Consultations and procedures out of hospital
General Practitioner consultations out of hospital
GP consultations for the treatment of general conditions are paid at the SRR from available savings (MSA). Costs in excess of the SRR can be paid from available savings upon special request.
If you visit a GP on the Discovery Health GP network, the Scheme pays a network rate directly to the network GP for consultations and a defined list of procedures. You will not incur a co-payment unless your benefits have been exhausted. Please read more on the GP network
Specialist consultations out of hospital
Specialists, excluding radiologists and pathologists, are paid from available savings (MSA) up to 125% of the SRR.
Procedures in rooms
Minor procedures in rooms performed by GPs and specialists will be paid from the Medical Savings Account. Specialists will be paid up to 125% of SRR and GPs 100% of SRR.
Specialist procedures performed in rooms instead of hospital will be paid by the Scheme at the Top-Up rate up to 230% of SRR, subject to authorisation, Scheme protocols and a defined list of procedures.
Specialist and GP consultations for chronic PMB conditions
Specialist and GP consultations for chronic PMB conditions are paid by the Scheme, but are subject to Scheme protocols and registration of the chronic condition.
Alternative healthcare services
Acupuncture, chiropody, chiropractic services (including x-rays), homeopathy and naturopathy are paid from available savings (MSA).
Allied healthcare services
Audiology, dietitians, occupational therapy, orthoptics, physiotherapy, podiatry, psychology, registered nurse services, social services and speech therapy are paid from available savings (MSA). Private nursing is subject to authorisation.
If any of these services are provided in support of in hospital procedures, they will be paid by the Scheme and not from your MSA.
*Orthotists and prosthetists are paid from available savings. The Scheme's Designated Service provider is the Discovery Health network of orthotists and prosthetists. If you use a non-DSP you are responsible for the difference in cost.