EXECUTIVE 2024PLAN

Reimagining your healthcare

For the best quality healthcare to support life’s inevitable moments, Discovery Health Medical Scheme provides comprehensive healthcare that is just right for you.

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Read this guide to understand more about your health plan including:

• What to do when you need to go to a doctor or to a hospital
• How you are covered for preventative screening, diagnosis and treatment of medical conditions
• Which benefits you need to apply for and if there are any limits for certain benefits
• Your access to a truly personalised health journey through the Discovery Health app.

Key terms

Above Threshold Benefit (ATB)

Once approved on the Chronic Illness Benefit (CIB), you have cover for medicine for an additional list of life-threatening or degenerative conditions, as defined by us.

Chronic Drug Amount (CDA)

The Chronic Drug Amount (CDA) is the monthly amount that we pay up to for a medicine class, subject to a member’s plan type.

Cover

Cover refers to the benefits you have access to and how we pay for these healthcare services such as consultations, medicine, and hospitals, on your health plan.

Emergency medical condition

An emergency medical condition, also referred to as an emergency, is the sudden and unexpected onset of a health condition that requires immediate medical and surgical treatment.

Key features

Unlimited cover for hospital admissions

There is no overall limit for hospital cover on the Executive Plan.

Full cover for chronic medicine

Full cover for chronic medicine on our formulary for all Chronic Disease List (CDL) conditions.

HealthID

HealthID is an online digital platform that gives your doctor fast, up-to-date access to your health information.

Day-to-day benefits

We cover your day-to-day healthcare expenses from your Medical Savings Account (MSA), Day-to-day Extender Benefit (DEB), or Above Threshold Benefit (ATB).

Medical Savings Account (MSA)

We pay your day-to-day medical expenses from your available funds allocated to your MSA.

Maternity benefit

You have cover for maternity and early childhood

You get cover for healthcare services related to your pregnancy and treatment for the first two years of your baby’s life.

During pregnancy

• Antenatal consultations: We pay for up to 12 consultations with your gynaecologist, GP or midwife.
• Ultrasound scans and screenings during pregnancy: You are covered for up to two 2D ultrasound scans.

Chronic benefits

The Chronic Illness Benefit (CIB) covers you for a defined list of 27 medical conditions known as the Chronic Disease List (CDL).

What we cover

You have access to treatment for a list of medical conditions under the Prescribed Minimum Benefits (PMBs).

Oncology Care Programme

You have access to comprehensive cover for cancer treatment. This includes access to high-cost medicine, innovative treatment, and extended cover once you reach certain limits.

How we cover medicine

You need to get your approved oncology medicine from a designated service provider (DSP) to avoid a 20% co-payment.

Hospital Benefit

The Executive Plan offers cover for hospital stays. There is no overall limit for the Hospital Benefit. You can go to any private hospital approved for funding by the Scheme.

Exclusions

Discovery Health Medical Scheme has certain exclusions. We do not pay for healthcare services related to specific conditions except where stipulated as part of a defined benefit or under the Prescribed Minimum Benefits (PMBs).

Additional benefits

You have access to extra benefits to enhance your cover, such as Assisted Reproductive Therapy (ART) and various mental health care programs.

This brochure is only a summary of the key benefits and features of Discovery Health Medical Scheme plans, subject to approval from the Council for Medical Schemes.