Are you recently diagnosed with High Blood Pressure? Or Diabetes? Did you know that your Medical aid actually covers your monthly medication? Different medical aid schemes may cover different chronic conditions, but the general 27 conditions are covered by most of the medical aid across all plans. Below we list them:
How to apply for Chronic illness benefit? Discovery:
Once the form has been received and reviewed you will get a confirmation via email whether or not the request has been approved, and/or what medications are approved/declined. The letter of benefit will have details on how you will be covered under the condition. If your script has an end date (such as 3 months or 6 months), to continue with treatment, you must visit the doctor again to get the new script, and send it to Discovery to assess and update the approved medication. If you have any updated new prescription (medication or dosage), you must email the new prescription to Discovery as well so they can update it on their system. Medications that are covered Discovery has its medication formulary. If you are on the Essential Smart plan or Keycare plan, then your medication MUST be from the formulary; if you are on other plans, then medications from the formulary will be paid fully, and medications outside of the formulary will be paid partially. Approved medicine on the Chronic Illness Benefit medicine list (formulary) Bonitas: There are two ways to activate your Chronic Illness Benefits with Bonitas
Follow-up consultation and nominated doctor online Doctors normally advise you to follow up online to save time, normally this is perfect for members who need blood test review. They would send you to the nearest pathology for a blood test. Momentum
For further queries regarding your Chronic Illness Benefit contact Namhla in our Health department tel(011)658-1333, email service@daberistic.com
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Discovery’s additional benefit the WELLTH fund came into effect on 01 January 2023. You and your family will have access to a once-off, additional risk benefit called the WELLTH Fund, offering up to R10 000 per family to empower you and your family members to understand and address your personal healthcare needs. What does the WELLTH Fund cover? The WELLTH Fund covers a comprehensive list of healthcare services to ensure that you are empowered to take specific action according to your individual health needs. This benefit is separate from and additional to the Screening and Prevention Benefit and will be available to all existing and new members of the Scheme. This benefit can be used for appropriate healthcare services up to your WELLTH Fund limit. Cover is subject to the Scheme's clinical entry criteria; treatment guidelines and protocols and qualifying healthcare services are covered up to a maximum of the Discovery Health Rate (DHR). Fund Allocation The WELLTH Fund is a once-per-lifetime benefit available to every beneficiary on Discovery Health Medical Scheme. The value of the benefit is allocated according to size and make-up of each family on a membership. To activate the WELLTH Fund, every person on a membership certificate aged 2+ must first complete their relevant health check at a healthcare provider in Discovery’s Wellness Network. Once the member and all their Dependants have completed their Health Checks, they will have access to WELLTH Fund of up to R10,000, below is a chart of how funds are allocated. The WELLTH FUND is allocated per membership, and therefore once it is activated any person on the membership can make use of any portion of the benefit. Discovery App WELLTH fund tracking On your Discovery APP the WELLTH Fund Dashboard (shown below) will allow members to view all available health checks and recommended next best actions, book consultations and keep track of their use of the WELLTH Fund. For more information on the Wellth Fund contact Jo in our Health Fund on 011 658 1333 or email us on service@daberistic.com
Source: Discovery Having a new addition to the family is an exciting time. Below we have put together a step by step guide to your Discovery Maternity benefits after birth. Post natal home care visits. To be applied just after your delivery. The service offers home visits for healthy mothers and their babies, and this will be paid from the hospital benefit if funding is approved. This service includes 3 days visits by a midwife within the 6 weeks postnatal period post early discharge from hospital (subject to availability). Eligibility criteria:
How to apply: 1. Fill in Home care application form prior to delivery. Click here. 2. Information required on the form:
4. After submission you will receive an email reference, please follow up on your application after 3 working days by calling in to Discovery on 0860 462 273. You can Activate cover for you and your baby up to two years after birth after Discharge. You have cover for healthcare services up to two years after birth, this will be paid up to Discovery scheme rate. To activate the benefits:
