Essential Saver Plan Guide 2012

Essential Saver Plan

Your Discovery Health Plan Guide

Message from Discovery Health

Discovery Health provides you with all the tools you need to know about your

health plan and how to make the most of your cover.

Thank you for giving us the opportunity to look after your healthcare cover needs. You can have peace of mind that Discovery Health places our members first with a focus on comprehensive benefits, value for money and services to improve the quality of care available to our members. Our substantial scheme reserves give you complete confidence that your medical scheme will be able to pay your claims not just today but over the long term. The Scheme enjoys an AA+ rating for its claims paying ability from independent rating agency, Global Credit Ratings. This is the highest rating a medical scheme can achieve and reflects the scheme’s sound financial position and the security we provide to you.

We are proud that all Discovery Health members have access to the broadest and best level of healthcare cover available in the market. In addition to excellent benefits, Discovery Health continues to invest heavily in our people and technology to ensure that we deliver world-class service to our members, through our call centres and walk-in centres around the country, and through our deployment of well-trained Discovery staff to assist our members when in hospital or facing difficult diagnoses, such as cancer.

In an effort to further increase value and improve the quality of care and service convenience for our members, Discovery Health will continue to expand the services we will offer members in 2012. Our Discovery MedXpress service is now operational nationally for the delivery of chronic medicines to your home or workplace, and we will extend this service to all other prescription medicines during the course of 2012.

Another innovation on this front is MedSaver, which brings you substantial savings of up to 25% on schedule 1 and 2 medicines. MedSaver is offered in partnership with Clicks and will be available in all Clicks stores from 2012.

We have designed this guide to provide you with a summary of information on how to get the most out of your Discovery Health Plan. You’ll find the Full Cover Choice stamp throughout the guide. It shows you when to use our range of online tools that help you choose full cover options for hospitalisation, specialists in hospital, chronic medicine and GP consultations.

We are here to help and guide you in making the best choices when it comes to your healthcare. We look forward to looking after you and your family in 2012.

Dr Jonathan BroombergCEO: Discovery Health

Milton StreakPrincipal Officer: Discovery Health Medical Scheme

Kind regards

Our scheme rules are available on our website

This brochure is a summary of the benefits and features of your Discovery Health Medical Scheme Plan, pending formal approval from the Council for Medical Schemes. The rules of the Discovery Health Medical Scheme apply to your benefits. If you want to refer to the full set of scheme rules on which this brochure is based, please email [email protected] or go to www.discovery.co.za

The rules and benefits explained in this guide apply to the main member and the dependants registered on their scheme membership.

ContentsSummary of benefits .........................................................................................................................1

Cover for medical emergencies ..........................................................................................................2

Hospital Benefits ...............................................................................................................................3

Cover for chronic conditions and oncology .........................................................................................7

Out-of-hospital cover .........................................................................................................................8

General exclusions ...........................................................................................................................10

Important tips when claiming ..........................................................................................................10

1 | Discovery

The Hospital Benefit covers you if you are admitted to hospital and Discovery Health has confirmed your admission and treatment before you are admitted.

You have cover for a list of chronic conditions and cover for cancer, HIV and AIDS.

Your health benefits include cover for medical expenses while travelling in other countries.

We pay your day-to-day expenses from the available money in your Medical Savings Account. We extend your day-to-day cover by paying for GP consultations through the Insured Network Benefit.

According to the Prescribed Minimum Benefits, you have the right to a guaranteed level of cover for a list of medical conditions and treatments even if your health plan’s benefits have run out. These benefits include cover for a list of 270 listed conditions, most emergency conditions and 27 listed chronic conditions, including HIV and AIDS. Medical schemes must provide cover for the diagnosis, treatment and cost of ongoing care for these conditions according to the Scheme’s rules and guidelines.

In most cases, Discovery Health plans offer benefits which are far richer than the Prescribed Minimum Benefits.

To find out how you can access Prescribed Minimum Benefits, go to www.discovery.co.za or contact us for more information.

If you want to change your plan

You can change to any other plan at the end of each year with effect from 1 January the following year, but not during the year. If you need advice on the appropriate Plan choice, please speak to your financial adviser before you decide to change your plan.

Detailed explanations of our benefits are available on www.discovery.co.za or you can contact us.

The benefits explained in this brochure are provided by the Discovery Health Medical Scheme, registration number 1125, administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider. In this document we refer to Discovery Health Medical Scheme (Pty) Ltd as Discovery Health.

