We hold Discovery’s 2027 contributions; its 2027 benefit rules are not in our records yet. Each row shows the 2026 rule, marked.
Benefits in force for 2026.
In hospital
Hospitals
2027 not in our records yet. 2026: Any hospital
(2026)
Specialists in hospital
200% of Scheme tariff. A specialist who charges more leaves a shortfall.
Discovery classic priority plan, p1
Specialists in hospital
2027 not in our records yet. 2026: 200% of Scheme tariff. A specialist who charges more leaves a shortfall.
Discovery classic priority plan, p1 (2026)
Chronic and cancer
Chronic conditions
27 conditions, the Chronic Disease List.
Chronic conditions
2027 not in our records yet. 2026: 27 conditions, the Chronic Disease List.
(2026)
Cancer
Up to R250 000 a year.
Discovery annexure 8a oncology treatment programme, p1
Cancer
2027 not in our records yet. 2026: Up to R250 000 a year.
Discovery annexure 8a oncology treatment programme, p1 (2026)
Day to day
Medical savings account
25% of your contribution goes into a savings account for day-to-day costs.
Discovery classic priority plan, p23
Medical savings account
2027 not in our records yet. 2026: 25% of your contribution goes into a savings account for day-to-day costs.
Discovery classic priority plan, p23 (2026)
Maternity
no managed-care maternity programme — benefit-based, paid from the scheme’s risk benefits, not savings.
Discovery catalogue maternity in hospital rows, per plan
Maternity
2027 not in our records yet. 2026: no managed-care maternity programme — benefit-based, paid from the scheme’s risk benefits, not savings.
Discovery catalogue maternity in hospital rows, per plan (2026)
GP visits
General Practitioners Paid from MSA first and then Limited ATB up to a maximum of 100% of Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
GP visits
2027 not in our records yet. 2026: General Practitioners Paid from MSA first and then Limited ATB up to a maximum of 100% of Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25 (2026)
Specialist visits
Specialists Paid from MSA first and then Limited ATB: Premier Rate providers: Up to a maximum of the Premier Rate. All other specialists: Up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
Specialist visits
2027 not in our records yet. 2026: Specialists Paid from MSA first and then Limited ATB: Premier Rate providers: Up to a maximum of the Premier Rate. All other specialists: Up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25 (2026)
Prescribed medicine (acute)
Prescribed medication for schedule 3 and above medication Preferentially priced generic and brand medication: Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Medication Rate and accumulation to Threshold at up to 100% of the Discovery Health Medication Rate. Payment from Limited ATB at up to 100% of the Discovery Health Medication Rate. Non-preferentially priced generic and brand medication: Payment from MSA first up to a maximum of 100% of the Discovery Health Medication Rate. Then payment from Limited ATB and accumulation to Threshold at up to either 50% or 75% of the Discovery Health Medication Rate, depending on the price of the medication relative to the cost of the preferentially priced medication. Member - R27 850 M + 1 dependant - R33 750 M + 2 dependants - R40 650 M + 3 dependants or more - R44 350 Limited to balance available in ATB
Discovery classic priority plan 2026, p26
Prescribed medicine (acute)
2027 not in our records yet. 2026: Prescribed medication for schedule 3 and above medication Preferentially priced generic and brand medication: Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Medication Rate and accumulation to Threshold at up to 100% of the Discovery Health Medication Rate. Payment from Limited ATB at up to 100% of the Discovery Health Medication Rate. Non-preferentially priced generic and brand medication: Payment from MSA first up to a maximum of 100% of the Discovery Health Medication Rate. Then payment from Limited ATB and accumulation to Threshold at up to either 50% or 75% of the Discovery Health Medication Rate, depending on the price of the medication relative to the cost of the preferentially priced medication. Member - R27 850 M + 1 dependant - R33 750 M + 2 dependants - R40 650 M + 3 dependants or more - R44 350 Limited to balance available in ATB
Discovery classic priority plan 2026, p26 (2026)
Basic dentistry
Dentistry Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Claims paid from the MSA and once in ATB accumulate to the benefit limit. Limited to balance available in ATB
Discovery classic priority plan 2026, p26
Basic dentistry
2027 not in our records yet. 2026: Dentistry Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Claims paid from the MSA and once in ATB accumulate to the benefit limit. Limited to balance available in ATB
Discovery classic priority plan 2026, p26 (2026)
Eyes (optometry)
Optometry consultations and optometry not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p29
Eyes (optometry)
2027 not in our records yet. 2026: Optometry consultations and optometry not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p29 (2026)
Basic X-rays
X-rays and radiology not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p27
Basic X-rays
2027 not in our records yet. 2026: X-rays and radiology not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p27 (2026)
Blood tests (pathology)
Pathology Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB. Point-of-care pathology testing is subject to meeting the Scheme's treatment guidelines and managed care criteria.
