Discovery Essential Priority: 2027 contributions and benefits

At a glance

Plan type: Comprehensive plan
Hospitals: Any private hospital
Hospital and specialists: 100% of Scheme tariff
Savings account: R799 a month for the main member (15%)
Chronic conditions: 27 (Chronic Disease List)
Cancer: R250 000 a year
Children you pay for: Up to 3

Discovery’s 2027 benefits are not in our records yet. Its 2027 contributions are below.

Monthly contributions

2027 rates take effect on 1 January 2027. 2027 contributions: Discovery 2027 contribution table, p1. Its 2027 benefits are not in our records yet. You pay for up to 3 children.

Member	2026	2027	Change
Main member	R5 327	R5 803	+8.9%
Adult dependant	R4 189	R4 564	+9.0%
Child	R2 127	R2 317	+8.9%

Benefits

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

Any hospital

Hospitals

2027 not in our records yet. 2026: Any hospital

(2026)

Specialists in hospital

100% of Scheme tariff. A specialist who charges more leaves a shortfall.

Discovery essential priority plan, p1

Specialists in hospital

2027 not in our records yet. 2026: 100% of Scheme tariff. A specialist who charges more leaves a shortfall.

Discovery essential 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

15% of your contribution goes into a savings account for day-to-day costs.

Discovery essential priority plan, p23

Medical savings account

2027 not in our records yet. 2026: 15% of your contribution goes into a savings account for day-to-day costs.

Discovery essential 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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential 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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential 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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential 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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential 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 with accumulation to Threshold at up to 100% of the Discovery Health Medication Rate. Member - R19 700; M + 1 dependant - R23 350; M + 2 dependants - R27 700; M + 3 dependants or more - R33 700

Discovery essential 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 with accumulation to Threshold at up to 100% of the Discovery Health Medication Rate. Member - R19 700; M + 1 dependant - R23 350; M + 2 dependants - R27 700; M + 3 dependants or more - R33 700

Discovery essential 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.

Discovery essential priority plan 2026, p25

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.

Discovery essential priority plan 2026, p25 (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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential 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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential 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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential 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. Accumulation to the Threshold up to a maximum of the Discovery Health Rate. Limited to balance available in ATB

Discovery essential priority plan 2026, p27 (2026)

Blood tests (pathology)

Radiology & Pathology. Up to a maximum of 100% of the Discovery Health Rate. Unlimited. 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.

Discovery essential priority plan 2026, p2

Blood tests (pathology)

2027 not in our records yet. 2026: Radiology & Pathology. Up to a maximum of 100% of the Discovery Health Rate. Unlimited. 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.

Discovery essential priority plan 2026, p2 (2026)

Full benefit list

Every benefit we hold for Essential 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 specialists up to a maximum of the Premier Rate; Other specialists up to a maximum of 100% of the Discovery Health Rate. Doctors and allied healthcare service providers while hospitalised: Up to a maximum of 100% of the Discovery Health Rate. Unlimited

Discovery essential 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 essential 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. 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.

Discovery essential 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.

Discovery essential priority plan 2026, p2

Day procedures

Gastroscopies, colonoscopies, proctoscopies, sigmoidoscopies and cystoscopies/cystourethroscopy performed in-hospital. Save for cover in Annexure 8 or for dyspepsia/children 12 and under, the first R4 650 (day clinic) or R7 500 (acute facility) per admission is payable by the beneficiary; R6 050 where performed in an acute facility by a value-based network doctor. Where both a gastroscopy and colonoscopy are performed: R5 700 (day clinic) / R9 450 (acute) / R7 650 (value-based network acute). The balance of the hospital account will be paid from Health Care Cover up to a maximum of 100% of the Discovery Health Rate.

Discovery essential priority plan 2026, p8

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 100% 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 essential priority plan 2026, p2

Dialysis

Chronic Dialysis. Up to a maximum of 100% of the Discovery Health Rate at the Scheme's network provider. Drugs paid at 100% of the Discovery Health Medication Rate. Unlimited

Discovery essential priority plan 2026, p9

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. Unlimited. 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.

Discovery essential priority plan 2026, p7

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. Unlimited at a network provider. A Deductible applies in respect of the hospital account, as set out in Annexure 5.

Discovery essential 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. Up to 80% of the Discovery Health Rate for the hospital account if performed at a non-network facility. Unlimited at a network provider for in-hospital treatment. Basket of care as set by the Scheme for out-of-hospital conservative treatment.

Discovery essential 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 100% of the Discovery Health Rate for related accounts paid from Health Care Cover. Unlimited

Discovery essential 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 essential 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 essential priority plan 2026, p12

Internal prostheses

Hip and knee joint replacements - prostheses. Unlimited at a network provider. Non-network provider: R31 850 per prosthesis per admission. The prostheses accumulate to the limit. The balance of the hospital and related accounts do not accumulate to the annual limit.