Summary of benefits

…make sure you understand the benefits you have on

the plan you chose…

Make the Full Cover ChoiceWe offer you the choice to be covered in full for hospitalisation, specialists in hospital and chronic medicine. Look out for the Full Cover Choice stamp in this brochure. It shows you when to use our range of online tools that help guide you to full cover.

2 | Discovery

What is a medical emergency?A medical emergency is the sudden and, at the time, unexpected onset of a health condition that needs immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy in line with the Scheme’s rules.

Cover for medical emergencies in South AfricaCover for going to hospitalIn an emergency, go straight to hospital. If you need medically equipped transport, call 0860 999 911. This line is managed by highly qualified emergency personnel who will send air or road emergency evacuation transport to you, depending on which is most appropriate. It is important that you, a loved one or the hospital let us know about your admission as soon as possible.

Cover for HIV medicinesIf you need HIV medicines to prevent HIV infection from mother-to-child transmission, occupational and traumatic exposure to HIV or sexual assault, call us immediately on 0860 99 88 77, as treatment must start as soon as possible.

Cover for going to casualtyIf you are admitted to hospital from casualty, we will cover the costs of the casualty visit from your Hospital Benefit, as long as we confirm your hospital admission.

If you go to a casualty or emergency room and you are not admitted to hospital, we will pay the costs from your available day-to-day benefits. Some casualties charge a facility fee, which we do not cover.

Cover under the Prescribed Minimum Benefits In an emergency, when your normal plan cover does not apply, for example you are in a waiting period, we will cover you in full in any hospital until you have been stabilised. If you are not being treated at a network provider, you may be transferred to a network provider once you are stable to ensure you have full cover. If you choose to be treated by a non-network provider, we will cover you up to 80% of the Discovery Health Rate in line with the Scheme’s rules.

There may be instances when you do not have Prescribed Minimum Benefit cover, like when you are in a waiting period or when you join a medical scheme for the first time, with no previous medical scheme membership. This can also happen if someone joins a medical scheme more than 90 days after leaving his or her previous medical scheme.

Cover while travelling overseasThe International Travel Benefit provides cover of up to R5 million for each person on each journey for emergency medical costs while you travel outside South Africa.

This cover is for a period of 90 days from your departure from South Africa. Cover includes appropriate emergency evacuation and transport if needed. You pay the first €100 or US $150 of day-to-day medical expenses.

Please find out how the International Travel Benefit works before you travel overseas and also read the scheme exclusions. Contact us to get detailed information or go to www.discovery.co.za

Cover for evacuation in Africa The Africa Evacuation Benefit covers you for emergency medical evacuations from certain sub-Saharan African countries back to South Africa. You can find the list of African countries this benefit covers and the details of the cover before travelling on www.discovery.co.za.

When you have a medical emergencyAll emergency treatments outside the borders of South Africa must be confirmed by calling International SOS on +27 11 541 1222. This number is displayed on your membership card.

Cover for medical emergencies

Benefit tips...• Call0860999911inanemergency• Letusknowaboutyouradmissionassoonaspossible• MakesureyouknowhowtheInternationalTravelBenefitworks

beforegoingoverseas

In-hospital benefits

3 | Discovery

Important information about your hospital coverYour hospital cover is made up of:

• the cover for the account from the hospital, and

• the cover for all other accounts, like accounts from your admitting doctor, anaesthetist or any approved healthcare expenses. We call these related accounts.

Limits, clinical guidelines and policies apply to some healthcare services and procedures in hospital.

How we pay the account from the hospital

We cover you in a private hospital for emergency and planned hospital admissions that you have confirmed with us. We cover your hospital account (the ward and theatre fees) at the rate agreed with the hospital. You have cover for a general ward, not a private ward.

Accounts from your doctor and other healthcare services

Your doctor or treating healthcare professional’s accounts are separate from the hospital account and are called related accounts. Related accounts include any account other than the hospital account. Examples of related accounts are the account from the admitting doctor, anaesthetist and any approved healthcare expenses, like radiology or pathology, which you incur during your hospital stay. Refer to the section on how we cover healthcare professionals for detailed information on how we cover related accounts.

Please contact us before you receive treatment for which we have not confirmed your benefits or to extend your hospital stay.