Discovery classic priority plan 2026, p27
Blood tests (pathology)
2027 not in our records yet. 2026: Pathology Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB. Point-of-care pathology testing is subject to meeting the Scheme's treatment guidelines and managed care criteria.
Discovery classic priority plan 2026, p27 (2026)
Full benefit list
Every benefit we hold for Classic Priority, in Discovery’s own wording, from its 2026 documents. Discovery’s full 2027 list is not in our records yet.
In hospital
Surgery and anaesthetics
Specialists Premier Rate providers: Up to a maximum of the Premier Rate. Classic Direct providers: Up to a maximum of the Classic Direct Rate. All other specialists: Up to a maximum of 200% of the Discovery Health Rate. Unlimited. Doctors and allied health care service providers while hospitalised Up to a maximum of 200% of the Discovery Health Rate.
Discovery classic priority plan 2026, p1
Hospital stay and theatre
Accommodation, theatre fees, materials used, prescribed medication for duration of hospitalisation Up to a maximum of 100% of the Discovery Health Rate. Subject to authorisation and/or approval and meeting the Scheme's clinical and managed care criteria. Unlimited
Discovery classic priority plan 2026, p2
Day procedures
Healthcare services reflected in Annexure 5 Beneficiary is responsible for a Deductible in respect of the hospital account for certain hospital events, unless the admission is related to a Prescribed Minimum Benefit diagnosis typically as a result of an emergency. The deductible will apply regardless of whether the procedure attracting the deductible was the primary reason for admission or not. Where such event is also subject to Annexure 9, the higher of the Deductible amount stipulated in either Annexure 5 or Annexure 9 shall be payable by the beneficiary in respect of the hospital account for elective admissions at a facility which is not a network facility. Unlimited
Discovery classic priority plan 2026, p1
Day procedures
Administration of defined intravenous infusions Up to a maximum of 100% of the Discovery Health Rate at the Scheme's network provider. A 20% co-payment shall be payable by the beneficiary in respect of the hospital account when treatment is received at a provider who is not a network provider. Medicines paid at 100% of the Discovery Health Medication Rate. Unlimited
Discovery classic priority plan 2026, p2
Day procedures
Gastroscopies, colonoscopies, proctoscopies, sigmoidoscopies and cystoscopies/cystourethroscopy performed in-hospital ... the first R4 650 in respect of the hospital account when performed in a day clinic, or R7 500 in respect of the hospital account when performed in acute facilities, is payable by the beneficiary per admission ... Where performed in an acute facility by a doctor who is part of the Scheme's value-based network, the first R6 050 in respect of the hospital account is payable by the beneficiary per admission ... Where both a gastroscopy and colonoscopy are performed per admission the first R5 700 ... in a day clinic, or R9 450 ... in acute facilities ... value-based network, the first R7 650 ... Unlimited
Discovery classic priority plan 2026, p8
Medicine on discharge
Medication and materials billed by hospital as TTO Save for cover contained in Annexure 7, TTOs are not covered from Hospital Benefits, but paid from Chronic Illness Benefit where applicable or from the MSA or Limited ATB as per the Prescribed Medication Benefit. Subject to Chronic Illness Benefit and Prescribed Medication Benefit where appropriate
Discovery classic priority plan 2026, p16
HIV/AIDS
HIV/AIDS and AIDS-related treatment Basis of cover is contained in Annexure 7. Unlimited
Discovery classic priority plan 2026, p15
HIV/AIDS
Post-exposure HIV prophylaxis following occupational exposure, traumatic exposure or sexual assault Up to a maximum of 100% of cost. Unlimited HIV prophylaxis for mother-to-child transmission Up to a maximum of 100% of cost. Unlimited
Discovery classic priority plan 2026, p15
Travel cover
International Travel Benefit as set out in Annexure B. Up to 100% of the cost for in-and out-of-hospital treatment ... R5 000 000 per person per journey for both in-and out-of-hospital treatment. The first US $150 or EUR100 in respect of out-of-hospital treatment per person per journey is payable by the member. The balance will be paid from Health Care Cover.
