Discovery Medical Aid, formerly known as the Discovery Health Medical Scheme (DHMS), is South Africa’s largest and most widely used open medical aid scheme, providing healthcare cover to millions of members nationwide. Open to all South Africans and residents, Discovery offers one of the broadest selections of medical plans, from cost-effective network products to premium comprehensive cover tailored for families, executives, and retirees.
Discovery is known for not just paying medical claims but also for its managed care programmes, preventative health initiatives, wellness engagement tools, and integration with the broader Discovery ecosystem (including Vitality rewards, banking, and insurance). This combination aims to support both immediate healthcare needs and long-term wellness outcomes.
Wide Range of Medical Aid Plans
Discovery Medical Aid offers a very broad portfolio of plans — often more than 20 different options — that cater to different budgets and healthcare priorities:
1. Executive & Comprehensive Plans
Unlimited private hospital cover with very few exclusions
Comprehensive day-to-day benefits (GP visits, specialists, dentistry, optometry)
Above Threshold Benefits (ATB) and savings extensions
Specialist programmes (e.g., cancer, dialysis, chronic conditions)
International coverage for emergency medical care when abroad
Advanced medicine benefits and Overseas Treatment options on select plans
2. Smart Plans & Saver Series
Discovery’s Smart series (including Active Smart, Classic Smart, Essential Smart, and Smart Saver plans) focuses on balanced cover with affordable contributions while still providing solid hospital benefits and essential day-to-day cover. These plans often include a Personal Health Fund — extra day-to-day funds that members can unlock by engaging with health activities.
3. KeyCare Plans
For individuals or families with more basic needs or tighter budgets, the KeyCare range provides network-based hospital and basic outpatient cover at lower contributions, ideal for young adults, graduates, or those starting medical aid.
Core Benefits & Cover Explained
Discovery’s cover extends across hospital, day-to-day, chronic care, preventative services, and specialised programmes — subject to plan choice and rules:
Unlimited Hospital Cover
Discovery provides no overall lifetime limits for hospitalisation, meaning emergency and planned admissions are funded according to your plan rules. Members can usually visit any private hospital, with preferred network benefits applying to certain plans to reduce out-of-pocket costs.
Day-to-Day Benefits
Covers common healthcare services such as:
GP and specialist consultations
Radiology and pathology tests
Dental and optometry care
Prescribed medications
Coverage depth depends on your plan — higher plans offer greater allocations and additional funding pools like Above Threshold Benefits (ATB) and Medical Savings Accounts (MSA).
Chronic & Disease-Specific Care
All plans include cover for Prescribed Minimum Benefit (PMB) chronic conditions (e.g., diabetes, hypertension). Some plans cover additional chronic conditions outside the PMB list and include structured disease management programmes such as diabetes or kidney care.
Screening and Prevention
Discovery offers a range of preventive and screening tests designed to detect early warning signs of serious health issues — including blood tests, cholesterol screenings, cancer screenings, and other essential checks.
Trauma & Emergency Support
Emergency services include hospital admissions, medically equipped transport, and trauma-related benefits, with specific programmes aimed at supporting members through critical care events.
International Benefits
Select plans include international emergency care cover (e.g., up to R5 million while travelling abroad) and Overseas Treatment Benefits for evidence-based treatment not available locally, though conditions and co-payments apply.
Personal Health Fund & Wellness Engagement
One of Discovery’s unique features is the Personal Health Fund. This dynamic benefit provides additional day-to-day funds as members actively manage their health through the Discovery Health platform. This usually involves completing health assessments, preventive screenings, and personalised “next best actions”, which encourage healthier lifestyles and potentially lower future healthcare costs.
Cost & Contribution Trends
Like all medical schemes in South Africa, Discovery adjusts its contributions annually to reflect healthcare cost inflation. For 2026, Discovery announced an average contribution increase of around 7.2–7.9% across many plans, with some structured to defer increases to ease member burden.
Discovery also continues to innovate with Smart Saver and Active Smart plans, designed to offer structured cover at competitive prices for younger members and families.
How to Claim & Member Support
Discovery Medical Aid supports multiple claim and support channels:
Online Member Portal & App — upload and track claims digitally
Email or postal claims — submit supporting documents easily
Contact line (e.g., 0860 000 628) — for quotes and direct assistance
Members can manage benefits, view contributions, check authorisations, and monitor personalised health pathways entirely through digital services.
Discovery Medical Aid — Contact Numbers & Support Channels (South Africa)
General Member Support & Enquiries
Discovery Contact Centre: 0860 000 628 — main number for plan info, quotes, benefits, claims support, and membership enquiries.
From Outside SA: +27 11 529 4958
Discovery’s contact centre helps with:
✔ Plan selection and benefits explanation
✔ Contribution queries and billing support
✔ Registration and onboarding questions
✔ Authorisation and chronic support queries
Medical Claims & Claims Support
Claims Fax Number: 0861 356 627
Claims Help (Contact Centre): 0860 000 628 — press the option for claims, or ask the receptionist for claim escalation assistance.
Claims support is also available online via the Discovery app and Member Zone, where you can upload supporting documents and check status.
Digital & Self-Service Support
Discovery Medical Aid App: Download via Google Play or Apple App Store (search “Discovery Health Medical Scheme”).
