The Scheme has entered into payment arrangements with various healthcare professionals that have agreed to charge at the Discovery Health Rate. You benefit from access to the broadest range of doctors, which represents over 90% of our members' doctor interactions. If you use healthcare professionals that we don't have payment arrangements with, we will pay at the rate applicable to your chosen plan and you may have a co-payment.
In terms of the Medical Schemes Act of 1998 (Act No. 131 of 1998) and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of:
To access Prescribed Minimum Benefits (PMBs), there are rules that apply:
If your treatment doesn't meet the above criteria, we will pay up to 80% of the Discovery Health Rate. You will be responsible for the difference between what we pay and the actual cost of your treatment.
What is an emergency
An emergency medical condition, also referred to as an emergency, is the sudden and, at the time unexpected onset of a health condition that requires immediate medical and surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person's life in serious jeopardy. An emergency does not necessarily require a hospital admission. We may ask you for additional information to confirm the emergency.
For more information, read our Guide to Prescribed Minimum Benefits, Prescribed Minimum Benefit treatment guidelines, Guide to Prescribed Minimum Benefits for in-hospital treatment and Prescribed Minimum Benefit list of conditions.