Discovery classic priority plan 2026, p20
Organ and stem cell transplants
Stem cell and organ transplants (pre-transplant work-up, in-hospital treatment, post-transplant treatment, immunosuppressive drugs, and donor costs) In-hospital: Up to a maximum of 100% of the Discovery Health Rate for the hospital account and up to a maximum of 200% of the Discovery Health Rate for related accounts. Out-of-hospital: Treatment related to transplant covered up to a maximum of 100% of the Discovery Health Rate. Basket of care as set by the Scheme specific to transplant
Discovery classic priority plan 2026, p2
Planned PMB procedures
Hip and knee joint replacements Up to a maximum of 100% of the Discovery Health Rate at a network provider. Network does not apply to any admissions related to trauma. Up to 80% of the Discovery Health Rate for the hospital account if performed at a non-network facility. Up to a maximum of 200% of the Discovery Health Rate for related accounts paid from Health Care Cover for treatment received at a non-network facility. Unlimited at a network provider Non-network provider: R31 850 per prosthesis per admission A Deductible applies in respect of the hospital account, as set out in Annexure 5.
Discovery classic priority plan 2026, p13
Planned PMB procedures
In-and out-of-hospital management for spinal care and surgery for a defined list of clinically appropriate procedures which include Lumbar Fusion, Cervical Fusion, Laminectomy, Laminotomy Up to a maximum of 100% of the Discovery Health Rate for the hospital account at a network facility. Network does not apply to any admissions related to trauma. Up to 80% of the Discovery Health Rate for the hospital account if performed at a non-network facility. Up to a maximum of 200% of the Discovery Health Rate for related accounts paid from Health Care Cover. Unlimited at a network provider for in-hospital treatment Basket of care as set by the Scheme for out-of-hospital conservative treatment
Discovery classic priority plan 2026, p13
Planned PMB procedures
Cataract surgery Up to a maximum of 100% of the Discovery Health Rate for the hospital account at a network facility. Up to 80% of the Discovery Health Rate for the hospital account if performed at a non-network facility. Up to a maximum of 200% of the Discovery Health Rate for related accounts paid from Health Care Cover. Unlimited
Discovery classic priority plan 2026, p14
Internal prostheses
Shoulder joint prostheses Up to a maximum of 100% of the Discovery Health Rate. Network supplier: Unlimited if prosthesis is supplied by the Scheme's network provider Non-network supplier: R50 000 per prosthesis per admission if prosthesis is not supplied by the Scheme's network provider A Deductible applies in respect of the hospital account, as set out in Annexure 5.
Discovery classic priority plan 2026, p12
Internal prostheses
Internal nerve stimulators Up to a maximum of 100% of the Discovery Health Rate. R192 000 per person per year The device accumulates to the limit. The balance of the hospital and related accounts do not accumulate to the annual limit.
Discovery classic priority plan 2026, p12
Internal prostheses
Spinal prostheses and/or devices Up to a maximum of 100% of the Discovery Health Rate. Maximum of one procedure per person per year Network supplier: Unlimited if prosthesis is supplied by the Scheme's network provider Non-network supplier: R24 250 per person for one spine level if prosthesis is not supplied by the Scheme's network provider R48 550 per person for two or more spine levels if prosthesis is not supplied by the Scheme's network provider
Discovery classic priority plan 2026, p14
Internal prostheses
Cardiac stents and balloons Up to a maximum of 100% of the Discovery Health Rate. Network supplier: Unlimited if supplied by the Scheme's network provider Non-network supplier: Drug-eluting stent: R14 950 per stent per admission if not supplied by the Scheme's network provider Bare metal stent limit: R10 650 per stent per admission if not supplied by the Scheme's network provider Drug-eluting balloon: R13 800 per balloon per admission if not supplied by the Scheme's network provider
Discovery classic priority plan 2026, p15
Internal prostheses
Cochlear implants and auditory brain implants (including processors) and processor upgrades Up to a maximum of 100% of the Discovery Health Rate. R252 000 per person per year Processor upgrade limited to R190 000 per person every three years The device and processors accumulate to the limit. The balance of the hospital and related accounts do not accumulate to the annual limit.
Discovery classic priority plan 2026, p11
Internal prostheses
Bone Anchored/Transcutaneous Hearing Aids (BAHA) and processor upgrades Up to a maximum of 100% of the Discovery Health Rate. R150 000 per person per year Processor upgrade limited to R78 000 per person every three years The device and processors accumulate to the limit. The balance of the hospital and related accounts do not accumulate to the limit.
