Overall, the Discovery Health Executive Medical Aid Plan is a trustworthy and comprehensive medical aid plan that provides an elevated level of coverage for in-hospital expenses to up to 3 Family Members. The Discovery Health Executive Medical Aid Plan starts from R10,303 ZAR.
| π Medical Aid Plan | π₯ Discovery Health Executive Plan | π₯ Bonitas Medical Fund BonComprehensive | π₯ Medihelp MedPlus |
| π International Cover | Up to US$1 million | R10 million | Scheme Tariff |
| π€ Main Member Contribution | R10,303 | R8,217 | R10,980 |
| π₯ Adult Dependent Contribution | R10,303 | R7,749 | R10,980 |
| π Child Dependent Contribution | R1,969 | R1,672 | R2,742 |
| π Annual Limit | Unlimited | Unlimited | Unlimited |
| πΆ Prescribed Minimum Benefits (PMB) | βοΈ Yes | βοΈ Yes | βοΈ Yes |
| βοΈ Screening and Prevention | βοΈ Yes | βοΈ Yes | βοΈ Yes |
| β‘οΈ Home Care | βοΈ Yes | βοΈ Yes | None |
| βοΈ Oncology Cover (Maximum ZAR) | R500,000 | R400,000 | Unlimited |
The Discovery Health Executive Plan starts from R10,303 and is a comprehensive medical insurance plan offered by Discovery Health. It provides an elevated level of coverage for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses. Gap Cover is available on the Discovery Health Executive Plan, along with 24/7 medical emergency assistance. Discovery Health Executive Plan has a trust rating of 4.8 according to the Trust Index.
| π Members | π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
| β‘οΈ Contributions (January 23 β March 23) | R10,303 | R10,303 | R1,969 |
| β‘οΈ Annual Medical Savings Account | R30,900 | R30,900 | R5,904 |
| β‘οΈ Annual Threshold Amount | R35,230 | R35,230 | R6,680 |
In case of a traumatic incident or after a traumatic event, you can get help from a trained professional. Calling Emergency Assist will help you and your loved ones in need. Furthermore, family members can get help after a traumatic event at any time. The survivors of gender-based violence can receive counseling and other support as part of this service. Discovery Health Emergency Cover covers the following medical services:
All medical schemes are required by the Prescribed Minimum Benefit (PMB) provisions of the Medical Schemes Act 131 of 1998 and its Regulations to cover the costs associated with the diagnosis, treatment, and care of:
Your medical condition must be on the list of Prescribed Minimum Benefit (PMB) conditions to qualify for coverage. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits. In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health network. Once your condition has stabilized, you will be transferred to a hospital or other service providers in the Discovery Health network, if necessary, according to the schemeβs rules. Discovery Health will cover up to 80% of the Discovery Health Rate if you do not use a DSP (DHR). Your responsibility will be the difference between what Discovery Health will pay and the actual cost of your treatment. Furthermore, Discovery Health will pay according to your planβs benefits if these criteria are not met.
This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases. The Discovery Health wellness providers cover a variety of screening tests, including blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms or ultrasounds, and prostate screenings. After all your membership members have completed their health check, you can access additional screening and preventive healthcare services through the WELLTH Fund.
The Discovery Health Screening and Prevention covers the following:
Additional Testing
Clinical eligibility requirements may apply to these tests:
Vaccines (there may be clinical entry requirements):
The WELLTH Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your individual health requirements. This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks. Your WELLTH Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Schemeβs clinical entry requirements, treatment protocols, and guidelines. The Discovery Health WELLTH Fund for the Executive Plan covers the following:
These include, for instance:
Consultation with your doctor for gynecological, prostate, or cardiac issues
The WELLTH Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider.
Furthermore, the benefit is available to new members in the joining year and subsequent years.
The benefit is available once per lifetime per beneficiary. Cover for eligible healthcare services is limited to the Discovery Health Rate (DHR), subject to the overall benefit maximum.
Your WELLTH Fund maximum is based on the size and composition of your family as stated in your policy:
Furthermore, the WELLTH Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.
The basket of care includes the following:
Access to the Long COVID Recovery Programme:
According to the Schemeβs clinical entry criteria and treatment guidelines, the program includes the following:
How members of the Discovery Health Executive Plan are covered in terms of Monkeypox:
Discovery Health Medical Scheme provides home-based access to health and wellness services. Connected Care is an integrated ecosystem of benefits, services, and digitally connected capabilities designed to assist you in managing your health and wellness.
| β€οΈ Health Monitoring Devices | Access to the most up-to-date medical examination, remote monitoring, and point-of-care devices to facilitate the delivery of quality care at home. |
| π Electronic Prescriptions | Electronic prescribing for expedited access to medications. |
| π Home Nurses | Hospital-related care is provided at home by registered nurses. |
| π Medicine Ordering and Tracking | Order and track the delivery of your medication from the dispensary to your door. |
| π Online Coaches | At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19. |
| π Condition-Specific Information | Educational content pertinent to your condition is readily accessible. |
Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations. Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions. You will not see any changes to your regular benefits because of having cover approved for these gadgets.
