We recognise that health professionals play a critical role in helping you improve your health and wellbeing by sharing their expert knowledge. We believe that we have a responsibility to you, our member and our industry to use our experience, our expertise and our scale to help keep private healthcare cover affordable. That is why we have entered into arrangements with specialists and GPs which offer them a higher rate of reimbursement while ensuring you have limited co-payments.
How our payment arrangements benefit you?
You can benefit by using healthcare professionals who we have an arrangement with because we will cover their approved consultations and procedures in full. We pay claims directly to the healthcare professional when we have an arrangement with them.
Where we don't have arrangements with a healthcare professional, we pay you directly if the claim is higher than the Discovery Health Rate. You are responsible for settling the claim directly with the doctor.
Note that you can have full or partial cover, depending on the provider. Full cover means that your claim will be paid in full by Discovery Health Medical Scheme. On the other hand, partial cover means that Discovery Health Medical Scheme will only pay for a portion of your claim and so you will need to pay for any shortfalls yourself.
Please select a plan series
Cover for General Practitioners (GPs)
Out-of-hospital
We pay GP claims up to 100% of the Discovery Health Rate (DHR) from the available funds in your Medical Savings Account (MSA).
Additionally, we pay GP claims up to 100% of the Discovery Health Rate from your Above Threshold Benefit when you have reached your Annual Threshold.
You also have extended cover through the Day-to-day Extender Benefit (DEB) when you have spent your annual MSA allocation. You can read more on this benefit here.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a GP that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) for GPs that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Specialists
Out-of-hospital
We pay specialist claims up to an agreed rate for specialists we have a payment arrangement with and up to three times (300%) the Discovery Health Rate (DHR) for specialists we don't have a payment arrangement with.
We pay these claims from the available funds in your Medical Savings Account (MSA) or from your Above Threshold Benefit, when you have reached your Annual Threshold.
If you have run out of funds in your Medical Savings Account and have not yet reached your Annual Threshold (ABT) (you are in the Self-payment Gap), you will need to pay these accounts.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a specialist that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 300% of the Discovery Health Rate (DHR) for specialists that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Allied, Therapeutic and Psychology
This includes acousticians, biokineticists, chiropractors, counsellors, dieticians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Please refer to the Allied, Therapeutic and Psychology benefit guide for more information.
Out-of-hospital
We pay for out-of-hospital allied, therapeutic and psychology healthcare services from the available funds allocated to your Medical Savings Account (MSA) and from the Above Threshold Benefit (ATB) once your claims add up to the Annual Threshold. We pay these claims up to a maximum of 100% of the Discovery Health Rate. If your healthcare provider charges above this rate, you will need to pay the balance.
Claims will add up to, and pay out from, your Above Threshold Benefit (ATB) at 100% of the Discovery Health Rate once you reach your Annual Threshold.
If you have run out of funds in your Medical Savings Account (MSA) and have not yet reached your Annual Threshold (you are in the Self-payment Gap), you will need to pay these accounts.
This benefit has a limit and is not a separate benefit. Limits apply to claims paid from your Medical Savings Account (MSA), claims paid by you (if you are in a self-payment gap) and claims paid from your Above Threshold Benefit (ATB).
In-hospital
We cover these from the Hospital Benefit at 200% of the Discovery Health Rate.
Cover for General Practitioners (GPs)
Out-of-hospital
We pay GP claims up to 100% of the Discovery Health Rate (DHR) from the available funds in your Medical Savings Account (MSA).
On Classic Smart Comprehensive, you pay R75 of the consultation fee with the balance of this fee covered up to the DHR. Video consultations are covered in full up to the DHR. You must go a GP in the Smart GP Network.
Additionally, we pay GP claims up to 100% of the Discovery Health Rate from your Above Threshold Benefit when you have reached your Annual Threshold.
You also have extended cover through the Day-to-day Extender Benefit (DEB) when you have spent your annual MSA allocation. You can read more on this benefit here.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a GP that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential plans for GPs that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Specialists
Out-of-hospital
We pay specialist claims up to an agreed rate for specialists we have a payment arrangement with and up to the Discovery Health Rate (DHR) for specialists we don't have a payment arrangement with.
