Whenever your doctor plans a hospital admission for you, you must let us know 48 hours before you go to hospital.<\/p>\n
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You can plan and authorise<\/a>\u00a0most admissions and also read the important information that tells you how we will pay for your hospital stay.<\/p>\n Your plan may require you to use a network<\/strong><\/p>\n Coastal Plans<\/b><\/p>\n – On the Coastal Plans, you must go to a hospital in one of the four coastal provinces for a planned admission. If you don\u2019t use a coastal hospital, we pay up to a maximum of 70% of the hospital account and you have to pay the difference.<\/p>\n Delta Network Options<\/b><\/p>\n – On the Delta network options , you must go to hospitals and day-clinics in the Delta Hospital Network<\/a> for a planned admission. If you don\u2019t use a hospital in the Delta Hospital Network for planned admissions, you must pay R5 000 upfront to the hospital.<\/p>\n KeyCare Plans<\/b><\/p>\n – On the KeyCare Plans, you must go to any hospital in the KeyCare Hospital Network. If you don\u2019t use a KeyCare Hospital Network for planned admission, you will have to pay the claims yourself.<\/p>\n <\/p>\n How we cover the account from Hospital<\/span><\/strong><\/p>\n Your hospital cover is made up of:<\/p>\n – 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\u2019s 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.<\/p>\n <\/p>\n Medical tests in Hospital<\/strong><\/span><\/p>\n There may be some medical tests that you require while in hospital.<\/p>\n Your cover for investigations<\/p>\n Scopes (gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies)<\/b><\/p>\n 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.<\/p>\n 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.<\/p>\n For scopes that are done in the doctor\u2019s rooms, the co-payment or deductible does not apply. We pay for the scope without using the member\u2019s day-to-day benefits.<\/p>\n MRI and CT scans<\/strong><\/p>\n We only cover MRI or CT scans if you are referred by an appropriate healthcare professional<\/a>. Approved MRI or CT scans will be covered from the Hospital Benefit. Phone us to confirm your benefits and cover.<\/p>\n <\/p>\n Claim<\/span><\/strong><\/p>\n
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Email<\/b> – scan and email your claims to ![\"\"](\"https:\/\/www.discovery.co.za\/discovery_coza\/web\/linked_content\/images\/health\/icons\/bullet_post.png\")
Post<\/b> – send your claims to Discovery Claims, PO Box 784262, Sandton, 2146<\/div>\n![\"\"](\"https:\/\/www.discovery.co.za\/discovery_coza\/web\/linked_content\/images\/health\/icons\/bullet_fax.png\")
Fax<\/b> – 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)<\/div>\n![\"\"](\"https:\/\/www.discovery.co.za\/discovery_coza\/web\/linked_content\/images\/health\/icons\/bullet_boxes.png\")
Claims drop-off boxes<\/b> – 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.<\/div>\n