Hospital benefits

We cover you in hospital for emergency and planned hospital admissions. There is no overall limit for

hospital cover on your plan. Your approved hospital admission is subject to your available cover on

your Plan. You can go to any private hospital for emergency and planned admissions.

Going to hospital can be a stressful experience. Discovery’s HospitalXpress makes your admission to hospital convenient and seamless. This service offers you express pre-admissions and online tools to authorise your admission and confirm your cover. HospitalXpress also connects you to select partners, bringing you a range of value-added services at the reduced prices you’re accustomed to as a Discovery member.

Benefit tips...YoucanaccesstheMaPSAdvisoronwww.discovery.co.zatosearch

forhealthcareprofessionalswhowehaveanagreementwith

In-hospital benefits

4 | Discovery

Benefit tips...• Youmustcallusatleast48hoursbeforeanyplannedprocedure• Youwillbecoveredinfullifyouusedoctorswhowehavean

agreementwith,relevanttoyourplantype• Goto“DoWeCover”onwww.discovery.co.zatofindoutmore

aboutourclinicalrulesandpolicies• Sometreatmentsyoureceivewhileinhospitalmayneedseparate

approvalorbenefitconfirmation

Before you go to hospital for any planned procedure, you must: • see your doctor who will decide if it is

necessary for you to be admitted • make sure you know how the account

from your admitting doctor will be covered • choose which hospital you want to be

admitted to • find out how we cover other healthcare

professionals, for example your anaesthetist • call us on 0860 99 88 77 to confirm your hospital

admission at least 48 hours before you go in. We will give you information that is relevant to how we will pay your hospital stay

If you do not confirm your admission, we will only pay 70% of the costs that we would normally cover.

Please refer to cover for medical emergencies for more information.

Cover is subject to our rulesWe pay medically appropriate claims. Your cover is subject to our scheme rules, funding guidelines and clinical rules.

There are some expenses that you may incur while you are in hospital that your Hospital Benefit does not cover, for example private ward costs. Please be aware that certain procedures, medicines or new technologies need separate approval while you are in hospital. Please discuss this with your doctor or hospital.

You can find out more about our clinical rules and policies for cover by contacting us or at www.discovery.co.za under “Do We Cover.”

Cover for Prescribed Minimum BenefitsIn most cases, Discovery Health plans offer benefits which are far richer than the Prescribed Minimum Benefits.

To access Prescribed Minimum Benefits, there are rules that apply:

• your medical condition must qualify for cover and be part of the list of defined Prescribed Minimum Benefit conditions.

• the treatment needed must match the treatments in the defined benefits.

• you must use designated providers in the Discovery Health network. This does not apply in life-threatening emergencies. However, even in these cases, where appropriate and according to the rules of the Scheme, you will be transferred to a healthcare provider in the Discovery network – otherwise we will pay up to 80% of the Discovery Health Rate. You will be responsible for the difference between what we pay and the actual cost of your treatment.

More information on our approach to Prescribed Minimum Benefits is available on www.discovery.co.za

In-hospital benefits

5 | Discovery

Your cover for healthcare professionals Full cover for specialists who we have an agreement with

You can benefit by using healthcare professionals who we have an agreement with as we will cover their approved procedures in full. These healthcare professionals, appropriate to your plan, are also the designated providers for Prescribed Minimum Benefits.

You can access the MaPS Advisor on www.discovery.co.za to search for healthcare professionals who we have an agreement with.

You may have a co-payment if you use other specialists

If you are treated by a specialist who we do not have an agreement with, we cover you up to 100% of the Discovery Health Rate. You may have a co-payment if your specialist charges above these rates.

Other healthcare professionals

We cover GPs and other healthcare services up to 100% of the Discovery Health Rate.

We cover radiology and pathology up to 100% of the Discovery Health Rate.

Your cover for investigationsScopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy)

We pay the first R2 600 of your hospital account from your Medical Savings Account. We pay the balance of the hospital account and your related accounts from your Hospital Benefit according to your plan’s benefits. A related account is the account from your admitting doctor, anaesthetist or any approved expense you incur during your hospital admission, other than the hospital account.

Contact us for a detailed explanation of how we cover scopes or go to www.discovery.co.za

MRI and CT scans

If your MRI or CT Scan is done as part of an approved admission, we pay up to 100% of the Discovery Health Rate from your Hospital Benefit. If you are admitted for conservative back or neck treatment, or if the scan is unrelated to your admission, we pay the first R2 300 of the scan from your Medical Savings Account.

