Monthly premium, per family
By age band, as Discovery publishes it. 2027 premiums take effect on 1 January 2027.
| Age | 2026 | 2027 | Change |
|---|---|---|---|
| 0_54 | Not available | Not available | |
| 55_64 | Not available | Not available | |
| 65_plus | Not available | Not available |
What it covers
What it pays
Limits and joining
Who is covered
In Discovery’s own words.
- Only members of Discovery Health Medical Scheme qualify for Discovery Gap Cover. KeyCare plans are excluded. If you downgrade your health plan to a KeyCare plan, your Gap Cover policy will be cancelled. Discovery discovery gap cover brochure 2027, p11
What each benefit means
In Discovery’s own words, with its examples of when it pays and when it doesn’t.
Why Gap Cover
You and your family already have medical scheme cover, but unexpected medical costs can still place significant financial strain on your family. This can happen when healthcare professionals charge more than what your medical scheme pays or when you have a life-changing event. Gap cover from Discovery is a cost-effective solution that gives you extra financial protection against these unforeseen costs.
Discovery discovery gap cover brochure 2027, p2
Hassle-free payments
With Discovery Gap Cover, you don’t have to submit a separate claim to us. We automatically identify gaps and then assess and pay once the medical scheme claim has been processed.
Discovery discovery gap cover brochure 2027, p4
In-hospital Specialist Gap Cover
In-hospital Specialist Gap Cover gives you cover of up to 500% of the medical scheme rate on Discovery Gap 500, up to 250% on Discovery Gap 250 and up to 100% on Discovery Gap 100 when your approved in-hospital specialist claim is higher than what your medical scheme pays your specialist.
Discovery discovery gap cover brochure 2027, p5
In-hospital Specialist Gap Cover
When you are admitted to hospital, your specialist may charge more than the amount covered by your medical scheme. When this happens, our gap cover pays for these tariff shortfalls on your approved specialist in-hospital claims. Your dental specialist’s claims also qualify for funding from this benefit where the claim was funded by your scheme’s hospital benefit.
Discovery discovery gap cover brochure 2027, p7
Hospital Admission Benefit Extender
On the Gap 500 and Gap 250 options, the Hospital Admission Benefit Extender further extends your cover for shortfalls on approved, in-hospital specialist claims up to the rate your specialist charges, subject to your benefit entitlements. Gaps still experienced over and above those covered by In-hospital Specialist Gap Cover are automatically covered by the Hospital Admission Benefit Extender.
Discovery discovery gap cover brochure 2027, p7
Hospital Admission Benefit Extender (Gap 500 & 250)
You have up to R15,000 extra gap cover on the 500 option and up to R7,500 extra gap cover on the 250 option, which you can use for shortfalls still remaining on approved specialist claims in-hospital, over and above what is covered by your In-hospital Specialist Gap Cover.
Discovery discovery gap cover brochure 2027, p9
Oncology Benefit Extender
Once you are registered on your scheme’s oncology benefit and you have reached the oncology threshold, the Oncology Benefit Extender will help you cover co-payments for cancer-related expenses approved by your medical scheme. You will get up to R110,000 to cover shortfalls on approved, cancer-related claims once you have reached your scheme’s oncology threshold. The amount depends on the Discovery Gap Cover option you choose.
Discovery discovery gap cover brochure 2027, p10
Waiting periods
In Discovery’s own words.
- There is an automatic three-month general waiting period for all healthcare services and treatment, except authorised emergency hospital admissions Discovery discovery gap cover brochure 2027, p12
- There is an automatic 12-month exclusion for any claims directly or indirectly related to the treatment of pregnancy and childbirth (if you are on the Gap 100 plan, this is an exclusion for the entire term of your policy), endometrial ablations, hysterectomy, joint replacements, scopes (including minimally invasive scopes, endoscopies, hysteroscopies and arthroscopies), cataracts, cholecystectomy, wisdom teeth, orthognathic surgery, dental implants, tonsillectomy, grommets, adenoidectomy, nasal procedures, hernia procedures and reflux surgery Discovery discovery gap cover brochure 2027, p12
- If you or any of your dependants have a pre-existing medical condition when you apply for cover or upgrade your cover, we will exclude any claims relating to the treatment of this condition for the first 12 months Discovery discovery gap cover brochure 2027, p12
- If you can show that you have had gap cover with another insurance company with less than 90 days’ break in cover between the time you ended your policy with them and activated your policy with us, these may not apply: Discovery discovery gap cover brochure 2027, p12
How to claim
In Discovery’s own words.
Claiming
You do not need to submit a separate Discovery Gap Cover claim to us. By providing consent to access your claims information, we will automatically identify any potential gap cover claims, and then pay according to your Discovery Gap Cover benefits once the medical scheme claim is processed. You will also receive a claims statement where you will see how your gap cover policy has covered any shortfalls.
Discovery discovery gap cover brochure 2027, p10
What it does not pay for
Discovery’s exclusions (8)
- All claims excluded by your medical scheme plan
- All claims where the hospital admission was not approved by your medical scheme and you did not get an authorisation number (except for in-hospital dentistry specialist claims, where the admission is not subject to a hospital authorisation)
- All oncology-related co-payments that are part of innovative cancer treatments related to the scheme’s Oncology Innovation Benefit
- Any claim related to weight-loss surgery
- Any claim where the healthcare service or treatment was not provided by an appropriately registered specialist (except for healthcare services specified in the Gap 500 Benefit Extender)
- Any claim that is incurred outside the borders of the Republic of South Africa or charged in any foreign currency, except claims that qualify for funding from the Travel Benefit Extender
- Any claims related to pregnancy and childbirth over the entire term of a Discovery Gap 100 policy.
- Any claims related to materials, consumables, and external equipment.
Discovery discovery gap cover brochure 2027, p11
Words used
As Discovery defines them.
- 2027 product name changes
- Discovery discovery gap cover brochure 2027, p4
- Overall annual limit
- Discovery discovery gap cover brochure 2027, p5
- Overall annual limit
- Discovery discovery gap cover brochure 2027, p6
- Underwriter
- Discovery discovery gap cover brochure 2027, p2
Questions about Discovery Gap 250 (Essential & Active plans)
Answered from Discovery’s brochures.
How much does Discovery Gap 250 (Essential & Active plans) cost in 2027?
From 1 January 2027: not available at 0_54; not available at 55_64; not available at 65_plus. One premium covers the whole family.
Is there a waiting period?
Yes. 3 months general, and 12 months for conditions you had before joining.
Does Discovery Gap 250 (Essential & Active plans) cover cancer?
Yes, Discovery Gap 250 (Essential & Active plans) includes cancer cover.
Which co-payments does it cover?
One co-payment a year that your medical scheme charges.
Is there a limit on what it pays?
Yes. R226 881 per person a year.
Factual information from Discovery’s published brochures. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v175, built 2026-10-19.