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Cover for investigations
We cover endoscopies such as gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy used to investigate the digestive system.
Admissions for scopes
Depending on where you have your scope done we pay the following amount from your available day-to-day benefits and the balance of the hospital and related accounts from your Hospital Benefit. If you do not have enough funds available in your Medical Savings Account (MSA), you will need to pay this amount.
Upfront payments for scope admissions:
Classic, Essential, Classic Smart and Delta options
DAY CLINIC ACCOUNT
R4,300
HOSPITAL ACCOUNT
R7,350, this co-payment will reduce to R6,100 if performed by a doctor who is part of the Scheme's value-based network
If both a gastroscopy and colonoscopy are performed in the same admission
Classic, Essential, Classic Smart and Delta options
DAY CLINIC ACCOUNT
R5,250
HOSPITAL ACCOUNT
R9,150, this co-payment will reduce to R7,600 if performed by a doctor who is part of the Scheme's value-based network
Upfront payments for scopes performed outside of the Day Surgery Network:
Where a scope is performed in a facility outside of the Day Surgery Network an upfront payment of R6,650 will apply, except if performed in a hospital outside the Day Surgery Network where an upfront payment of R7,350 will apply. Where both a gastroscopy and colonoscopy are performed the upfront payment of R9,150 will apply. For Delta options, the out-of-network upfront payment of R10,200 will apply.
No upfront payment applies:
If scopes are performed in the doctor's rooms, as part of a confirmed Prescribed Minimum Benefits (PMB) condition, or the patient is under the age of 12, you will not have to pay any amount upfront. We pay the account from the Hospital Benefit.
DOWNLOAD THE COVER FOR DIAGNOSTIC ENDOSCOPIES BENEFIT GUIDE
Cover for radiology
X-rays can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
In-hospital
We cover up to the Discovery Health Rate (100%).
Out-of-hospital
We pay for out-of-hospital radiology expenses from your available funds in your Medical Savings Account.
Cover for MRI/CT Scans
Scans are covered from your Hospital Benefit. Depending on the circumstances, you may be liable for an upfront deductible. Note that only a specialist or trauma unit GP in our network may refer you for a MRI or CT scan.
We pay for scans as an out-of-hospital expense if:
- A scan is done as part of a pre-operative work-up for a planned surgical procedure.
- A scan is needed for conservative back and neck treatment during an approved admission. Specific rules and limits apply to conservative back and neck scans.
Scans done as part of an approved admission
We pay up to the Discovery Health Rate (DHR) from your Hospital Benefit if the scan is related to your hospital admission.
Other scans
If it is not related to your admission or for conservative back and neck treatment, we pay the first R3,670 from your available day-to-day benefits and the balance from your Hospital Benefit, up to the Discovery Health Rate (DHR). Limited to one scan per spinal and neck region.
Cover for pathology
Pathology can be done either in-hospital as part of a planned admission or out-of-hospital as part of your day-to-day benefits.
In-hospital
We cover up to the Discovery Health Rate (100%).
Out-of-hospital
We pay for out-of-hospital pathology expenses from your available funds in your Medical Savings Account.