Discovery essential priority plan 2026, p13

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; R48 550 per person for two or more spine levels if prosthesis is not supplied by the Scheme's network provider.

Discovery essential 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; Bare metal stent limit: R10 650 per stent per admission; Drug-eluting balloon: R13 800 per balloon per admission if not supplied by the Scheme's network provider.

Discovery essential priority plan 2026, p15

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 essential priority plan 2026, p14

Mental health admissions

Management of mental health disorders. Up to a maximum of 100% of the Discovery Health Rate for related accounts. 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 essential 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 essential priority plan 2026, p10

HIV/AIDS

HIV/AIDS and AIDS-related treatment. Basis of cover is contained in Annexure 7. Unlimited. HIV Management for members registered on the Scheme's Disease Management Programme: Basis of cover is contained in Annexure 7. Up to 100% of the Discovery Health Rate for services in the Scheme's basket of care if referred by the Scheme's DSP.

Discovery essential 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 essential priority plan 2026, p15

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 essential priority plan 2026, p16

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 €100 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 essential priority plan 2026, p20

Travel cover

Africa Evacuation Benefit as set out in Annexure B. Up to 100% of the cost and where such treatment is paid in a foreign currency, the cost will be paid at an exchange rate for such currency as set by the bank at which the Scheme has its account. Subject to authorisation. For medical emergencies only.

Discovery essential priority plan 2026, p20

Palliative care

Advanced Illness Benefit. Up to a maximum of 100% of the Discovery Health Rate. Subject to authorisation and the treatment meeting the Scheme's guidelines and managed care criteria. Unlimited

Discovery essential priority plan 2026, p15

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. Procedures performed in the Short Stay Surgical Care Network: Up to a maximum of 100% of the Discovery Health Rate at a network provider for clinically appropriate low acuity surgical procedures.

Discovery essential priority plan 2026, p3

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 essential priority plan 2026, p20

Travel cover

International clinical review service — up to a maximum of 75% of the cost of the consultation. Unlimited.

Discovery essential priority plan 2026, p19

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

Prescribed medicine (acute)

Discovery essential 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 essential priority plan 2026, p26

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 Scheme protocols, clinical entry criteria and drug utilisation review. As contained in Annexure 7

Discovery essential priority plan 2026, p24

Chronic medicine (Chronic Disease List)

Diabetes Management / Cardiovascular Disease Management for members registered on the Scheme's Disease Management Programme. Basis of cover is contained in Annexure 7. Up to 100% of the Discovery Health Rate for services covered in the Scheme's basket of care if referred by the Scheme's DSP. Basket of care as set by the Scheme

Discovery essential priority plan 2026, p24

Auxiliary services

Allied and therapeutic healthcare services including: acousticians, biokineticists, chiropractors, dieticians, homeopaths, nursing providers, occupational therapists, physiotherapists, podiatrists, psychologists, psychometrics, 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 – R10 100; Member + dependant – R15 250; Member + 2 dependants – R18 950; Member + 3 or more dependants – R22 800

Discovery essential 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... Paid from MSA first and then Limited ATB Up to a maximum of 100% of the Discovery Health Rate. Member – R10 100; Member + dependant – R15 250; Member + 2 dependants – R18 950; Member + 3 or more dependants – R22 800

Discovery essential priority plan 2026, p28

Psychologist and counselling visits

Allied and therapeutic healthcare services including: ...psychologists, psychometrics, counsellors, social workers... Paid from MSA first and then Limited ATB Up to a maximum of 100% of the Discovery Health Rate. Member – R10 100; Member + dependant – R15 250; Member + 2 dependants – R18 950; Member + 3 or more dependants – R22 800

Discovery essential priority plan 2026, p28

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 essential priority plan 2026, p28

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. R28 900 per family, limited to balance available in ATB. Limit is pro-rated when beneficiary joins after 01 January

Discovery essential priority plan 2026, p28

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. The device must be approved by the Scheme

Discovery essential priority plan 2026, p4

Medical appliances

Point-of-care medical devices. Up to a maximum of 75% of the Discovery Health Rate paid from Health Care Cover. One device per family. The device must be approved by the Scheme

Discovery essential priority plan 2026, p4

Basic dentistry

Discovery essential priority plan 2026, p25

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. R23 400 per person per year applicable to dental appliances and prostheses and the placement of such appliances/prostheses and orthodontics (surgical and non-surgical). Limited to balance available in ATB

Discovery essential 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. 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. The balance of the hospital/day-case facility account will be paid from Health Care Cover up to a maximum of 100% of the Discovery Health Rate. Dentist, anaesthetist and related accounts will be paid from Health Care Cover up to a maximum of 100% of the Discovery Health Rate. Premier Rate providers: Up to the applicable Premier Rate.