Discovery classic priority plan 2026, p11
Internal prostheses
Intra-ocular lenses for cataract surgery Up to a maximum of 100% of the Discovery Health Rate. Covered in full when supplied by the Scheme's preferred suppliers, otherwise covered up to the Discovery Health Rate for the lens
Discovery classic priority plan 2026, p14
Mental health admissions
Management of mental health disorders Up to a maximum of 100% of the Discovery Health Rate for the hospital account in a network facility. Up to a maximum of 80% of the Discovery Health Rate for the hospital account if a non-network facility is used. Up to 21 days in-hospital, or up to 15 out-of-hospital consultations, for conditions as defined in Annexure A of the Regulations. All other conditions up to 21 days in-hospital
Discovery classic priority plan 2026, p10
Mental health admissions
Alcohol and drug rehabilitation Basis of cover is contained in Annexure 7. 21 days in-hospital treatment per person per year
Discovery classic priority plan 2026, p10
MRI, CT and PET scans
MRI and CT Scans Up to a maximum of 100% of the Discovery Health Rate for in-hospital scans performed in respect of treatment related to an authorised admission. Subject to referral by appropriate specialist. If done for conservative back or neck treatment or unrelated to admission, the first R4 000 paid from MSA or Limited ATB and the balance from Health Care Cover up to a maximum of 100% of the Discovery Health Rate. Unlimited
Discovery classic priority plan 2026, p7
Dialysis
Chronic Dialysis Up to a maximum of 100% of the Discovery Health Rate at the Scheme's network provider. Unlimited Drugs paid at 100% of the Discovery Health Medication Rate.
Discovery classic priority plan 2026, p9
Step-down and sub-acute care
Home-based healthcare for clinically appropriate chronic and acute treatment and conditions that can be treated at home In addition to cover contained in Annexure 7, up to a maximum of 100% of the Discovery Health Rate. Basket of care as set by the Scheme
Discovery classic priority plan 2026, p3
Palliative care
Advanced Illness Benefit Up to a maximum of 100% of the Discovery Health Rate. Unlimited Subject to authorisation and the treatment meeting the Scheme's guidelines and managed care criteria.
Discovery classic priority plan 2026, p16
Cancer treatment
Non-PMB oncology (Oncology Treatment Programme): 100% of the Discovery Health Rate up to a Threshold Claim Amount of R250,000 per person per 12-month cycle, then 80% of DHR with no overall limit. PMB oncology unlimited at PMB level via DSP (ICON/SAOC); voluntary non-network use funded at 80% of DHR (20% co-payment).
Discovery annexure 8a oncology treatment programme 2026, p1
Specialised (biological) medicine in hospital
Not covered. The Specialised Medicine and Technology Benefit is not available on this plan.
Discovery 2026 specialised medicine and technology benefit, p2
Planned PMB procedures
World Health Organisation (WHO) recognised disease outbreaks (e.g. COVID-19): in addition to cover contained in Annexure 7, up to a maximum of 100% of the Discovery Health Rate. Subject to the Scheme's preferred provider (where applicable), protocols and the condition and treatment meeting the Scheme's entry criteria and guidelines.
Discovery classic priority plan 2026, p20
Travel cover
International clinical review service — up to a maximum of 75% of the cost of the consultation. Unlimited.
Discovery classic priority plan 2026, p16
Fertility treatment
Not covered. Assisted Reproductive Therapy Benefit not available on this plan — the benefit is available on the Executive Plan and Comprehensive Series only.
discovery- 2026 - assisted reproductive therapy benefit, p2
Day to day
GP visits
General Practitioners Paid from MSA first and then Limited ATB up to a maximum of 100% of Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
GP visits
Pharmacy clinic consultation with or without video call consultation with a General Practitioner Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
GP visits
Day-to-day Extender Benefit for: - pharmacy clinic consultations with or without video call consultations with a General Practitioner; - General Practitioner consultations ... Available once the MSA has been depleted and before the Threshold is reached (during the self-payment gap). Out-of-hospital consultation codes billed by a network pharmacy clinic or GP that meets the digital platform criteria shall be paid from Health Care Cover up to a maximum of 100% of the Discovery Health Rate.
Discovery classic priority plan 2026, p23
GP visits
Virtual urgent care consultations In addition to the cover contained in Annexure 7, up to a maximum of 100% of the Discovery Health Rate paid from Health Care Cover for virtual urgent care consultations. 4 consultations per family per year ... Consultations in excess of the annual limit or those not meeting the Scheme's clinical entry criteria, paid from MSA or Limited ATB up to a maximum of 100% of the Discovery Health Rate.
