Discovery Health’s Extended Medical Aid Benefits for COVID-19

extended medical aid benefits

Discovery Health has launched a series of proactive interventions in response to the COVID-19 pandemic, including extended medical aid benefits.

South Africa’s largest medical aid scheme is funding these extended benefits from its risk pool.

WHO Global Outbreak Benefit: out-of-hospital cover paid from risk

The WHO Global Outbreak Benefit is designed to complement the existing state-sanctioned Prescribed Minimum Benefits (PMB) diagnosis and treatment guidelines that are automatically paid by the scheme.

Discovery Health members across all the scheme’s options are now eligible for extended benefits targeting COVID-19-related out-of-hospital expenses that aren’t covered by PMBs.

On submission of a risk assessment and, depending on the outcome of that assessment, a screening consultation with a scheme doctor, at-risk patients are referred for COVID-19 testing.

Extended COVID-19 cover applies to those who test positive

A positive diagnosis for the virus is required to unlock extended cover for the following healthcare services:

  • out-of-hospital supportive treatment and management of COVID-19, including medication and oximeters to monitor oxygen saturation levels
  • pathology tests, as specified by the scheme
  • a defined set of scans and X-rays
  • accommodation at accredited isolation facilities.

Screening consultations with network doctors, and reverse transcription polymerase chain reaction (RT-PCR) tests as per doctors’ referrals, are covered by the extended benefits.

PMBs cover consults and tests of negative members

Members who test negative for the virus are covered for a screening consult and one referred RT-PCR test by the PMBs.

In both instances, the costs are paid from risk and have no impact on day-to-day benefits or the funds available in a member’s savings account.

Do extended benefits cover COVID-19 in-hospital stays?

A scheme member who is infected with COVID-19, and is pre-authorised for admission to hospital, is covered by the hospital benefit that applies to his or her particular medical aid option.

Discovery waives gap cover waiting periods

In addition to offering medical scheme members extended benefits for the duration of the COVID-19 pandemic, Discovery has committed to paying all gap-cover claims relating to the virus.

As a consequence, the waiting periods imposed on new clients have been temporarily waived.

Once the coronavirus outbreak is brought under control, the situation will be re-assessed.

The usual terms and conditions are likely to be reapplied.

Do you want the benefits of belonging to SA’s largest medical scheme?

Claims relating to COVID-19 are draining the solvency levels of medical schemes in South Africa.

Joining a scheme that has a solid financial base – and a great reputation – is more critical than ever.

As the largest medical scheme in South Africa, Discovery Health offers exactly that.

How IFC can help

At IFC, we offer informed, objective advice about South African medical aid schemes and can advise you about Discovery Health’s extended medical aid benefits for COVID-19.

We can assist you in joining the scheme that best suits your needs and budget. Contact us for more information or to discuss your needs.

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