We pay the balance of the scan from your Hospital Benefit, up to 100% of the Discovery Health Rate. Specific rules and limits apply to conservative back and neck scans.

Contact us for a detailed explanation of how we cover MRI and CT scans or go to www.discovery.co.za

Your cover for dental treatmentYou need to pay a portion of your hospital or day-clinic account upfront for dental admissions. This amount varies, depending on your age and the place of treatment:

Members Hospital Day clinicMembers younger than 13 years

R1 300 R650

Members 13 years and older

R3 300 R2 200

We pay the balance of the hospital account from your Hospital Benefit, up to 100% of the Discovery Health Rate.

We pay the related accounts, which include the dental surgeon’s account, from your Hospital Benefit, up to 100% of the Discovery Health Rate.

No overall dental limit

There is no overall limit for dental treatment. We pay for all dental appliances, their placement and orthodontic treatment (including the related accounts for orthognathic surgery) at 100% of the Discovery Health Rate from your Medical Savings Account, as long as you have money available.

Severe dental and oral surgery

The Severe Dental and Oral Surgery Benefit covers a defined list of procedures, with upfront payments and no overall limits. This benefit is subject to authorisation and the Scheme’s rules and guidelines.

You can benefit by using healthcare professionals who we have an

agreement with as we will cover their approved procedures in full

In-hospital benefits

6 | Discovery

Only the following healthcare services have an annual limit:

Hospital limits Annual limit

Cochlear implants, auditory brain implants and processors

R140 000 for each person for each benefit

Internal nerve stimulators R106 000 for each person

Hip, knee and shoulder joint prostheses There is no overall limit if you get your prosthesis from a preferred supplier. If you choose not to, a limit of R33 000 will apply to each prosthesis.

Prosthetic devices used in spinal surgery R21 000 for the first level, R42 000 for two or more levels, limited to one procedure for each person

Mental health benefit 21 days for each person

Alcohol and drug rehabilitation 21 days for each person

Terminal care benefit R28 000 for each person in their lifetime

Chronic dialysis We cover these expenses in full if we have approved your treatment plan and you use a provider in our network. If you go elsewhere, you have to make a co-payment

* If you join the medical scheme after January, you won’t get the full limit because it is calculated by counting the remaining months in the year.

Treatment in hospital that we cover from your day-to-day benefitsWe cover the following treatment you get in hospital from your Medical Savings Account:

• Casualty treatment if you are not admitted

• Medicine to take home

• External medical items

Unlimited healthcare servicesMost of your in-hospital healthcare services have no overall limit. These are:

• GPs

• Specialists

• Allied healthcare professionals, like physiotherapists

• Pathology and radiology

7 | Discovery

Cover for chronic conditions and oncology

We need to approve your applicationWe need to approve your application before we cover your condition from the Chronic Illness Benefit. To apply, contact us to get an application form or go to www.discovery.co.za. Complete the relevant application form with your doctor and send it to us. We will send you a letter detailing the cover available to you.

We pay medicine up to a maximum of the Discovery Health Medicine Rate.

The Discovery Health Medicine Rate is the price of medicine as well as a fee for dispensing it. Discovery Health has negotiated contracts with over 1 200 pharmacies, who have agreed to charge no more than this rate. If you use a pharmacy outside of this network, you will have to pay part of the dispensing fee charged by the pharmacy.

Use our online MaPS Advisor on www.discovery.co.za to find a network pharmacy.

Please note that the medicine list and the Chronic Drug Amount are updated from time to time based on regulatory changes and continued clinic appropriateness.

Visit www.discovery.co.za or contact us for a detailed explanation of the cover offered through the Chronic Illness Benefit.

What we cover as a Prescribed Minimum BenefitThe Chronic Illness Benefit covers certain diagnostic tests, consultations and medicines each year for the chronic conditions listed in the Prescribed Minimum Benefits, called the Chronic Disease List. This cover includes tests and consultations during the year for both the diagnosis and ongoing management for each condition.

If you do not use healthcare professionals who we have an agreement with, you will have to pay part of the treatment costs yourself. Contact us for the latest copy of the treatment guidelines or go to www.discovery.co.za

Your cover for cancer treatmentOur Oncology Programme covers the first R200 000 of approved cancer treatment over a 12-month cycle. We do not limit your cancer treatment costs, but you will need to pay 20% of the costs of treatment that costs more than R200 000.