We pay these claims from the available funds in your Medical Savings Account (MSA) or from your Above Threshold Benefit, when you have reached your Annual Threshold.
If you have run out of funds in your Medical Savings Account and have not yet reached your Annual Threshold (you are in the Self-payment Gap), you will need to pay these accounts.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a specialist that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential plans for specialists that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Allied, Therapeutic and Psychology
This includes acousticians, biokineticists, chiropractors, counsellors, dieticians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Please refer to the Allied, Therapeutic and Psychology benefit guide for more information.
Out-of-hospital
We pay for out-of-hospital allied, therapeutic and psychology healthcare services from the available funds allocated to your Medical Savings Account (MSA) and from the Above Threshold Benefit (ABT) once your claims add up to the Annual Threshold. We pay these claims up to a maximum of 100% of the Discovery Health Rate. If your healthcare provider charges above this rate, you will need to pay the balance.
Claims will add up to, and pay out from, your Above Threshold Benefit at 100% of the Discovery Health Rate once you reach your Annual Threshold.
If you have run out of funds in your Medical Savings Account (MSA) and have not yet reached your Annual Threshold (ATB) (you are in the Self-payment Gap), you will need to pay these accounts.
This benefit has a limit and is not a separate benefit. Limits apply to claims paid from your Medical Savings Account (MSA), claims paid by you (if you are in a self-payment gap) and claims paid from your Above Threshold Benefit (ATB).
In-hospital
We cover these from the Hospital benefit at 100% of the Discovery Health Rate.
Cover for General Practitioners (GPs)
Out-of-hospital
We pay GP claims up to 100% of the Discovery Health Rate (DHR) from the available funds in your Medical Savings Account (MSA).
Additionally, we pay GP claims up to 100% of the Discovery Health Rate from your Above Threshold Benefit when you have reached your Annual Threshold.
You also have extended cover through the Day-to-day Extender Benefit (DEB) when you have spent your annual MSA allocation. You can read more on this benefit here.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a GP that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential plans for GPs that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Specialists
Out-of-hospital
We pay specialist claims up to an agreed rate for specialists we have a payment arrangement with and up to the Discovery Health Rate (DHR) for specialists we don't have a payment arrangement with.
We pay these claims from the available funds in your Medical Savings Account (MSA) or from your Above Threshold Benefit (ATB), when you have reached your Annual Threshold.
If you have run out of funds in your Medical Savings Account and have not yet reached your Annual Threshold (you are in the Self-payment Gap), you will need to pay these accounts.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a specialist that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential plans for specialists that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Allied, Therapeutic and Psychology
This includes acousticians, biokineticists, chiropractors, counsellors, dieticians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Please refer to the Allied, Therapeutic and Psychology benefit guide for more information.
Out-of-hospital
We pay for out-of-hospital allied, therapeutic and psychology healthcare services from the available funds allocated to your Medical Savings Account (MSA) and from the Above Threshold Benefit (ABT) once your claims add up to the Annual Threshold. We pay these claims up to a maximum of 100% of the Discovery Health Rate. If your healthcare provider charges above this rate, you will need to pay the balance.
Claims will add up to, and pay out from, your Above Threshold Benefit at 100% of the Discovery Health Rate once you reach your Annual Threshold.
If you have run out of funds in your Medical Savings Account (MSA) and have not yet reached your Annual Threshold (you are in the Self-payment Gap), you will need to pay these accounts.
This benefit has a limit and is not a separate benefit. Limits apply to claims paid from your Medical Savings Account (MSA), claims paid by you (if you are in a self-payment gap) and claims paid from your Above Threshold Benefit (ABT).
In-hospital
We cover these from the Hospital Benefit at 100% of the Discovery Health Rate.
Cover for General Practitioners (GPs)
Out-of-hospital
We pay GP claims from the available funds in your allocated Medical Savings Account (MSA).
You also have extended cover through the Day-to-day Extender Benefit (DEB) when you have spent your annual MSA allocation.You can read more on this benefit here.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a GP that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential and Coastal plans for GPs that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Specialists
Out-of-hospital
We pay specialist claims from the available funds in your allocated Medical Savings Account (MSA).
