Frequently asked questions

You will be able to access the registered scheme rules approved by the Council of Medical Schemes when you log in.

You need to let Discovery Health Medical Scheme know 30 days in advance (a calendar month's notice) of your intention to withdraw yourself or your dependants from the scheme. Contact us on 0860 99 88 77.

You cannot withdraw money from your allocated Medical Savings Account (MSA) but we will pay any positive balances from your allocated MSA if:

• You have resigned from the Scheme
• You have downgraded your health plan to a plan that does not offer an allocated Medical Savings Account

Money is paid on the first claims run in the fifth month after the effective withdrawal date. This allows for the payment of late claims to be accommodated.

Schemes can apply waiting periods when;

• You have never belonged to a medical scheme
• You have had a break in membership of more than 90 days before joining Discovery Health Medical Scheme

You will not have cover or access to the Prescribed Minimum Benefits during your waiting periods. This includes cover for emergency admissions.

The Medical Schemes Act allows medical schemes to apply a late joiner penalty if an applicant, or the dependant of an applicant, who at the date of application:

• Is 35 years or older; and
• Was not a member or a dependant of a registered South African medical scheme (foreign schemes are not recognised) on or before 1 April 2001; or has allowed more than a 3 month consecutive break in membership since 1 April 2001.

The Medical Savings Account (MSA) is an amount that gets set aside for you at the beginning of the year or when you join Discovery Health Medical Scheme. You pay back this amount monthly as part of your medical scheme contribution. Members on the Executive, Comprehensive, Priority and Saver plans get a Medical Savings Account. We pay for day-to-day medical expenses like GP visits, radiology and pathology from the Medical Savings Account, as long as you have money available. Any money remaining in the Medical Savings Account at the end of the year will carry over to the next year.

If you leave the Scheme or downgrade your health plan before the year is up, you may owe the Scheme the portion of the Medical Savings Account you have used but have not yet paid back.

1. The Self-payment Gap (SPG) is a temporary gap in cover when you run out of funds in your Medical Savings Account (MSA) but have not yet reached your Annual Threshold benefit. You will have to pay for day-to-day claims from your own pocket during this period. You must still submit claims to us so that we know when to start paying from your Above Threshold Benefit. Watch this short video for more information or read more here.

The Above Threshold Benefit (ATB) is a 'safety net' included on Discovery Health Medical Scheme's Executive, Comprehensive and Priority Plans. The day-to-day claims that you submit to Discovery Health Medical Scheme are added up at the Discovery Health Rate depending on the limits for any specific treatment and conditions. Once the claims add up to a certain amount, known as the Annual Threshold, your claims start paying from the Above Threshold Benefit. You may run out of money in the Medical Savings Account before we start paying from the Above Threshold Benefit. This is called a Self-payment Gap.

A benefit is a pool of funds in a medical scheme reserved for specific healthcare services. For example, the Hospital Benefit pays for healthcare services when you are admitted to hospital as part of an approved admission.

A limit is the maximum amount or a cap on what we will pay for a particular type of healthcare service. This applies when the service is paid from a specific benefit. For example, your optometry claims either pay from the Medical Savings Account or Above Threshold Benefit but we will only pay these claims up to the optometry limit for your health plan.

Discovery Health Medical Scheme members on a Delta Plan must go to hospitals and day-clinics in the Delta hospital network for a planned admission. If you don't use a hospital in the Delta hospital network for planned admissions, you must pay a non-refundable amount upfront to the hospital. View the list here.

To track the progress of your claims, you can use the Claims Search tool when you log in, or you can call 0860 99 88 77 and follow the phone voice prompts, or SMS 'Claim' to 31347 to see your most recently processed claim.

You must send us your claim within four months from the date you saw your healthcare professional.

If your healthcare professional has sent us the claim, you do not need to send us another copy. Please keep that copy for your records.

Your condition must be covered on our list of conditions. Please visit your doctor who will submit a Chronic Illness Benefit application form to us electronically or who will help you complete a Chronic Illness Benefit application form. The completed application form can be sent to us via:

• Email to CIB_APP_FORMS@discovery.co.za
• Post to Discovery Health, CIB Department, PO Box 652919, Benmore, 2010.

Discovery Health Medical Scheme may ask you for motivation with your application form. Please check if you have submitted all the relevant documents needed to process your application.

Discovery Health Medical Scheme covers each procedure according to the benefits available on your health plan. Discovery Health Medical Scheme members can see if their procedure or treatment is covered with our 'Do We Cover" tool. If you need to go to hospital, you must call us to confirm your admission to hospital. We will explain how your procedure will be covered.

Use the Do We Cover tool for your specific procedure.

In an emergency, go straight to hospital. If you need medically equipped transport, call 0860 999 911. Highly qualified emergency personnel manage this line. They will send air or road emergency evacuation transport to you, depending on which is most appropriate. Remember that you, a loved one or the hospital must let us know about your admission as soon as possible.

