Consultations and procedures out of hospital

General Practitioner consultations out of hospital

GP consultations (visits and virtual) 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 G P network

Specialist consultations out of hospital

Specialists, excluding radiologists and pathologists, are paid from available savings (MSA). Specialist consultations and procedures will be funded up to the agreed rate when visiting a Premier Network Specialists.

For consultations with non-network specialists, claims will be reimbursed at 125 % of the Scheme Reimbursement Rate (SRR) from your available MSA.

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. Minor procedures in rooms performed by Premier Network Specialists will be paid up to the agreed rate.

Procedures performed in rooms by specialists instead of hospital will be paid by the Scheme for Premier Network Specialists at the agreed rate or non-network specialists 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.

Psychiatric conditions - PMB

15 consults at a network psychologist.

When enrolled by a Premier Plus GP, you have access to antidepressant medication.

Psychiatric conditions - Non-PMB

3 GP or psychologist consults up to R3 465 per beneficiary with your enrolling Premier Plus GP.

Antidepressant medication funded form the Non-PMB Chronic Medication Benefit if the chronic condition has been registered.