Discovery classic priority plan 2026, p11
Specialist visits
Specialists Paid from MSA first and then Limited ATB: Premier Rate providers: Up to a maximum of the Premier Rate. All other specialists: Up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
Prescribed medicine (acute)
Prescribed medication for schedule 3 and above medication Preferentially priced generic and brand medication: Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Medication Rate and accumulation to Threshold at up to 100% of the Discovery Health Medication Rate. Payment from Limited ATB at up to 100% of the Discovery Health Medication Rate. Non-preferentially priced generic and brand medication: Payment from MSA first up to a maximum of 100% of the Discovery Health Medication Rate. Then payment from Limited ATB and accumulation to Threshold at up to either 50% or 75% of the Discovery Health Medication Rate, depending on the price of the medication relative to the cost of the preferentially priced medication. Member - R27 850 M + 1 dependant - R33 750 M + 2 dependants - R40 650 M + 3 dependants or more - R44 350 Limited to balance available in ATB
Discovery classic priority plan 2026, p26
Over-the-counter medicine
Over the counter medication (OTC) inclusive of schedule 0, 1 and 2 drugs whether prescribed or not, and products that are considered lifestyle enhancing Paid from MSA with no accumulation to Threshold and not covered from Limited ATB. Limited to funds available in MSA
Discovery classic priority plan 2026, p26
Blood tests (pathology)
Pathology Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB. Point-of-care pathology testing is subject to meeting the Scheme's treatment guidelines and managed care criteria.
Discovery classic priority plan 2026, p27
Blood tests (pathology)
Radiology & Pathology Up to a maximum of 100% of the Discovery Health Rate. Pathology is subject to a preferred provider network. Where members use a non-preferred provider payment will be made directly to the member. Point-of-care pathology testing is subject to meeting the Scheme's treatment guidelines and managed care criteria. Unlimited
Discovery classic priority plan 2026, p1
Basic X-rays
X-rays and radiology not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p27
Basic X-rays
Radiology & Pathology Up to a maximum of 100% of the Discovery Health Rate. Unlimited
Discovery classic priority plan 2026, p1
MRI, CT and PET scans
MRI and CT Scans The first R4 000 in respect of each out-of-hospital MRI and CT scan as well as each MRI and CT scan for conservative back or neck treatment or unrelated to hospital admissions, is payable from MSA or Limited ATB, and accumulated to the Annual Threshold, with the balance from Health Care Cover up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p28
Eyes (optometry)
Optometry consultations and optometry not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p29
Eyes (optometry)
Spectacles, frames, contact lenses, intra-ocular lenses, refractive eye surgery and other healthcare services to treat errors of refraction irrespective of cause Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R6 850 per person per year, limited to balance available in ATB
Discovery classic priority plan 2026, p30
Hearing aids
Hearing aids Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R25 150 per family per year, limited to balance available in ATB
Discovery classic priority plan 2026, p29
Medical appliances
External Medical Items (EMI) including those supplied by orthotists and prosthetists Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R43 000 per family per year, limited to balance available in ATB
Discovery classic priority plan 2026, p29
Medical appliances
Point-of-care medical devices: Payment from MSA up to a maximum of 100% of the Discovery Health Rate. Payment from Limited ATB and accumulation to Threshold at 75% of the Discovery Health Medication Rate. One device per family
Discovery classic priority plan 2026, p29
Medical appliances
External Medical Items (EMI) including those supplied by orthotists and prosthetists Up to a maximum of 100% of the Discovery Health Rate. Unless part of defined benefit those listed in Annexure 6 are paid from the MSA or Limited ATB at 100% of Discovery Health Rate. Claims paid from the MSA and once in ATB accumulate to the benefit limit. Unlimited. R43 000 per family per year for items listed in Annexure 6 and limited to balance available in ATB
Discovery classic priority plan 2026, p15
Medical appliances
Home-monitoring devices for clinically appropriate chronic and acute conditions Up to a maximum of 100% of the Discovery Health Rate paid from Health Care Cover. Up to R4 850 per person per year
Discovery classic priority plan 2026, p4
Alternative healthcare
