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Sizwe Medical Fund under provincial curatorship

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Discovery Questions and Answers

1. Cover for planned hospital admissions

Before you go to hospital for any planned procedure, you must:

  • See your doctor
  • Check whether your specialist participates in a payment arrangement
  • Call us on 0860 99 88 77 to confirm your hospital admission at least 48 hours before you go to hospital. If you do not confirm your admission, we will only pay 70% of the costs that we would normally cover.

When you contact us, give us the following details:

  1. Your Discovery Health membership number
  2. When you will be admitted to hospital and how long you will stay
  3. The date of the procedure
  4. The name of the hospital or clinic
  5. Your treating doctor’s name, practice number and phone number
  6. Your diagnosis (ask your doctor for the ICD-10 diagnosis code)
  7. The procedure name (ask your doctor for the CPT or RPL procedure codes).

If one of your dependants is admitted, give us their details.

2. Cover for medicine

Discovery Health covers medicine either from the Chronic Illness Benefit or from your day-to-day benefits, where applicable.

Chronic medicine

This is medicine that you need to take on a daily basis over a long period of time. Not all medicine that is taken for a long period of time will be paid as chronic.

For us to cover a medicine as chronic, we need to approve it for one of our covered chronic conditions.

More about the Chronic Illness Benefit