All members have access to private hospitals. We cover the costs of planned hospital admissions from your Hospital Benefit. There is no overall limit for hospitalisation.

Let us know if you need to go to hospital

Whenever your doctor plans a hospital admission for you, you must let us know 48 hours before you go to hospital.

You can plan and authorise most admissions and also read the important information that tells you how we will pay for your hospital stay.

Your plan may require you to use a network

Coastal Plans

– On the Coastal Plans, you must go to a hospital in one of the four coastal provinces for a planned admission. If you don’t use a coastal hospital, we pay up to a maximum of 70% of the hospital account and you have to pay the difference.

Delta Network Options

– On the Delta network options , you must go to hospitals and day-clinics in the Delta Hospital Network for a planned admission. If you don’t use a hospital in the Delta Hospital Network for planned admissions, you must pay R5 000 upfront to the hospital.

KeyCare Plans

– On the KeyCare Plans, you must go to any hospital in the KeyCare Hospital Network. If you don’t use a KeyCare Hospital Network for planned admission, you will have to pay the claims yourself.

How we cover the account from Hospital

Your hospital cover is made up of:

– The cover for the account from the hospital (the ward and theatre fees) at the rate agreed with the hospital from your hospital account. The cover for your treating healthcare professional’s accounts, such as the admitting doctor, anaesthetist and any approved healthcare expenses like radiology or pathology are separate from the hospital account and are called related accounts.

Medical tests in Hospital

There may be some medical tests that you require while in hospital.

Your cover for investigations

Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies)

Scopes are used to investigate certain conditions such as gastric ulcers, reflux and infections. A scope can also be done to perform a specific surgical procedure.

Where scopes are done in hospital, a co-payment or deductible applies to the hospital account. We pay all the other approved accounts that are related to the procedure from the Hospital Benefit.

For scopes that are done in the doctor’s rooms, the co-payment or deductible does not apply. We pay for the scope without using the member’s day-to-day benefits.

MRI and CT scans

We only cover MRI or CT scans if you are referred by an appropriate healthcare professional. Approved MRI or CT scans will be covered from the Hospital Benefit. Phone us to confirm your benefits and cover.

Claim

You can send us your claims in one of these ways:

Email – scan and email your claims to claims@discovery.co.za

Post – send your claims to Discovery Claims, PO Box 784262, Sandton, 2146

Fax – fax your claims to 0860 329 252 (please ensure that the fax details are clear by first making a photocopy and then faxing that through)

Claims drop-off boxes – drop off your claims in our drop-off boxes located for your convenience in most pharmacies, medical practices and at Virgin Active and Planet Fitness gyms nationwide.

Remember: If your healthcare professional has already sent us the claim, you do not have to send us another copy.

 

What to remember

– Claims must be submitted within four months. Older claims will be considered expired and will not be paid

– Make sure that your membership number, the healthcare professional’s details including the practice number are clear on the claim

– Send a detailed claim and not just a receipt as we need the details of what you are claiming for in order to process your claim quickly and correctly.