Discovery essential priority plan 2026, p5

Specialised dentistry

Severe dental and oral procedures reflected in Annexure 3. Up to a maximum of 100% 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.

Discovery essential 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.

Discovery essential priority plan 2026, p6

GP visits

Discovery essential 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. Limited to balance available in ATB

Discovery essential priority plan 2026, p22

Specialist visits

Discovery essential priority plan 2026, p25

Specialist visits

Specialists. Premier Rate specialists: Up to a maximum of the Premier Rate. Classic Direct specialists: Where a procedure is performed in the Scheme's day-surgery network, claims will be funded up to a maximum of the agreed Discovery Health Rate. Other specialists: Up to a maximum of 100% of the Discovery Health Rate. Unlimited

Discovery essential priority plan 2026, p1

Specialist visits

International clinical review service. Up to a maximum of 75% of the cost of the consultation. Subject to the Scheme's preferred provider, protocols and clinical entry criteria. Unlimited

Discovery essential priority plan 2026, p19

Eyes (optometry)

Discovery essential priority plan 2026, p29

Eyes (optometry)

Spectacles, frames, contact lenses, intra-ocular lenses, refractive eye surgery and other health care 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, limited to balance available in ATB. Limit is pro-rated if beneficiary joins after 01 January

Discovery essential priority plan 2026, p29

Hearing aids

Hearing aids. Paid from MSA first and then Limited ATB up to a maximum of 100% of the Discovery Health Rate. R17 850 per family, limited to balance available in ATB. Claims paid from the MSA and once in ATB accumulate to the benefit limit.

Discovery essential priority plan 2026, p29

Hearing aids

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.

Discovery essential priority plan 2026, p11

Hearing aids

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.

Discovery essential priority plan 2026, p11

Blood tests (pathology)

Discovery essential priority plan 2026, p2

Blood tests (pathology)

Pathology. 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. Point-of-care pathology testing is subject to meeting the Scheme's treatment guidelines and managed care criteria. Limited to balance available in ATB

Discovery essential priority plan 2026, p30

Blood tests (pathology)

Self-administered antigen testing for COVID-19. Paid from MSA first and then Limited ATB at a maximum of 100% of the Discovery Health Rate. R1 090 per family per year and limited to balance available in ATB. Accumulation to the Threshold up to a maximum of the Discovery Health Rate.

Discovery essential priority plan 2026, p27

Basic X-rays

Discovery essential 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 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. Subject to referral by an appropriate specialist.

Discovery essential priority plan 2026, p27

Procedures in the doctor’s rooms

Gastroscopies, colonoscopies, proctoscopies, sigmoidoscopies and cystoscopies/cystourethroscopy performed in-rooms. Up to a maximum of 100% 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 100% of the Discovery Health Rate. Unlimited

Discovery essential priority plan 2026, p9

Procedures in the doctor’s rooms

Conservative treatment for dyspepsia. Up to a maximum of 100% of the Discovery Health Rate. Basket of care as set by the Scheme. Subject to authorisation and/or approval and the treatment meeting the Scheme's clinical entry criteria, treatment guidelines and protocols.

Discovery essential priority plan 2026, p9

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 and/or delivery; antenatal consultations: 8 per pregnancy; prenatal screening (NIPT): 1 per pregnancy; pregnancy scans: 2 per pregnancy; blood tests: 1 routine basket per pregnancy; postnatal consultations for complications: 1 per delivery; dietician nutrition assessment: 1; mental health consultations: 2 during pregnancy or after delivery; consultations for infants: 2 per child. Services in excess of the limit paid from MSA and limited ATB.

Discovery essential 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 essential priority plan 2026, p29

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. 3D and 4D scan will be paid up to the maximum of the cost of a 2D scan. Non-invasive Prenatal Screening Test or defined chromosome testing: Paid from MSA and then Limited ATB up to a maximum of 100% of the Discovery Health Rate.

Discovery essential priority plan 2026, p27

Care after a hospital stay

Home-based support programme following prolonged NICU admissions. Up to a maximum of 100% of the Discovery Health Rate. Basket of care as set by the Scheme. Home-based virtual care for the elderly: Up to a maximum of 100% of the Discovery Health Rate, for members 65 years and older. Basket of care as set by the Scheme

Discovery essential priority plan 2026, p3

Casualty visits

Emergency Medical Services local. Up to a maximum of 100% of the Discovery Health Rate. Inter-hospital transfers subject to authorisation. Unlimited

Discovery essential priority plan 2026, p20

Casualty 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 essential priority plan 2026, p11

Casualty visits

Over and above the DTPMB entitlement, this benefit also covers certain out-of-hospital healthcare services arising from an emergency, trauma-related event resulting in the following PMB conditions: Paraplegia, Quadriplegia, Near-drowning related injury, Severe anaphylactic reaction, Poisoning, Crime-related injury, Severe burns, External and internal head injuries, Loss of limb. Trauma benefit services include: Allied healthcare services, External medical items, Hearing aids, Prescribed Medicine. External Medical Items limited to items in Table C except prosthetic limbs limited to R107 650 per person per year. Cover applies to 31 December of the following year after the trauma occurred.

