The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Got itTests and scans involve any investigative procedures that are undertaken to identify and diagnose medical conditions that would not normally be detected with the naked eye.
Depending on your plan type, Discovery Health Medical Scheme provides cover for in- and out-of-hospital tests and scans, including investigations, radiology, blood tests, MRI and CT scans.
Please select a plan series
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
Admissions for scopes
Depending on where you have your scope done, we pay the following amount from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit. If you do not have enough funds available in your day-to-day benefits, you will need to pay this amount.
Upfront payments for scope admissions:
DAY CLINIC ACCOUNT
R4,300
HOSPITAL ACCOUNT
R6,250, this co-payment will reduce to R5,000 if performed by a doctor who is part of the Scheme's value-based network
If both a gastroscopy and colonoscopy are performed in the same admission
DAY CLINIC ACCOUNT
R5,250
HOSPITAL ACCOUNT
R7,750, this co-payment will reduce to R6,300 if performed by a doctor who is part of the Scheme's value-based network
No upfront payment applies:
If scopes are performed in the doctor's rooms, as part of a confirmed Prescribed Minimum Benefits (PMB) condition, or the patient is under the age of 12, you will not have to pay any amount upfront. We pay the account from the Hospital Benefit.
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for out-of-hospital radiology expenses from your available day-to-day benefits.
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.
We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.
If it is not related to your admission or for conservative back and neck treatment, we pay of the first R3,670 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate. For conservative back and neck scans a limit of one scan per spinal and neck region applies.
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for out-of-hospital radiology expenses from your available day-to-day benefits.
Download Comprehensive Series Guide
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
Admissions for scopes
Depending on where you have your scope done we pay the following amount from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit. If you do not have enough funds available in your day-to-day benefits, you will need to pay this amount.
Upfront payments for scope admissions:
DAY CLINIC ACCOUNT
R4,300
HOSPITAL ACCOUNT
R6,250, this co-payment will reduce to R5,000 if performed by a doctor who is part of the Scheme's value-based network
If both a gastroscopy and colonoscopy are performed in the same admission
DAY CLINIC ACCOUNT
R5,250
HOSPITAL ACCOUNT
R7,750, this co-payment will reduce to R6,300 if performed by a doctor who is part of the Scheme's value-based network
Upfront payments for scopes performed outside of the Day Surgery Network:
For Classic Comprehensive an upfront payment of R6,650 will apply.
Where both a gastroscopy and colonscopy are performed the higher upfront payment of R7,750 will apply.
For Classic Smart Comprehensive, an upfront payment of R11,650 will apply.
No upfront payment applies:
If scopes are performed in the doctor's rooms, as part of a confirmed Prescribed Minimum Benefits (PMB) condition, or the patient is under the age of 12, you will not have to pay any amount upfront. We pay the account from the Hospital Benefit.
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
In-hospital
We cover up to the Discovery Health Rate (100%).
Out-of-hospital
We pay for out-of-hospital radiology expenses from your available day-to-day benefits.
On Classic Smart Comprehensive, we pay specialist-referred radiology at the Discovery Health rate, up to the Specialist Benefit limit. Out-of-hospital radiology is paid from your Above Threshold Benefit once you reach your Annual Threshold.
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.
We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.
If it is not related to your admission or for conservative back and neck treatment, we pay of the first R3,670 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate. For conservative back and neck scans a limit of one scan per spinal and neck region applies.
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for out-of-hospital radiology expenses from your available day-to-day benefits.
On Classic Smart Comprehensive, we pay specialist-referred radiology at the Discovery Health rate, up to the Specialist Benefit limit. Out-of-hospital radiology is paid from your Above Threshold Benefit once you reach your Annual Threshold.
Download Priority Series Guide
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
Admissions for scopes
Depending on where you have your scope done, you will have to pay the following amount, and we will pay the balance of the hospital and related accounts from your Hospital Benefit.
Upfront payments for scope admissions:
DAY CLINIC ACCOUNT
R4,300
HOSPITAL ACCOUNT
R6,600, this co-payment will reduce to R5,600 if performed by a doctor who is part of the Scheme's value-based network
If both a gastroscopy and colonoscopy are performed in the same admission
DAY CLINIC ACCOUNT
R5,250
HOSPITAL ACCOUNT
R8,650, this co-payment will reduce to R7,050 if performed by a doctor who is part of the Scheme's value-based network
Upfront payments for scopes performed outside of the Day Surgery Network:
Where a scope is performed in a facility outside of the Day Surgery Network an upfront payment of R6,650 will apply, except if performed in a hospital outside the Day Surgery Network where an upfront payment of R6,900 will apply.
Where both a gastroscopy and colonoscopy are performed the upfront payment of R8,650 will apply.
No upfront payment applies:
If scopes are performed in the doctor's rooms, as part of a confirmed Prescribed Minimum Benefits (PMB) condition, or the patient is under the age of 12, you will not have to pay any amount upfront. We pay the account from the Hospital Benefit
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for out-of-hospital radiology expenses from your available day-to-day benefits.
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.
We pay for scans as an out-of-hospital expense if:
We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.
If it is not related to your admission or for conservative back and neck treatment, we pay of the first R3,670 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate. For conservative back and neck scans, you must also pay the first R3,670 of the hospital account. We pay the balance of the scan from the Hospital Benefit up to 100% of the Discovery Health Rate. A limit of one scan per spinal and neck region applies for conservative back and neck scans.
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for out-of-hospital radiology expenses from your available day-to-day benefits.
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
Admissions for scopes
Depending on where you have your scope done we pay the following amount from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit. If you do not have enough funds available in your Medical Savings Account (MSA), you will need to pay this amount.