We cover chemotherapy and oncology-related medicines up to the Discovery Health Medicine Rate. We pay consultations, radiotherapy, radiology, pathology, scopes and scans up to 100% of the Discovery Health Rate. You may be responsible to make a co-payment if your healthcare professional charges more than the Discovery Health Rate.

Cancer treatment that qualifies as a Prescribed Minimum Benefits is always covered in full.

Please call us to register on the Oncology Programme.

Visit www.discovery.co.za for a detailed explanation of the cover offered through the Oncology Programme.

Chronic Illness BenefitYou have cover for a list of chronic conditions. You have full cover for approved medicine on Discovery Health’s medicine list or up to a set monthly amount (Chronic Drug Amount) for medicine not on our list. You will be responsible for the balance if your medicine costs more than the Chronic Drug Amount.

When you use MedXpress, Discovery Health’s convenient medicine delivery service, you pay no delivery or administration fees. Discovery Health’s qualified service agents can also advise you on the most cost-effective alternatives and you will always be charged at the Discovery Health Medicine Rate or less – minimising co-payments. Call us on 0860 99 88 77 to make use of this free service.

Cover for chronic conditions

Benefit tips...• YoumustregisterforcoverfromtheChronicIllnessBenefit.We

offeryoucomprehensivecoverforalistofconditions.

Benefit tips...• YoumustregisterontheDiscoveryCareprogrammesto

accessthesebenefits• Moredetailsareavailableonwww.discovery.co.zaoryou

cancontactus

You have extensive cover for chronic conditions, HIV and AIDS and cancer.

8 | Discovery

Out-of-hospital cover

We first pay your claims from your Medical Savings AccountWe pay day-to-day medical expenses like GP visits, radiology and pathology from your Medical Savings Account, as long as you have money available. Your Medical Savings Account is an amount that you get at the beginning of the year or when you join Discovery Health. You have access to the full amount from day one. If you have funds in your Medical Savings Account at the end of the year, we will carry over these funds to the next year.

If you run out of money in your Medical Savings Account before your claims add up to the Annual Threshold, you will have to pay for your day-to-day medical expenses yourself.

If you leave Discovery Health or downgrade your health plan before the year is up, you will owe Discovery Health the portion of the Medical Savings Account you have used but have not yet paid back.

Annual Medical Savings Account amounts*:

Main member R2 352Adult dependant R1 764Child ** R936

* If you join the medical scheme after January, you won’t get the full limit because it is calculated by counting the remaining months in the year.

** We count a maximum of three children when we calculate the annual Medical Savings Account amounts

The Insured Network Benefit ensures you have no gaps in cover for GPs • We extend your day-to-day cover through the

Insured Network Benefit by paying GP consultation fees when you have spent your annual Medical Savings Account deposit. We cover your consultations if you go to a GP in our network. The maximum number of consultations that we cover for a single member and a family each year depends on your plan type:

Single Member Family2 consultations 4 consultations

This benefit only covers the consultation fee, we pay for any other healthcare services from your available day-to-day benefits.

To find a GP in our network, use our MaPS Advisor on www.discovery.co.za or contact us.

Cover for day-to-day medical expenses

Your Medical Savings Account is an amount that you get at the beginning of the year or when you join Discovery Health. You have

access to the full amount from day one.

9 | Discovery

Out-of-hospital cover

How we make your Medical Savings account last longerWe pay these day-to-day expenses without using your Medical Savings Account:

• The Screening and Prevention Benefit covers certain tests at a Discovery Wellness Network provider, like blood glucose, blood pressure, cholesterol and body mass index. We also cover a mammogram, Pap smear, PSA (a prostate screening test) and HIV screening tests. Members 65 years or older and members registered for certain chronic conditions are also covered for a seasonal flu vaccine.

• We cover out-of-hospital claims for recovery after certain traumatic events from the Trauma Recovery Extender Benefit. The cover applies to the rest of the year in which the trauma took place, and to the year after your trauma.

• We pay for scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) from your Hospital Benefit if it’s done in your doctor’s rooms. We pay up to 100% of the Discovery Health Rate. Please call us before you have a scope done in your doctor’s rooms to confirm your benefits.