Through Connected Care, you and your doctor can work together to keep your chronic condition under control while you are at home. Eligible members can use various digital services connected to smart remote monitoring and point-of-care devices, as well as individualized coaching consultations, to monitor and control their chronic condition in the comfort of their homes.
Hospital at Home patients receives specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being. They all work together to make your healthcare more efficient and your life safer. Suppose you have a valid pre-authorization for hospitalization. In that case, Discovery Health will use your Hospital Benefit to cover any services provided as part of Discoveryβs Hospital at Home program. For those who meet the programβs clinical and benefit criteria, this unlocks cover for approved medical devices and services. Furthermore, Discovery Health covers the following:
This includes cover and treatment for COVID-19, as well as post-discharge care. In addition, you are eligible for the Home Monitoring Device Benefit.
Members can have their claims paid from their MSA at the Discovery Health Rate or Cost.
Claims will be funded above the DHR if claims are paid at cost from MSA.
Claims paid from MSA above the DHR do not count towards the ATB.
Video Consultations with GPS
Pharmacy Clinic Consultations
Claims over the annual benefit limit
Claims over the DHR
Products to enhance your lifestyle
Childhood vaccines and immunizations
The tables below detail how much the Executive plan pays for your day-to-day expenses.
| π Healthcare Providers and Medicine | What Discovery Health Pays: |
| π©Ί Specialists Discovery Health has arrangements with | Up to the agreed rate |
| π Specialists Discovery Health does not have arrangements with | 3x the Discovery Health Rate (300%) |
| π GPS and other healthcare professionals | Up to 100% of the Discovery Health Rate |
| π Preferred Medicine | Up to 100% of the Discovery Health Rate |
| π °οΈ Non-Preferred Medicine | Up to 75% of the DHR if the medicine falls within the 25% preferred equivalent |
| π Members | 1οΈβ£ Single Member | 2οΈβ£ +1 Dependent | 3οΈβ£ 2 Dependents | 4οΈβ£ 3 and More Dependents |
| Prescribed Medicine (Schedule 3 and higher) | R46,450 | R54,450 | R62,350 | R70,300 |
OTC Medicine, Childhood vaccines and immunization, lifestyle-enhancing products: Discovery Health will pay claims from the MSA funds. However, these claims will not add up to the Annual Threshold, and neither are they paid from the ATB if the Self-Payment Gap reaches R0
This includes all allied healthcare services, including acousticians, biokinetics, chiropractors, counselors, dietitians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Discovery covers the following:
In addition, Discovery Health covers the following additional services:
With the Discovery Health Executive plan, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your babyβs life. This applies from the date of activation of the benefit for each pregnancy and for each child from birth until they are two years old.
Discovery Health Maternity Benefit covers the following:
During Pregnancy:
After giving birth, Discovery Health covers the following:
Discovery Health prenatal and postnatal care includes:
The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL). Furthermore, you are protected for 22 additional conditions listed on the Additional Disease List (ADL).
Discovery Health Chronic Benefit Cover Summarized
You are covered for medications up to the monthly CDA.
Discovery Health Executive Plan Full List of conditions covered:
On the Executive Plan, you can get your medication from more than 2,500 pharmacies in the Schemeβs pharmacy network. Through MedXpress, you can order or reorder your medication online and have it delivered to your place of business or residence. Alternatively, you can:
Furthermore, you can set reminders and prompts to help you take your medication as prescribed and on time. For example, your approved chronic medication will be displayed automatically. You will be prompted to take your medication and confirm each dose.
Discovery Health will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions. You must be registered with these condition-specific care programs to access additional benefits and services. On a personalized dashboard, you and your Premier Plus GP can identify the next steps to manage your condition and maintain your health over time optimally. The cover is subject to the Schemeβs clinical entry requirements, treatment protocols, and guidelines.
Your GP, dietitian, and health coach will coordinate care.
Consultations, pathology tests, and medicine are covered for enrolled members.
The program provides medication coverage, virtual and in-person psychotherapy, and additional GP visits for treatment evaluation, tracking, and monitoring.
The program covers extra glucometer strips and dietitian and biokinetics visits.
You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
Discovery Health will cover approved cancer treatment for 12 months.
Covering R500,000. If your treatment exceeds the cover amount, Discovery Health will cover up to 80% of the additional costs unless the Oncology Innovation and Extended Oncology Benefit cover it.
Discovery Health Rate covers 100% of cancer-related healthcare services (DHR).
This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services.
The Executive plan includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
| π Discovery Hospital Benefit | What Discovery Health Pays on the Executive Plan |
| π The Hospital Account | The full account is according to the agreed rate with the hospital. |
The first R3,470 from the day-to-day benefit if it is unrelated, and the balance from the Hospital Benefit according to the DHR.
R4,050 Day Clinic
R4,950 Day Clinic if done in the same admission
R5,900 co-payment in-hospital, reduced to R4,700 if the doctor performing it forms part of Discovery Healthβs value-based network.
