The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Got itOnce the claims you have sent to us add up to the Annual Threshold, we pay the rest of your claims form the Above Threshold Benefit (ATB), at the Discovery Health Rate or a portion of it. The Executive Plan has an unlimited ATB, and the Comprehensive and Priority plans have a limited ATB. However, before we pay claims from the Above Threshold Benefit, you may have to pay some of your day-to-day medical expenses from your pocket. We call this a Self-payment Gap (SPG).
Please note: We do not pay certain claims, for example over-the-counter medicine, from the Above Threshold Benefit.
We add up the Discovery Health Rate of the day-to-day claims that you send us. When your day-to-day claims reach a fixed rand amount - known as the Annual Threshold - we pay claims from the Above Threshold Benefit.
We set the Annual Threshold amount at the beginning of each year. The number and type of dependants (adult or spouse or child) on your plan will also determine the amount.
