Discovery Health Gap Cover

gap cover

South Africa’s largest financial services group, Discovery Ltd., offers gap cover products that dovetail with benefits provided by Discovery Health medical aid options.

The Gap Cover policy is underwritten by Discovery Insure, and Supplementary Gap Cover policy is underwritten by Discovery Life.

Rates are based on age, family structure and the existing level of medical aid cover provided by Discovery Health. Members of KeyCare plans cannot apply for Discovery Gap Cover.

What’s covered by Discovery Gap Cover?

Discovery provides the following benefits across both Gap Cover policies:

  • funds to cover the shortfall between what the medical scheme pays and specialists charge for authorised in-hospital procedures
  • additional cover for hospital admissions, over and above the in-hospital specialist benefit
  • gap-related oncology benefits that kick in once the scheme’s oncology threshold has been reached

Discovery Health members who subscribe to the top tier Gap Cover Comprehensive product are entitled to:

  • benefits for certain out-of-hospital expenses related to hospital admissions
  • co-payment and deductible cover for specified scopes and scans conducted in- and out-of-hospital
  • emergency international travel benefits

Discovery Gap Cover options

Discovery offers two Gap Cover products that provide the extra level cover that you and your family need.

Discovery Gap Cover Core

Discovery Gap Cover Core is an affordable option that covers the shortfall of essential in-hospital expenses. Benefits include:

  • gap cover of up to 200 percent the scheme rate for in-hospital specialist consultations, up to an overall annual limit of R157 500 per person
  • a hospital extender benefit of up to R10 000 per family per year to cover the specialist shortfall
  • an oncology extender benefit of up to R75 000 per person per year to cover cancer-related co-payments

The value of the Hospital Extender benefit is determined by the type of Discovery Health medical aid option you belong to, the number of beneficiaries covered by the option, and your Vitality status.

Discovery Gap Cover Comprehensive

Discovery Gap Cover Comprehensive covers the specialist gap by up to 200 percent. The overall annual limit is R157 500 per person.

It offers enhanced hospital and oncology extender benefits, of up to R20,000 per family, and R100,000 per person, per year.

Additional benefits include:

  • co-payment or deductible cover for endoscopies conducted in-hospital
  • cover for co-payments or deductibles for out-of-hospital MRI and CT scans
  • cover for shortfalls on emergency medical claims outside of South Africa
  • an international travel deductible on emergency out of hospital claims

Waiting periods

There is a 3-month general waiting period, and a 12-month waiting period on pre-existing conditions, on Discovery Gap Cover policies.

Gap cover claims relating to a range of treatments and procedures, such as joint replacements, tonsillectomies, hernia procedures, hysterectomies and certain scopes, are not covered within the first 12 months.

Discovery Supplementary Gap Cover

Discovery Supplementary Gap Cover is available to scheme members under the age of 60 years.

It is an add-on option to the Discovery Gap Cover policies, and offers lump sum payouts on the diagnosis of serious, life threatening illnesses.

Key benefits include:

  • a lump sum of up to R550 000 to enable access to advanced treatments
  • premium protection that pays medical scheme contributions for up to two years
  • a monthly sum of R10 000 to pay for home support
  • up to 25 percent back on scheme premiums, based on Vitality status

Why choose Discovery as your gap cover provider?

Discovery is a global financial services giant listed on the JSE. It’s been in existence since 1992, and there are currently more than 20 million Discovery policy holders worldwide.

Advantages of Discovery Gap Cover include:

  • affordable monthly premiums based on the existing level of cover with Discovery Health
  • a seamless and integrated claims payment process
  • single and family rates
  • gap cover for scans out-of-hospital
  • lump sum supplementary gap cover as a low-cost add-on

At IFC, we offer informed, objective advice about South African medical aid schemes, and can assist you in joining the scheme that best suits your needs and budget. Contact us for more information or to discuss your needs.