R7,300 co-payment in-hospital, reduced to R5,950 if the doctor performing it forms part of Discovery Healthβs value-based network.
The upfront payment will not apply if:
| π Cochlear Implants, Auditory Brain Implants, and processors | R230,400 per person per benefit |
| π Internal Nerve Stimulators | R175,200 per person |
| π Major Joint Surgery | No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R30,900 per prosthesis per admission. |
Three days for attempted suicide admissions.
Other mental health admissions are 21 days.
Network facilities cover all mental health admissions.
The spinal surgery network covers approved spinal surgery admissions.
Dental treatment is unlimited.
However, all dental appliances, prostheses, placement, and orthodontic treatment (including orthognathic surgery) are paid at 100% of the Discovery Health Rate (DHR).
Your daily benefits cover these claims up to R32,600 per person.
The Severe Dental and Oral Surgery Benefit covers procedures without upfront payment or limit.
The Basic Dental Trauma Benefit covers unexpected dental injuries requiring emergency treatment after an accident.
Dental admissions require prepayment of your hospital or day clinic bill, except for severe dental and oral surgery.
Age and treatment location determine this amount.
Your Hospital Benefit pays the hospital bill up to 100% of the Discovery Health Rate (DHR).
Your Hospital Benefit covers related bills, including the dentistβs, up to 100% of the Discovery Health Rate (DHR).
Specialists receive 300% of the Discovery Health Rate (DHR).
Hospital Account β R7,800 for members 13> and R3,000 for members
Discovery Health Executive Plan provides the following additional benefits.
Exclusions include the following:
Discovery Healthβs waiting periods are as follows:
| π Medical Aid Plan | π₯ Discovery Health Executive Plan | π₯ Bonitas Medical Fund BonComprehensive | π₯ Medihelp MedPlus |
| π International Cover | Up to US$1 million | R10 million | Scheme Tariff |
| π€ Main Member Contribution | R10,303 | R8,217 | R10,980 |
| π₯ Adult Dependent Contribution | R10,303 | R7,749 | R10,980 |
| π Child Dependent Contribution | R1,969 | R1,672 | R2,742 |
| π Annual Limit | Unlimited | Unlimited | Unlimited |
| β‘οΈ Oncology Cover | R500,000 | R400,000 | Unlimited |
| πΆ Prescribed Minimum Benefits | βοΈ Yes | β Yes | βοΈ Yes |
| π» Screening and Prevention | β Yes | βοΈ Yes | β Yes |
| π Hospital Cover | βοΈ Yes | β Yes | βοΈ Yes |
As the name suggests, the Discovery Health Executive Plan provides the most comprehensive care and benefits for its members. This exclusive plan ensures that members are covered in and out-of-hospital in terms of procedures, diagnosis, and appropriate treatments. Another benefit is that the Discovery Health Executive Plan goes beyond the borders of South Africa and offers international travel and treatment. In addition, the plan has a handy medical savings account to cover day-to-day expenses. Furthermore, while there is a self-payment gap when your MSA is depleted, once you reach the Annual Threshold Benefit, Discovery Health ensures that you are still covered for various treatments, medicines, and procedures.
You might also like the following service Discovery has to offer
If you join Discovery Executive Plan while pregnant, you will be subject to a three-month general waiting period or a 12-month condition-specific waiting period for existing medical conditions, including pregnancy.
No, Discovery Health does not pay for DNA testing.
Discovery Executive Plan covers bone density testing, typically one test per qualifying beneficiary annually.
Discovery Executive covers one pap smear per qualifying beneficiary every three years.
There is a limit of R9 010 per person for the year. The optometry limit covers lenses, frames, contact lenses and surgery or any healthcare service to correct refractive errors of the eye, like excimer laser. Eye tests are not subject to the limit and are paid from the available day-to-day benefits.
Discovery Executive Plan covers one mammogram per member every two years.
The Discovery Executive Plan typically includes a wide range of benefits, such as in-hospital coverage, day-to-day benefits, chronic medication coverage, and more.
Get a Discovery Health Medical Aid quote from our Dedicated Medical Aid Specialists Broker
The Executive Plan is typically one of the more comprehensive plans offered by Discovery Health, offering a higher level of coverage than its other plans. However, the specific benefits and cover levels will vary between the different plans, so it is important to compare them carefully before deciding.
The cost of the Executive Plan will vary based on factors such as your age, location, and the specific plan you have chosen. However, it is usually more expensive than the other plans offered by Discovery Health due to the higher level of coverage it provides. The Executive Plan starts from R10,303 per month.
The Executive Plan typically includes a network of preferred hospitals that you can use. You may also be able to use other hospitals, but this may result in additional out-of-pocket expenses.
Pre-existing medical conditions are typically covered under the Executive Plan, but there may be waiting periods or exclusions for certain conditions.
Yes, you can usually add family members to your Executive Plan, including your spouse and children.
You can typically claim your Executive Plan by contacting Discovery Health and providing the necessary information and documentation. This may include medical receipts and a claim form. However, the process for making a claim may vary depending on your chosen plan.