Other alternative allied healthcare services as listed in Annexure 1 Paid from MSA with no accumulation to Threshold and not covered from Limited ATB. Limited to funds available in MSA
Discovery classic priority plan 2026, p28
Physiotherapy and other therapists
Allied and therapeutic healthcare services including: acousticians, biokineticists, chiropractors, dieticians, homeopaths, nursing providers, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, counsellors, social workers, speech and hearing therapists Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Member - R15 250 Member + dependant - R21 550 Member + 2 dependants - R27 900 Member + 3 or more dependants - R32 950 Limited to balance available in ATB
Discovery classic priority plan 2026, p28
Psychologist and counselling visits
Management of mental health disorders Up to a maximum of 200% of the Discovery Health Rate for related accounts. Up to 21 days in-hospital, or up to 15 out-of-hospital consultations, for conditions as defined in Annexure A of the Regulations. All other conditions up to 21 days in-hospital
Discovery classic priority plan 2026, p10
Maternity care (out of hospital)
Out-of-hospital healthcare services related to pregnancy and delivery: Up to 100% of the Discovery Health Rate, or agreed rate. Paid from Health Care Cover and is subject to applicable limits. - antenatal classes and/or postnatal visits: 5 consultations or classes per pregnancy - antenatal consultations: 8 per pregnancy - prenatal screening, including chromosome testing or Non Invasive Prenatal Testing (NIPT): 1 per pregnancy - pregnancy scans: 2 per pregnancy - blood tests: 1 routine basket of pregnancy tests per pregnancy - postnatal consultations for complications post delivery: 1 per delivery - dietician nutrition assessment: 1 during pregnancy or after delivery - mental health consultations: 2 during pregnancy or after delivery - consultations for infants: 2 per child
Discovery classic priority plan 2026, p22
Maternity care (out of hospital)
Antenatal classes Once the out-of-hospital cover related to pregnancy and delivery is reached, paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R2 500 per family, per pregnancy, limited to balance available in ATB
Discovery classic priority plan 2026, p30
Maternity care (out of hospital)
Non-invasive Prenatal Screening Test or defined chromosome testing Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p27
Maternity care (out of hospital)
Pregnancy scans Once the out-of-hospital cover related to pregnancy and delivery is reached, paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. 3D and 4D scan will be paid up to the maximum of the cost of a 2D scan.
Discovery classic priority plan 2026, p28
Casualty visits
Non-PMB trauma services obtained from a casualty unit Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate for children under the age of 10. Limited to funds available in ATB
Discovery classic priority plan 2026, p25
Casualty visits
non-PMB trauma services obtained from a casualty unit for children under the age of 10 years ... Out-of-hospital consultation, facility fee and consumable codes billed by the casualty unit for children under the age of 10 shall be paid from Health Care Cover up to a maximum of 100% of the Discovery Health Rate. In network casualty visit: Once MSA has been used up and before Threshold is reached, limited to 2 visits per child Not in the network: Limited to funds available in MSA and ATB
Discovery classic priority plan 2026, p23
Basic dentistry
Dentistry Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Claims paid from the MSA and once in ATB accumulate to the benefit limit. Limited to balance available in ATB
Discovery classic priority plan 2026, p26
Specialised dentistry
All dental appliances and prostheses and the placement of such appliances/prostheses as well as orthodontics (surgical and non-surgical) are paid from MSA or Limited ATB up to a maximum of 100% of the Discovery Health Rate. Claims paid from the MSA and once in ATB accumulate to the benefit limit. R23 400 per person per year. Cover is subject to the balance available in ATB. Limit applies regardless of place of service and is pro-rated if beneficiary joins after 01 January
Discovery classic priority plan 2026, p5
Specialised dentistry
Dentistry A Deductible of R8 950 for admissions to hospital or a Deductible of R5 750 for admissions to day-case facilities shall be payable by the beneficiary in respect of the hospital/day-case facility account. The balance of the hospital/day-case facility account will be paid from Health Care Cover up to a maximum of 100% of Discovery Health Rate. For beneficiaries 13 years and younger a Deductible of R3 470 for admissions to hospital or a Deductible of R1 550 for admissions to day-case facilities ... Dentist, anaesthetist and related accounts will be paid from Health Care Cover up to a maximum of 100% of the Discovery Health Rate.