Benefits after Activation of Baby Program
****Keycare members needs to go to chosen GP or a referral is required.
Navigate and find your services closest to you. To find an GP, Paediatrician, ENT, Gynaecologist, Dietitian, Psychologist or Antenatal service providers:
Source Discovery There are several ways to get customer support from Discovery South Africa:
Note: For specific departments such as Vitality or Discovery Life, there may be separate contact details available on the Discovery South Africa website. Click here for Quick access What about on WhatsApp? Yes, you can also get customer support from Discovery South Africa through WhatsApp. Here's how to do it:
Discovery’s additional benefit the WELLTH fund came into effect on 01 January 2023. This benefit is a once-off benefit to all medical aid members in which it provides up to R10,000 in additional cover for a family’s healthcare needs. Fund Allocation The WELLTH Fund will be activated in 2023, once members completed their health check in 2022 or 2023 This sets the baseline for a member’s Health Status. To activate the WELLTH Fund, every person on a membership certificate aged 2+ must first complete their relevant health check at a healthcare provider in Discovery’s Wellness Network. Once the member and all their dependents have completed their Health Checks, they will have access to WELLTH Fund of up to R10,000, below is a chart of how funds are allocated. Where to use your WELLTH Fund The WELLTH Fund covers over and above the annual Screening and Prevention Benefit. Discovery App WELLTH fund tracking On your Discovery APP the WELLTH Fund Dashboard (shown below) will allow members to view all available health checks and recommended next best actions, book consultations and keep track of their use of the WELLTH Fund. How tests are covered
This benefit is available once per beneficiary, per lifetime. Discovery pays the above healthcare services from the WELLTH Fund up to the Scheme Rate and up to your WELLTH Fund limit. Some of these tests and treatments have a rand value limit depending on the number of active dependents you have on your membership. Once you have reached your allocated rand value limit for the tests, Discovery will pay any extra screening and preventive tests and treatments from your available day-to-day benefits, where applicable. The Scheme’s clinical entry criteria, treatment guidelines and protocols apply. The normal claims process applies. Discovery will automatically pay this from your WELLTH Fund. FAQ
Yes, the WELLTH Fund covers the following specific medical devices if they have a registered NAPPI code and are bought from a registered healthcare provider with a valid practice number (such as a pharmacy or doctor):
It depends on which health plan you have. Plan network rules apply for members on Smart and KeyCare plans:
Members on all other plans may use a provider of their choice and do not have to use a network provider to be covered by the WELLTH Fund. 4. The WELLTH Fund tool has recommended a list of check-ups that I should go for, am I only covered for these check-ups? No, the WELLTH Fund Tool is just a guide for which screening check-ups are most suitable for you, based on your age and gender. However, you can go for any of the screening and preventative check-ups covered by the WELLTH Fund - you don't have to go for those recommended by the tool. 5. Can I claim for medication from the WELLTH Fund? No, you cannot claim any medication from the WELLTH Fund. 6. How can I book an appointment to use my WELLTH Fund?
For more information, please contact our Health department on 011 658 1333 or email us on service@daberistic.com Source: Discovery If you have Vitality and your children are under your policy, Kids under the age of 18 can enjoy free movie tickets and adults can enjoy half-price movie tickets! So how do you get your kids to enjoy free movies? Children between 2 and 18 years old on a Vitality Health policy can watch movies for free at selected cinemas before 7pm, after completion of an online Kids Vitality Health Review. Complete the Kids Vitality Health Review every 12 months to keep the Vitality Kids movie benefit. The Vitality Kids movie benefit is not available to Vitality Active members.
To get assistance with activating your Vitality Kids contact Jo in our Health department, email service@daberistic.com, Tel 011-658-1333, Option 2 for Medical Aid. On 21st September 2022, Discovery hosted their virtual workshop with over 10,000 brokers, to announce Discovery's benefits and contribution updates for 2023. Below is a summary what you need to look forward to in 2023 for Discovery Health and Vitality. Discovery Health No increase in contributions until 01 April 2023 Every year, medical schemes increase contributions by medical inflation to meet the expected cost of healthcare claims in the following year. Discovery Health will only increase contributions for 2023 on 1 April 2023. Members will therefore enjoy 2023 benefits at 2022 rates, for the first three months of the year. The increase on 1 April 2023 will be in line with medical inflation, expected to range between CPI plus 3 - 4%, which would be about 10% increase. Discovery will only confirm the exact increase percentage and new premium in February 2023. 2023 Benefit updates
Introducing Essential Dynamic Smart Plan If you are a tech-savvy, then there’s good news! Discovery Health is introducing a new plan called Essential Dynamic Smart Plan in 2023, it only costs R1450 per month and it is personalized. It will connect a member with the most efficient hospital for their admission at a specific point in time. (Deductible/co-payment will occur if choosing other providers) Introducing the WELLTH Fund The WELLTH Fund enables members to better understand their health status. The fund does this by giving risk funding of up to R10,000 per family for a broad range of health screenings and preventive healthcare services – over and above the yearly Screening and Prevention Benefit. It is going to start from 01st January 2023 for 24 months. Simply unlock the benefit by having one health check-up. Vitality Highlights In 2023, Vitality will enhance its benefits to focus on monetizing healthy behaviour and encouraging good clinical outcomes to drive more engagement and better health. The Vitality HealthyWeight programme This new programme uses the latest trends in behaviour change to help members achieve their ideal and healthy weight through a personal nutrition coach, simple meal plans, recipes and shopping lists. Vitality members can access Vitality HealthyWeight at affordable rates, with all at risk Vitality members receiving higher additional discounts. The Easiest Way to Join Gym
If you have Discovery Bank, you can now join the gym with Vitality without any admin with the gym staff, you can simply activate the gym benefit on the App, and skip the gym activation fee! If you like to know more about your cover or review your current Option contact Tammy in our Health department tel (011) 658-1333 email: service@daberistic.com Source: Discovery |
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January 2025
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