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a specialist that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential and Coastal plans for specialists that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Allied, Therapeutic and Psychology
This includes acousticians, biokineticists, chiropractors, counsellors, dieticians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Please refer to the Allied, Therapeutic and Psychology benefit guide for more information
Out-of-hospital
Claims for allied, therapeutic and psychology healthcare professionals are paid from the available funds in the Medical Savings Account (MSA). Once you run out of funds you will need to pay for these costs yourself.
In-hospital
We cover these from the Hospital benefit at 100% of the Discovery Health Rate.
Cover for General Practitioners (GPs)
Out-of-hospital
You need to pay for out-of-hospital GP claims
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a GP that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential and Coastal plans for GPs that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Specialists
Out-of-hospital
You need to pay for out-of-hospital specialist claims
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a specialist that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic plans, and up to 100% of the DHR for Essential and Coastal plans for specialists that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Allied, Therapeutic and Psychology
This includes acousticians, biokineticists, chiropractors, counsellors, dieticians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Out-of-hospital
These plans do not cover claims for allied, therapeutic and psychology healthcare professionals. You are responsible for payment.
In-hospital
We cover these from the Hospital benefit at 100% of the Discovery Health Rate.
Cover for General Practitioners (GPs)
Out-of-hospital
You pay R65 on Classic and R120 on Essential of the consultation fee with the balance of this fee covered at 100% of the Discovery Health Rate (DHR).
Video consultations with your Smart network GP are covered in full up to the DHR.
You need to visit a Smart Network GP.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a GP that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic, and up to 100% of the DHR on Essential for GPs that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Specialists
Out-of-hospital
You need to pay for out-of-hospital specialist claims.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a specialist that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 200% of the Discovery Health Rate (DHR) on Classic, and up to 100% of the DHR for Essential for specialists that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Allied, Therapeutic and Psychology
This includes acousticians, biokineticists, chiropractors, counsellors, dieticians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Out-of-hospital
These plans do not cover claims for allied, therapeutic and psychology healthcare professionals. You are responsible for payment.
In-hospital
We cover these from the Hospital benefit at 100% of the Discovery Health Rate.
Cover for General Practitioners (GPs)
Out-of-hospital
You have unlimited cover for medically appropriate GP consultations. When joining, you must choose a GP from the KeyCare or KeyCare Start GP network, depending on the plan you choose. You must go to your chosen GP for us to cover your consultations, including some minor procedures. Preauthorisation is required after your 15th GP visit.
On KeyCare Plus Plan and KeyCare Start Plan, if your chosen GP is not available, each person on your plan has access to 2 nurse-led consultations at a network provider. The nurse may dispense formulary medicines. The nurse can refer you for a virtual GP consultation if required. The virtual GP can then refer you for a face-to-face consultation with a network GP where needed. Pathology and radiology can only be requested by the virtual GP or face-to-face GP (subject to the KeyCare formulary). Virtual and face-to-face GPs can prescribe formulary medicines as well. On KeyCare Start Regional Plan, you must use the KeyCare Online Practice to access healthcare.
The KeyCare Core Plan does not offer day-to-day benefits. You need to pay for out-of-hospital GP claims yourself.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a GP that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 100% of the Discovery Health Rate (DHR) for GPs that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Specialists
Out-of-hospital
You have 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. Claims are covered from the Specialist Benefit at the agreed rate or up to 100% of the Discovery Health Rate (DHR) for specialists we don't have a payment arrangement with.
Cover depends on the plan you choose.
In-hospital
We will pay for these claims in full from your Hospital Benefit if you use a specialist that we have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
We pay up to 100% of the Discovery Health Rate (DHR) for specialists that we do not have a payment arrangement with, as long as their accounts are part of an approved hospital admission.
Cover for Allied, Therapeutic and Psychology
This includes acousticians, biokineticists, chiropractors, counsellors, dieticians, homeopaths, nurses, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, social workers, speech and language therapists, and audiologists.
Out-of-hospital
These plans do not cover claims for allied, therapeutic and psychology healthcare professionals. You are responsible for payment.
In-hospital
We cover these from the Hospital benefit at 100% of the Discovery Health Rate.