Discovery classic priority plan 2026, p5
Specialised dentistry
Severe dental and oral procedures reflected in Annexure 3 Up to a maximum of 200% of the Discovery Health rate for related accounts. Up to a maximum of 100% of the Discovery Health rate for hospital account. Where such event is also subject to Annexure 9, a R7 250 Deductible shall be payable by the beneficiary in respect of the hospital account for elective admissions at a facility which is not a network facility. Unlimited
Discovery classic priority plan 2026, p6
Specialised dentistry
Basic Dental Trauma Benefit Basis of cover as contained in Annexure B. R70 800 per person per year for dental appliances and prosthesis and the placement of such appliances/prosthesis A Deductible of R8 950 for admissions to hospital or a Deductible of R5 750 for admissions to day-case facilities shall be payable by the beneficiary ... For beneficiaries younger than 13 years a Deductible of R3 470 for admissions to hospital or a Deductible of R1 550 for admissions to day-case facilities ...
Discovery classic priority plan 2026, p6
Chronic medicine (Chronic Disease List)
Medication for the chronic Prescribed Minimum Benefit conditions Save for medication contemplated in Rule 15.18 of the Main Body of the Rules, basis of cover contained in Annexure 7. Subject to the Scheme's protocols, clinical entry criteria and drug utilisation review. As contained in Annexure 7
Discovery classic priority plan 2026, p24
Procedures in the doctor’s rooms
Gastroscopies, colonoscopies, proctoscopies, sigmoidoscopies and cystoscopies/cystourethroscopy performed in-rooms Up to a maximum of 200% of the Discovery Health Rate when performed at an in-rooms network provider. Save for the cover contained in Annexure 8, where indicated and approved for dyspepsia, and for children aged 12 and under, the first R1 800 is payable by the beneficiary. Where both a gastroscopy and colonoscopy are performed, the first R3 100 is payable by the beneficiary. The balance of the account will be paid from Health Care Cover up to a maximum of 200% of the Discovery Health Rate. Unlimited
Discovery classic priority plan 2026, p9
Care after a hospital stay
Over and above the DTP PMB entitlement, this benefit covers certain out-of-hospital healthcare services arising from an emergency, trauma-related event resulting in defined PMB conditions. Paid from Health Care Cover, subject to applicable limits (external medical items per Table C; prosthetic limbs limited to R107 650 per person per year). Excludes OTC medicines, optometry, antenatal classes and dentistry (other than as specified).
Discovery classic priority plan 2026, p21
GP visits
General Practitioners Paid from MSA first and then Limited ATB up to a maximum of 100% of Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
GP visits
Pharmacy clinic consultation with or without video call consultation with a General Practitioner Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
Specialist visits
Specialists Paid from MSA first and then Limited ATB: Premier Rate providers: Up to a maximum of the Premier Rate. All other specialists: Up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p25
Prescribed medicine (acute)
Prescribed medication for schedule 3 and above medication Preferentially priced generic and brand medication: Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Medication Rate and accumulation to Threshold at up to 100% of the Discovery Health Medication Rate. Payment from Limited ATB at up to 100% of the Discovery Health Medication Rate. Non-preferentially priced generic and brand medication: Payment from MSA first up to a maximum of 100% of the Discovery Health Medication Rate. Then payment from Limited ATB and accumulation to Threshold at up to either 50% or 75% of the Discovery Health Medication Rate, depending on the price of the medication relative to the cost of the preferentially priced medication. Member - R27 850 M + 1 dependant - R33 750 M + 2 dependants - R40 650 M + 3 dependants or more - R44 350 Limited to balance available in ATB
Discovery classic priority plan 2026, p26
Blood tests (pathology)
Pathology Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB. Point-of-care pathology testing is subject to meeting the Scheme's treatment guidelines and managed care criteria.