Upfront payments for scope admissions:
DAY CLINIC ACCOUNT
R4,300
HOSPITAL ACCOUNT
R7,350, this co-payment will reduce to R6,100 if performed by a doctor who is part of the Scheme's value-based network
If both a gastroscopy and colonoscopy are performed in the same admission
DAY CLINIC ACCOUNT
R5,250
HOSPITAL ACCOUNT
R9,150, this co-payment will reduce to R7,600 if performed by a doctor who is part of the Scheme's value-based network
Upfront payments for scopes performed outside of the Day Surgery Network:
Where a scope is performed in a facility outside of the Day Surgery Network an upfront payment of R6,650 will apply, except if performed in a hospital outside the Day Surgery Network where an upfront payment of R7,350 will apply. Where both a gastroscopy and colonoscopy are performed the upfront payment of R9,150 will apply. For Delta options, the out-of-network upfront payment of R10,200 will apply.
No upfront payment applies:
If scopes are performed in the doctor's rooms, as part of a confirmed Prescribed Minimum Benefits (PMB) condition, or the patient is under the age of 12, you will not have to pay any amount upfront. We pay the account from the Hospital Benefit.
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for out-of-hospital radiology expenses from your available funds in your Medical Savings Account.
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.
We pay for scans as an out-of-hospital expense if:
We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.
Other scans
If it is not related to your admission or for conservative back and neck treatment, we pay the first R3,670 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate (DHR). Limited to one scan per spinal and neck region.
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for out-of-hospital pathology expenses from your available funds in your Medical Savings Account.
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
Admissions for scopesp
Depending on where you have your scope done, you have to pay the following amount and we pay the balance of the hospital and related accounts from your Hospital Benefit.
Upfront payments for scope admissions:
DAY CLINIC ACCOUNT
R4,300
HOSPITAL ACCOUNT
R7,350, this co-payment will reduce to R6,100 if performed by a doctor who is part of the Scheme's value-based network
If both a gastroscopy and colonoscopy are performed in the same admission
DAY CLINIC ACCOUNT
R5,250
HOSPITAL ACCOUNT
R9,150, this co-payment will reduce to R7,600 if performed by a doctor who is part of the Scheme's value-based network
Upfront payments for scopes performed outside of the Day Surgery Network:
Where a scope is performed in a facility outside of the Day Surgery Network, an upfront payment of R11,650 will apply. On the Essential Dynamic Smart, an upfront payment of R14,050 will apply to facilities outside of the Essential Dynamic Smart Day Surgery Network.
No upfront payment applies:
If scopes are performed in the doctor's rooms, as part of a confirmed Prescribed Minimum Benefits (PMB) condition, or the patient is under the age of 12, you will not have to pay any amount upfront. We pay the account from the Hospital Benefit.
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
You need to pay for out-of-hospital radiology expenses.
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.
We pay for scans as an out-of-hospital expense if:
We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.
On Classic Smart, if it is not related to your admission or for conservative back and neck treatment, we pay the first R3,670 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate (DHR). Limited to one scan per spinal and neck region.
On Essential Smart and Essential Dynamic Smart plans you do not have cover for conservative back and neck treatment. We will therefore not pay for MRI or CT scans for conservative back and neck treatment.
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
You need to pay for out-of-hospital pathology expenses.
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
Admissions for scopes
Depending on where you have your scope done, you have to pay an upfront amount and we pay the balance of the hospital and related accounts from your Hospital Benefit.
Upfront payments for scope admissions:
DAY CLINIC ACCOUNT
R4,300
HOSPITAL ACCOUNT
R7,350, this co-payment will reduce to R6,100 if performed by a doctor who is part of the Scheme's value-based network
If both a gastroscopy and colonoscopy are performed in the same admission
DAY CLINIC ACCOUNT
R5,250
HOSPITAL ACCOUNT
R9,150, this co-payment will reduce to R7,600 if performed by a doctor who is part of the Scheme's value-based network
Upfront payments for scopes performed outside of the Day Surgery Network:
Where a scope is performed in a facility outside of the Day Surgery Network an upfront payment of R6,650 will apply, except if performed in a hospital outside the Day Surgery Network where an upfront payment of R7,350 will apply. Where both a gastroscopy and colonoscopy are performed the upfront payment of R9,150 will apply. For Delta options, an upfront payment of R10,200 will apply.
No upfront payment applies:
If scopes are performed in the doctor's rooms, as part of a confirmed Prescribed Minimum Benefits (PMB) condition, or the patient is under the age of 12, you will not have to pay any amount upfront. We pay the account from the Hospital Benefit.
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
You need to pay for out-of-hospital radiology expenses.
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.
We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.
If it is not related to your admission, or for conservative back and neck treatment, we do not pay for it.
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
You need to pay for out-of-hospital pathology expenses.
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
On KeyCare Plus and KeyCare Start, we pay for a list of basic X-rays at a network provider. Your chosen GP must ask for the X-rays to be done.
Out-of-hospital radiology expenses are not covered on the KeyCare Core plan.
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible.
We pay for scans as an out-of-hospital expense if:
We pay your accounts up to a maximum of the Discovery Health Rate for approved hospital admissions at a network hospital.
Specialist cover up to R5,300 on KeyCare Plus and KeyCare Core, and up to two visits up to R2,650 on KeyCare Start per person per year. Your chosen GP must refer you to a specialist and you need a reference number from us before your consultation with the specialist. On KeyCare Plus, 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. Please note that there is no benefit for MRI and CT scans related to conservative back or neck treatment on the KeyCare plans.
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
We cover up to the Discovery Health Rate (100%).
We pay for a list of blood, urine and other fluid and tissue tests from a network provider. Your chosen GP must ask for these tests by filling in a KeyCare pathology form.
Out-of-hospital pathology expenses are not covered on the KeyCare Core plan.