Discovery essential priority plan 2026, p21

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 essential priority plan 2026, p21

Prescribed medicine (acute)

Discovery essential priority plan 2026, p26

Auxiliary services

Discovery essential 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... Paid from MSA first and then Limited ATB Up to a maximum of 100% of the Discovery Health Rate. Member – R10 100; Member + dependant – R15 250; Member + 2 dependants – R18 950; Member + 3 or more dependants – R22 800

Discovery essential priority plan 2026, p28

Psychologist and counselling visits

Discovery essential priority plan 2026, p28

Medical appliances

Discovery essential priority plan 2026, p28

Basic dentistry

Discovery essential priority plan 2026, p25

Specialised dentistry

Discovery essential priority plan 2026, p5

GP visits

Discovery essential priority plan 2026, p25

Specialist visits

Discovery essential priority plan 2026, p25

Eyes (optometry)

Discovery essential priority plan 2026, p29

Eyes (optometry)

Discovery essential priority plan 2026, p29

Hearing aids

Discovery essential priority plan 2026, p29

Blood tests (pathology)

Discovery essential priority plan 2026, p30

Blood tests (pathology)

Discovery essential priority plan 2026, p27

Basic X-rays

Discovery essential priority plan 2026, p27

MRI, CT and PET scans

Discovery essential priority plan 2026, p27

Maternity care (out of hospital)

Discovery essential priority plan 2026, p29

Maternity care (out of hospital)

Discovery essential priority plan 2026, p27

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. Screening Benefit C (children 2-18) and Screening Benefit D (members 65 years and older) also up to 100% of the Discovery Health Rate at a network provider. Unlimited

Discovery essential priority plan 2026, p16

Screening and prevention

Screening Benefit B - Consist of appropriate tests... 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. Tests in excess of annual limit paid from MSA or Limited ATB.

Discovery essential priority plan 2026, p16

Screening and prevention

Additional cover for Mammogram, breast MRI and biopsy, BRCA testing, colonoscopy and cervical cancer screening. Up to a maximum of 100% of the Discovery Health Rate for test code. Basket of care as set by the Scheme. Once off BRCA testing and colonoscopy

Discovery essential priority plan 2026, p16

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 essential priority plan 2026, p17

Screening and prevention

Preventative Benefit - Seasonal Influenza Vaccination. Up to a maximum of 100% of the Discovery Health Medication Rate for the vaccination. One seasonal influenza vaccine per person per year. Seasonal flu vaccines in excess of the annual limit paid from MSA or Limited ATB. Note: Consultation and other healthcare services to administer the vaccine, paid from MSA or Limited ATB.

Discovery essential 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.

Discovery essential priority plan 2026, p18

Screening and prevention

Vaccines and immunisations. Save for where stipulated under a defined benefit, paid from MSA with no accumulation to Threshold and not covered from Limited ATB. Limited to funds available in MSA. New born screening also paid from MSA with no accumulation to Threshold and not covered from Limited ATB.

Discovery essential priority plan 2026, p26

Conditions

The Chronic Disease List conditions are Prescribed Minimum Benefits on every medical aid. How each one works on a medical aid:

Discovery’s 2026 documents name no chronic conditions beyond the Chronic Disease List on Essential Priority.

Questions about Essential Priority

Answered from Discovery’s documents.

How much does Essential Priority cost in 2027?

From 1 January 2027: R5 803 a month for the main member, R4 564 for an adult dependant and R2 317 for a child. You pay for up to 3 children.

How much is Essential Priority going up for 2027?

For the main member, from R5 327 to R5 803 a month, +8.9%.

Does Essential Priority have a medical savings account?

Yes. 15% of your contribution goes into a savings account, which pays for day-to-day costs such as GP visits and medicine.

How many chronic conditions does Essential Priority cover?

27, the conditions on the Chronic Disease List.

Will I have a shortfall if my specialist charges more?

Essential Priority pays specialists in hospital at 100% of the Scheme tariff. If a specialist charges more than that, the difference is a shortfall. Gap cover is the product that pays shortfalls.

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Factual information from Discovery Health Medical Scheme’s published documents. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v175, built 2026-10-19.