Discovery classic priority plan 2026, p27
Basic X-rays
X-rays and radiology not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p27
MRI, CT and PET scans
MRI and CT Scans The first R4 000 in respect of each out-of-hospital MRI and CT scan as well as each MRI and CT scan for conservative back or neck treatment or unrelated to hospital admissions, is payable from MSA or Limited ATB, and accumulated to the Annual Threshold, with the balance from Health Care Cover up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p28
Eyes (optometry)
Optometry consultations and optometry not otherwise specified Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p29
Eyes (optometry)
Spectacles, frames, contact lenses, intra-ocular lenses, refractive eye surgery and other healthcare services to treat errors of refraction irrespective of cause Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R6 850 per person per year, limited to balance available in ATB
Discovery classic priority plan 2026, p30
Hearing aids
Hearing aids Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R25 150 per family per year, limited to balance available in ATB
Discovery classic priority plan 2026, p29
Medical appliances
External Medical Items (EMI) including those supplied by orthotists and prosthetists Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R43 000 per family per year, limited to balance available in ATB
Discovery classic priority plan 2026, p29
Medical appliances
Point-of-care medical devices: Payment from MSA up to a maximum of 100% of the Discovery Health Rate. Payment from Limited ATB and accumulation to Threshold at 75% of the Discovery Health Medication Rate. One device per family
Discovery classic priority plan 2026, p29
Physiotherapy and other therapists
Allied and therapeutic healthcare services including: acousticians, biokineticists, chiropractors, dieticians, homeopaths, nursing providers, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrists, counsellors, social workers, speech and hearing therapists Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Member - R15 250 Member + dependant - R21 550 Member + 2 dependants - R27 900 Member + 3 or more dependants - R32 950 Limited to balance available in ATB
Discovery classic priority plan 2026, p28
Maternity care (out of hospital)
Antenatal classes Once the out-of-hospital cover related to pregnancy and delivery is reached, paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R2 500 per family, per pregnancy, limited to balance available in ATB
Discovery classic priority plan 2026, p30
Maternity care (out of hospital)
Non-invasive Prenatal Screening Test or defined chromosome testing Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Limited to balance available in ATB
Discovery classic priority plan 2026, p27
Maternity care (out of hospital)
Pregnancy scans Once the out-of-hospital cover related to pregnancy and delivery is reached, paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. 3D and 4D scan will be paid up to the maximum of the cost of a 2D scan.
Discovery classic priority plan 2026, p28
Casualty visits
Non-PMB trauma services obtained from a casualty unit Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate for children under the age of 10. Limited to funds available in ATB
Discovery classic priority plan 2026, p25
Basic dentistry
Dentistry Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Claims paid from the MSA and once in ATB accumulate to the benefit limit. Limited to balance available in ATB
Discovery classic priority plan 2026, p26
Specialised dentistry
All dental appliances and prostheses and the placement of such appliances/prostheses as well as orthodontics (surgical and non-surgical) are paid from MSA or Limited ATB up to a maximum of 100% of the Discovery Health Rate. Claims paid from the MSA and once in ATB accumulate to the benefit limit. R23 400 per person per year. Cover is subject to the balance available in ATB. Limit applies regardless of place of service and is pro-rated if beneficiary joins after 01 January
Discovery classic priority plan 2026, p5
Screening and prevention
Screening and prevention
Screening Benefit A - Group of tests consisting of blood glucose test, blood pressure test, cholesterol test and Body Mass Index (BMI) Up to a maximum of 100% of the Discovery Health Rate for group of tests at a network provider. Unlimited
Discovery classic priority plan 2026, p16
Screening and prevention
Screening Benefit B - Consist of appropriate tests (including self-sampling kits, where appropriate) and as determined by the Scheme: HIV screening, Mammogram, Prostate-Specific Antigen (PSA), colorectal and cervical cancer screening ... One Mammogram every 2 years, one Pap Smear every 3 years or one HPV test every 5 years and one PSA test per person per year One faecal occult blood test or immunochemical test every 2 years per person for persons between the ages of 45 to 75 years
Discovery classic priority plan 2026, p17
Screening and prevention
Preventative Benefit - Pneumococcal vaccination Up to a maximum of 100% of the Discovery Health Medication Rate for the vaccination. Up to 2 pneumococcal vaccine doses per person per lifetime Pneumococcal vaccines in excess of the limit paid from MSA or Limited ATB. Note: Consultation and other healthcare services to administer the vaccine, paid from MSA or Limited ATB.
Discovery classic priority plan 2026, p16
Screening and prevention
Preventative Benefit - Seasonal Influenza Vaccination Up to a maximum of 100% of the Discovery Health Medication Rate for the vaccination. Seasonal flu vaccines in excess of the annual limit paid from MSA or Limited ATB. One seasonal influenza vaccine per person per year
Discovery classic priority plan 2026, p18
Screening and prevention
Screening Benefit C - Group of age appropriate tests including but not limited to growth assessment, blood pressure and health and milestone tracking Up to a maximum of 100% of the Discovery Health Rate at a network provider, for children between the ages of 2 and 18. Unlimited
Discovery classic priority plan 2026, p17
Screening and prevention
Screening Benefit D - Group of age appropriate screening tests Up to a maximum of 100% of the Discovery Health Rate at a network provider, for members 65 years and older. Unlimited
Discovery classic priority plan 2026, p17
Screening and prevention
Additional screening assessment or consultation Up to a maximum 100% of the Discovery Health Rate at an accredited network provider. One consultation per person per year
Discovery classic priority plan 2026, p17