Discovery Medical Aid: A Complete Guide
Discovery Medical Aid, officially known as the Discovery Health Medical Scheme (DHMS), is South Africa’s largest open medical scheme. With over half of the market share, it serves millions of South Africans who rely on it for private healthcare cover.
Although Discovery Health administers the scheme, it is technically a not-for-profit entity, governed under the Medical Schemes Act and regulated by the Council for Medical Schemes. This means that contributions from members go directly into paying benefits, with administration costs and reserves managed separately.
Discovery has built its reputation on offering members a wide range of plans, integrated digital tools, and benefits linked to its well-known wellness programme, Vitality.
Plan Structure and Benefits
Discovery Medical Aid offers more than 20 plan options, carefully structured to suit different needs and budgets. Whether you’re looking for a high-end plan with extensive benefits or a cost-effective entry-level option, the scheme has an option to match.
Hospital Cover
All plans include unlimited cover for hospital admissions. Members have access to private hospitals, although planned procedures generally require prior authorisation. Emergencies are fully covered, and in many cases, Discovery has agreements with hospital networks to manage costs.
Day-to-Day Benefits
Day-to-day medical expenses such as GP visits, specialists, dentists, and optometry are covered depending on your plan choice. Many plans use a Medical Savings Account (MSA), where part of your monthly contribution is set aside for outpatient expenses. Once this account runs out, some plans offer an Above Threshold Benefit (ATB) that kicks in after you’ve spent a certain amount.
Selected plans also include the Day-to-Day Extender Benefit, which ensures essential services like GP consultations or pathology tests remain covered even when your MSA is depleted, provided you use Discovery’s network providers.
Chronic Illness Cover
Discovery provides cover for all conditions listed under the Prescribed Minimum Benefits (PMBs), which is a legal requirement. Higher-tier plans also include a broader list of chronic conditions, ensuring access to the necessary treatment and medication for long-term illnesses.
Maternity and Childcare
Expecting parents can access maternity benefits that cover pre-birth checkups, ultrasounds, and screenings. After birth, babies are covered from day one, and postnatal care, including checkups and certain vaccinations, is provided. On certain premium plans, assisted reproductive therapy like IVF is also supported.
International Travel and Evacuation
Many Discovery Medical Aid plans include emergency medical cover while travelling abroad. Depending on your plan, this could range from several million rand’s worth of cover to more extensive global protection. Discovery also offers an Africa Evacuation Benefit, which ensures members in neighbouring countries can be transported back to South Africa for treatment if needed.
Preventive and Wellness Benefits
Screenings for conditions like diabetes, cholesterol, and cancer are included, along with vaccinations and wellness checkups. Discovery actively promotes preventive healthcare, believing that early detection improves outcomes and reduces long-term costs.
Digital Tools and Additional Features
Discovery members benefit from a range of digital innovations, including online pre-authorisation, virtual GP consultations, and access to a global second-opinion service. The scheme also offers “Hospital at Home” for certain conditions, where patients can receive hospital-level treatment in their homes.
Plan Tiers and Options
Discovery’s plan structure is divided into categories, each catering to a specific need:
- Executive Plan: The most comprehensive option, offering unlimited hospital cover, extensive day-to-day benefits, international emergency cover, and specialised support like assisted reproduction.
- Comprehensive Series: Offers strong hospital cover and generous day-to-day benefits with a savings account and threshold benefits.
- Priority, Saver, Core, and Smart Plans: Mid-range options designed for affordability while maintaining good hospital cover. Savings and thresholds vary by plan.
- KeyCare Series: Entry-level options focused on affordability. These rely on hospital and provider networks, offering essential cover at lower contributions.
Monthly contributions differ across the plans, with rates depending on your chosen option, the number of dependants, and your age.
Joining, Changing, or Leaving
Joining is straightforward: you can apply online, through a broker, or directly with Discovery. Depending on your health and membership history, waiting periods may apply before certain benefits are activated.
- Waiting periods: Typically range from three months for general cover to 12 months for pre-existing conditions.
- Late joiner penalties: If you join after age 35 and haven’t had consistent cover, you may face additional premium loadings.
- Withdrawals: You can resign from the scheme or remove dependants with at least 30 days’ written notice. If you leave a plan that has a Medical Savings Account, any positive balance will be refunded a few months after all outstanding claims are processed.
Strengths of Discovery Medical Aid
- Comprehensive Cover – All plans include unlimited hospital cover, which gives members confidence in their access to private healthcare.
- Range of Options – From entry-level to premium, the flexibility allows individuals and families to match their healthcare needs to their budget.
- Preventive Care – Emphasis on screenings and early detection helps members stay healthier and reduces the risk of major medical events.
- Digital Innovation – Discovery’s app and online tools make managing medical aid easier, from authorisations to virtual consultations.
- Vitality Integration – Members can link their medical aid to the Vitality wellness programme, earning rewards for healthy behaviour and improving lifestyle outcomes.
Considerations Before Joining
While Discovery is the market leader, there are factors potential members should weigh:
- Cost: Premium plans come with high monthly contributions, which may be out of reach for some households.
- Complexity: With over 20 plan options and various rules, members need to carefully study benefits and limitations to avoid unexpected costs.
- Network Restrictions: Lower-tier plans often require members to use specific hospitals or GPs, which may not always be convenient.
- International Cover Limits: Overseas cover is limited to emergencies and doesn’t extend to elective procedures abroad.
The Role of Discovery in South Africa’s Healthcare
It has played a major role in shaping private healthcare in South Africa. Since its founding in the early 1990s, the company has expanded into multiple financial services sectors, but its medical aid remains the cornerstone of the brand.
With government moving ahead on the proposed National Health Insurance (NHI), the role of private medical schemes like Discovery is likely to evolve. While the future regulatory landscape is uncertain, Discovery’s size and influence mean it will remain a central player in South African healthcare for years to come.
Practical Tips for Prospective Members
- Compare plans: Discovery offers online tools to help you weigh the benefits and costs of different options.
- Consider life stage: Young singles may find Smart or Core plans suitable, while families often benefit from Comprehensive or Priority options.
- Check provider networks: Make sure your preferred hospital or GP is within Discovery’s network before committing.
- Review annually: Healthcare needs change, and reviewing your plan every year ensures you don’t overpay or under-insure.
- Use wellness benefits: Take advantage of screenings, vaccinations, and preventive programmes—it’s included in your cover.
Discovery Medical Aid is South Africa’s leading medical scheme, offering a wide range of plans, strong hospital cover, and innovative benefits. Its integration with digital tools and wellness initiatives sets it apart from competitors, making it a trusted choice for millions.
For anyone considering joining, the key is to match your health needs and budget to the right plan. With careful selection and use of benefits, it can provide peace of mind and access to some of the best healthcare available in the country.