Screening and Prevention
Preventive screening is important to make sure that medical conditions are detected early. As a Discovery Health Medical Scheme member, you have access to essential screening and prevention benefits. These tests are paid from the Screening and Prevention Benefit. Consultations that do not form part of Prescribed Minimum Benefits (PMBs) will be paid from your available day-to-day benefits. This benefit pays for certain tests that can detect early warning signs of serious illnesses. We cover various screening tests at our wellness providers, for example, blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms and prostate screenings.
The tests that the Screening and Prevention Benefit covers
Tests covered by the benefit
The benefit covers the following tests:
- One mammogram every two years (male and female)
- One Pap smear once every three years or an HPV test every five years
- One prostate-specific antigen (PSA) test each year
The Health Check
You also have cover for a group of tests called a Health Check, at one of our wellness networks. The Health Check includes the following group of tests:
- Blood glucose
- Blood pressure
- Cholesterol
- Body Mass Index (BMI) or weight assessment.
You can have two Health Checks a year at a pharmacy in the Discovery Wellness Network.
Seasonal flu vaccination
One seasonal flu vaccine each year covered up to a maximum of the Discovery Health Rate (DHR), if you are pregnant, a registered healthcare professional, older than 65 years or if you are registered for one of the following chronic conditions:
- Asthma
- Bronchiectasis
- Cardiac failure
- Cardiomyopathy
- Chronic obstructive pulmonary disease (COPD)
- Chronic renal disease
- Coronary artery disease
- Diabetes (Types 1 and 2)
- HIV
Members who do not meet these criteria can still have a flu vaccination which will be covered from the available funds in your day-to-day benefits, where applicable.
How to get the most out of the benefits available to you
You must have all of the Vitality Health Check tests done at the same time at a pharmacy in the Discovery Wellness Network. The pharmacy will send the claim to Discovery Health. If you choose to have the tests done at any other provider, or separately, the costs of the tests will be paid from your day-to-day benefits, if available.
You may have certain co-payments
- The preventive tests, including the mammogram, Pap smear, prostate specific antigen and bowel screening test are paid up to the Discovery Health Rate. You may be responsible for any shortfall if the healthcare provider charges more than the Discovery Health Rate.
- The Screening and Prevention Benefit does not cover the cost of any related consultations. Consultations are covered from the available funds in your day-to-day benefits.
- The Screening and Prevention Benefit covers the seasonal flu vaccines for members over the age of 65 and members registered for the specified chronic conditions only. Members who do not meet these criteria can still have a flu vaccination and this will be covered from the balance available in the Medical Savings Account.
- The Screening and Prevention Benefit covers one of each type of test in a year with the exception of HIV blood tests, which are unlimited. Further tests will be paid from your available day-to-day benefits.
- The screening tests and flu vaccinations must be referred and done by an appropriately registered healthcare professional, and network provider where applicable.
- A liquid-based cytology Pap smear (code 4559) will be paid up to the Discovery Health Rate for a normal Pap smear (code 4566).
- You do not have to be a Vitality member to get cover for the Vitality Health Check from the Screening and Prevention Benefit. Only Vitality members will earn Vitality points for the screening tests.
What you need to do
- To find a pharmacy in our Wellness Network or a GP in the Premier Plus Network, visit www.discovery.co.za or click on Find a healthcare provider in the Discovery Health app.
- Have the tests at a registered healthcare professional and make sure your pathology and radiology tests have been appropriately referred. You can visit any pathologist or radiologist to have the tests done.
You also have access to a mental wellbeing assessment per year. You can find out more about this benefit here.
Go to hospital
Cover for all the costs while you are hospitalised is not automatic. When you know you are going to hospital, you need to tell us beforehand. You must preauthorise your admission to hospital at least 48 hours before you go in. In the event of an emergency please phone our Discovery Care Hospital Services on 0860 99 88 77 as soon as you can and follow the prompts to obtain approval.
Full Cover Choice
When you make the Full Cover Choice, you won't be faced with any gaps or co-payments when you claim. Look out for the Full Cover Choice stamp - it shows you when you can make the Full Cover Choice and avoid co-payments.