Discovery Health - Gap Comprehensive: Essential & Coastal Gap Cover

Discovery Health - Gap Comprehensive: Essential & Coastal Gap Cover

Discovery’s Comprehensive gap cover provides in-hospital cover for medical expense shortfalls at up to 500% of the medical scheme tarriff.

It also offers extended gap cover benefits for hospital admission (including gap cover for private ward fees); oncology; scopes and scans; and medical emergencies while travelling.

Discovery's Gap Comprehensive: Essential & Coastal gap cover is available to existing members of Discovery Health Essential or Coastal medical aid plans.

Gap Cover Benefits

Co-payment benefit

Cover for co-payments or deductibles on hospital account for endoscopies (gastroscopy, sigmoidoscopy, proctoscopy and colonoscopy). Includes cover on copayments that applies to out-of-hospital MRI and CT scans

Dental benefit

No Benefit

Diagnosis benefit

Medical Breakthrough Funder available through Supplementary Gap Cover benefit, at an additional cost Refer to member guide for details

Emergency/casualty benefit

No Benefit

Full time students over 21

Covered, as long as they are registered as medical scheme dependants

Gap cover limits

An overall annual limit of R160,000 per beneficiary per year

Gap cover percentage benefit

In-hospital Specialist Gap Cover gives cover of up to 500% of the medical scheme rate. This amount is over and above what the medical scheme pays

Lives Covered

Main medical scheme member of Discovery (excl KeyCare); All family members registered as medical scheme dependants 24 month waiting period applies when; Join date is after 1 March 2017 OR Option downgrade is done after 1 March 2017

Maximum entry age

There is no maximum entry age applicable

Oncology benefit

Cover up to R40,000 available. OBE: Once registered on schemes oncology benefit is reached, up to R40,000 additional cover relating to approved cancer related claims

Oncology supplementary benefit

No Benefit

PMB cover

Prescribed Minimum Benefits are covered
*No cover for emergency or involuntary PMB treatment

Sub-limit benefit

No Benefit

Trauma counselling

No Benefit

Gap Cover Contributions

Contributions

Single - Under 54 yrs

R 300


Single - Btw 54-64 yrs

R 549


Single - Over 65 yrs

R 730


Family - Under 54 yrs

R 685


Family - Btw 54-64 yrs

R 1 045


Family - Over 65 yrs

R 1 375

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