If you have a medical emergency while overseas, call ER24 on +27 11 529 6900 with your membership number as it appears on your membership card.

Find out more about what to do in an emergency.

We enter into agreements with healthcare professionals to ensure certainty of cover for our members and higher levels of reimbursement for healthcare professionals who we pay in full. Our agreements cover 90% of GP and specialists visits respectively.

You can a find a healthcare professional we have an agreement with when you log in.

The International Travel Benefit offers medical emergency cover, for 90 days from date of departure, outside the borders of the Republic of South Africa to members on all plans (excluding KeyCare plans).

Each person is covered up to a limit of R10 million on the Executive Plan and R5 million on the Classic, Essential or Coastal Plans.

• Notify ER24 as soon as possible after the emergency on +27 11 529 6900 to authorise the admission and issue a payment guarantee.
• ER24 arranges direct payment to overseas healthcare professionals.
• If the medical condition necessitates an evacuation and you are fit to travel, ER24 will arrange your return to South Africa.

Remember: certain healthcare services will not be covered while travelling.

You need to get an International Travel Benefit letter when you log in as proof of your medical cover for visa application purposes or get a copy from the   on your smartphone.

If you are going to travel for more than 90 days, you must apply for extra travel insurance from your travel agent before your departure from South Africa.

It is important to notify us of your pregnancy so that you always know how we cover you for your pregnancy-related healthcare services, whether these are received in or out of hospital.

You can call us on 0860 99 88 77 or visit www.discovery.co.za to activate your Maternity and early childhood benefits, find out how you are covered and to authorise your hospital admission. When you do, remember to have the following information at hand:

• Date of the admission
• Name or practice number of the hospital or clinic
• Name and practice number of the treating doctors and anaesthetist (if available)
• ICD-10 code from your treating doctor (this is an alphanumerical code that describes your diagnosis (pregnancy)
• RPL code from your treating doctor (this is a procedure code that describes how you plan to deliver your baby).

Read more about pregnancy and having a baby or watch this video.

How to activate your Maternity Benefit

The Maternity Benefit is available from 2018 per pregnancy per child up to two years after birth.

The Maternity and early childhood benefits will be effective from the date of activation and are activated:

• When you create your pregnancy or baby profile on www.discovery.co.za or on the Discovery app,
• When you preauthorise your pregnancy and delivery or
• When you register your baby onto the Scheme.

If your baby was born and registered onto the Scheme before 2018, you can activate the post-birth benefits by creating your baby profile on www.discovery.co.za or on the Discovery app.

You need to complete a newborn application form and submit it to us to ensure that your baby is covered

To ensure all medical treatment for your baby is covered it is advisable to register your baby on your medical aid within 30 days from the date of birth.

Your baby will be registered from their date of birth, however contributions will only be charged from the first day of the month following the birth.

We allow up to 90 days for the baby to be added from the date of birth, after which we may apply certain conditions to your baby's registration with the Scheme. If the baby is added after 90 days, or within 90 days of birth but not from the date of birth, waiting periods may be applied.

Include your baby's ID number

It is compulsory to include a newborn's ID number when a member adds their newborn baby to their Discovery Health Medical Scheme membership. Having this identity number will make sure Discovery Health Medical Scheme keeps up-to-date and complete records for members' health policy, which is important for delivering the best service.

Remember to activate the My Baby programme to unlock additional benefits once your baby has been registered on your medical aid.

Activate the My Baby programme on the website or Discovery app to unlock your early childhood benefits and gain access to immediate support, advice and tools.

These benefits are available to you until your baby turns 2.

You have access to comprehensive maternity and post-birth benefits covered from the Maternity Benefit at the Discovery Health Rate. This cover does not affect your day-to-day benefits and depends on the plan you choose:

• Antenatal consultations
• Ultrasound scans
• Prenatal screening
• Blood tests
• Flu vaccine
• Pre- and postnatal care

To access your Maternity Benefits you need to activate the My Pregnancy programme on the Discovery app or website.

Read more about your Maternity Benefits here

You can get the application forms and benefit brochures by logging in and following the below steps;

• Select "Find documents and your certificates"
• View and select from the list of documents.

As a Discovery Health Medical Scheme member, you can get a copy of your membership certificate via the website and the Discovery app.

As a Discovery Health Medical Scheme member, you can get a copy of your tax certificate via the website and the Discovery app.

Discovery MedXpress is a convenient medicine delivery service, particularly for monthly medicine repeats. Members can order their medicine over the phone, on the Discovery app and online and have it delivered to an address of their choice or collect it from a pharmacy.

Discovery MedXpress is the designated service provider for chronic medicine on all Delta and Core plans.

If you have trouble logging in to the website, read these guidelines on how to unlock your account or retrieve your username and/or password.