medical scheme for it to be recognized. As an example, when you do not have a South African medical aid, you are not contributing to the South African risk.

These are services where the member is not in hospital, and is covered for benefits for any out of hospital costs only.

Discovery Health decided that they are obliged to pay the same rate as they are now adults, and also irrespective of whether they are studying or not.

All members are charged the same rate as it does not depend on your age but to the benefits that are being offered to a member. Generally, pensioners claim more on medical aids.

If the membership has a spouse or adult dependant, then they can continue with the membership and become the principal member. If it is an individual membership, then the membership cancels.

No. In term of the Medical Schemes Act, no medical scheme may refuse a person who is dependent on the member. Dependants of a member are his/her spouse or partner; A child under the age of 21 or older and a child who is dependent upon the member due to a mental or physical disability; immediate family in respect of whom the member is legally liable for family care and support and any persons who are recognized by the scheme as dependants. Immediate family is classified as the mother, father, brother or sister of the member. The scheme concerned may require proof of such dependency.

Yes, they can with the assistance of his/her parents or guardian. However, they will become the principal member and pay the appropriate premium.

No, it is legislated that you cannot belong to more than one medical scheme, and the member can be penalized for this. When you don’t belong to a medical aid in South Africa, you are not contributing to SA’s risk pool, therefore it will be unfair to claim from it.

If a court awarded medical benefits to your spouse in a divorce case, then you are allowed to keep them on your membership. In the event that you get married again, then your new spouse can also join your medical aid, or you may arrange for the ex-spouse to go on to her own medical aid.

Any children, including stepchildren or adopted children who are your dependants can also join your medical aid.

This is a portion of the cost for which you are responsible. Certain procedures and certain plans specify co-payments applicable. This co-payment is non-refundable.

These are plans where a member must make use of a network of doctors, hospitals, dentist etc.in order to be covered. This keeps the costs for the medical aids down, which in turn assists in cheaper premiums.

This is a group of medical service providers chosen on specified plans, where a member needs to go to in order to have unlimited benefits, as well as where no co-payments will be charged.

The South African Medical schemes Act requires that all medical schemes provide cover for the 26 Chronic diseases on the Chronic Disease List, on all the plans. These conditions are listed under the defined lists of all medical schemes.

No, any medical aid in South Africa cannot legally refuse your medical aid membership. However, any “closed” medical aid scheme on the other hand is only available for employees of a specific employer or company, is not available to any other members of the public.

Correct. You have up to four months to submit claims, thereafter claims will not be processed.

No, only when you terminate your membership. However, if you have any debt owing to the scheme then this can be paid from the MSA to offset the debt.

No, you are not allowed to pay it from the MSA, as the Medical Schemes Act does not allow it.

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If you are looking for a leading medical aid scheme – then look no further! At PvB & Associates, we offer multiple Discovery Health plans for you and your family. Get in touch with us today.

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