The Discovery Health Medicine RateFor medicine, we pay up to the Discovery Health Medicine Rate. The Discovery Health Medicine Rate is the price of medicine as well as a fee for dispensing it. Discovery Health has negotiated contracts with over 1 200 pharmacies, who have agreed to charge no more than this rate. If you use a pharmacy outside of this network, you will have to pay part of the dispensing fee charged by the pharmacy.

Use our online MaPS Advisor on www.discovery.co.za or contact us to find a network pharmacy.

Your cover for day-to-day healthcare services is limited to money in your Medical Savings AccountWe pay for these healthcare services from your Medical Savings Account:

• GPs

• Specialists

• Allied healthcare professionals, like physiotherapists

• Radiology and pathology

• Dentistry

• Private nursing

• Prescribed and over-the-counter medicine

• External medical items

• Hearing aids

• Optical care

• MRI and CT scans: we pay the first R2 300 of your MRI or CT scan from your Medical Savings Account. We cover the balance of the scan from your Hospital Benefit up to the Discovery Health Rate. For conservative back and neck treatment, specific rules and limits may apply.

Benefit tips... How to make the money in your Medical Savings Account go further:

• ChooseaGPintheDiscoveryHealthGPNetwork

• Chooseaspecialistwhowehaveanagreementwith

• Usegenericmedicinesanddon’tpayforover-the-countermedicines(OTCs)fromyourMSA

10 | Discovery

General exclusionsDiscovery Health has certain exclusions. We will not pay for healthcare services related to the following, except where stipulated as part of a defined benefit or under the Prescribed Minimum Benefits.

General exclusion list1. Cosmetic procedures and treatments2. Otoplasty for bat ears, Portwine stains and blepharoplasty (eyelid surgery)3. Breast reductions or enlargements and gynaecomastia4. Obesity5. Frail care6. Infertility7. Wilfully self-inflicted illness or injury8. Alcohol, drug or solvent abuse9. Wilful and material violation of the law10. Wilful participation in war, terrorist activity, riot, civil commotion, rebellion or uprising11. Injuries sustained or healthcare services arising during travel to or in a country at war12. Experimental, unproven or unregistered treatments or practices13. Search and rescue14. Any costs for which a third party is legally responsible

We also do not cover the complications or the direct or indirect expenses that arise from any of the exclusions listed above, except where stipulated as part of a defined benefit or under the Prescribed Minimum Benefits.

If we apply waiting periods because you have never belonged to a medical scheme or have had a break in membership of more than 90 days before joining Discovery Health, you will not have access to the Prescribed Minimum Benefits during your waiting periods. This includes cover for emergency admissions.

The benefits outlined in this guide are a summary of the plans registered in the medical scheme rules. These benefits are reviewed annually and amended in line with the requirements of the Medical Schemes Act and also take into account the requirements of the Consumer Protection Act where it relates to the business of a medical scheme.

Important tips when claimingWhen claiming from Discovery Health for your medical costs, whether these are hospital, chronic or day-to-day, these steps apply.

• Check with your healthcare professional if they have sent your claims to us to avoid duplicates

• Send your claims within four months, otherwise we will consider them expired and not pay them

• When sending claims, please make sure the following details are clear:

1. Your membership number

2. The service date

3. Your healthcare professional’s details and practice number

4. The amounts charged

5. The relevant consultation, procedure or NAPPI code and diagnostic (ICD-10) codes

6. The name and birth date of the dependant for whom the service was done

7. If paid, attach your receipt or make sure the claim says ‘paid’

• Remember to always keep copies of your claims for your records

• To see the status of your claim, you can go to www.discovery.co.za

Claiming for healthcare after a motor vehicle accident Discovery Health pays for your healthcare expenses when you’re involved in a motor vehicle accident. According to the rules of the Discovery Health Medical Scheme, you need to lodge a claim with the Road Accident Fund. If your claim with the Road Accident Fund is successful and both Discovery Health Medical Scheme and the Road Accident Fund pay your medical expenses, you’ll need to reimburse the medical expenses paid by the Road Accident Fund to Discovery Health.

11 | Discovery

You can send us your claims in the following waysEmail

You can scan and email your claims to [email protected]

Post

You can post your claims to the following address:

Discovery – Claims

PO Box 784262

Sandton

2146

Claims drop-off boxes

You can drop your claims in our claims drop-off boxes situated around the country in convenient places such as pharmacies and medical practices, as well as at most Virgin Active or Planet Fitness gyms.