Member Zone: discoveryhealthmedicalscheme.co.za/ (login for self-service)
Here, members can:
✔ View benefit statements
✔ Upload and track claims
✔ Check authorisations
✔ Manage dependants and contact info
Discovery Vitality & Wellness Support
Discovery’s wellness component — Discovery Vitality — also has dedicated support lines, usually accessed through the same Discovery contact centre or app.
Emergency Services
If your plan includes emergency medical accommodation or trauma response, the Discovery Membership Card lists the 24/7 emergency assistance number relevant to your plan. In general medical emergencies, call Discovery first at 0860 000 628 to be directed.
Complaints & Escalation
If you have unresolved service issues:
Discovery Complaints Unit:
Phone: 0860 000 628 — request escalation or complaints support.
Email: complaints@discovery.co.za (official central complaints email).
If a complaint is not resolved satisfactorily, you may escalate to the Council for Medical Schemes (CMS):
CMS Contact: 0861 123 267
medicalschemes.com
Pros and Cons of Discovery Medical Aid
Pros (Advantages)
1. Extensive Plan Variety
Discovery offers one of the broadest medical aid portfolios in SA — from KeyCare (entry) to Executive comprehensive plans, giving flexibility for all budgets and health needs.
2. Strong Hospital & Specialist Cover
Many Discovery plans include unlimited private hospital cover with wide hospital network access and substantial specialist funding.
3. Wellness Integration (Personal Health Fund & Vitality)
Discovery’s wellness-linked incentives — like the Personal Health Fund and Vitality programme — reward members for healthy behaviour and can unlock extra funds for day-to-day benefits.
4. Digital Convenience
Discovery’s app and Member Zone are highly functional, enabling claims upload, benefit checks, authorisation requests, and health engagement — reducing paper and phone calls.
5. Managed Chronic Care Programmes
Discovery invests heavily in structured chronic condition management, improving health outcomes for long-term patients and reducing overall cost pressures.
6. Preventive Screening Benefits
Plans often include early screening tests and preventative checks, supporting healthier lifestyles and early detection of disease.
7. Large Provider Network
Discovery’s extensive contracts with private hospitals, GPs, specialists, and pathology providers reduce co-payments and improve network access.
8. International and Overseas Benefits
Many mid-to-high tier plans include emergency cover abroad and Overseas Treatment Benefits for certain evidence-based treatment options not available locally.
Cons (Challenges)
1. Contribution Increases
Like all SA medical schemes, Discovery adjusts contributions annually — and premium increases (e.g., ~7–8% for 2026) can impact budgets, especially for families.
2. Complexity of Options
The wide range of plans and benefit structures can be overwhelming without guidance — especially when comparing Savings vs. Comprehensive plans.
3. Exclusions & Limits on Some Benefits
Day-to-day limits, sub-caps, and specific benefit rules must be understood — a plan may not fully cover certain services without additional funding sources.
4. Authorisation Requirements
Certain procedures require pre-authorisation or documentation, which some members find administratively burdensome.
5. Potential Out-of-Pocket Costs
Despite broad coverage, co-payments or shortfalls can occur, particularly if providers are outside prescribed networks or benefit limits are exceeded.
Discovery Medical Aid Plan Comparison Table
Below is a simplified overview of core plan differences — specifics may vary by year and benefit structure, so always check the official brochure:
| Plan Category | Hospital Cover | Day-to-Day Benefits | Chronic Care | Wellness / PHF | International |
|---|---|---|---|---|---|
| KeyCare | Network limited | Basic | PMB only | No | No |
| Smart Series (e.g., Active, Classic, Essential) | Broader network | Moderate | PMB + structured | Personal Health Fund | Partial on higher Smart |
| Comprehensive | Extensive / any private hospital | High day-to-day + ATB | Yes | Yes | Yes (emergency) |
| Executive / Premium | Unlimited private | Very high + extensive ATB | Full support | Strong PHF & Choice | Yes, high travel limits |
Legend:
PMB = Prescribed Minimum Benefits
PHF = Personal Health Fund
ATB = Above Threshold Benefits
Tips for Choosing the Best Discovery Medical Aid Plan, 17th December 2025
1. Know your healthcare needs before selecting a plan
Assess your doctor visits, specialist needs, and chronic conditions to choose a plan that fits your lifestyle and avoids overpaying or underinsuring.
2. Understand the difference between KeyCare, Smart, and Comprehensive plans
KeyCare focuses on network-based hospitals, Smart plans offer moderate day-to-day benefits, and Comprehensive plans provide broad hospital and specialist access.
3. Learn how Medical Savings Accounts work
Some Discovery plans include savings accounts for routine care; once depleted, you may pay out-of-pocket until other benefits activate.
4. Plan around Above Threshold Benefits (ATB)
ATB activates after a specific spend level, helping you plan medical visits and avoid unexpected costs later in the year.
5. Always use network doctors and hospitals
Using network providers reduces co-payments and claim shortfalls; going outside may increase personal costs even on higher-tier plans.
6. Get pre-authorisation for planned procedures
Hospital admissions, MRIs, CT scans, and certain surgeries require pre-authorisation; without it, claims may be partially paid or rejected.
7. Register chronic conditions as early as possible
Registration unlocks structured care, approved medications, and ongoing support, preventing delays in treatment approval.
8. Know your Prescribed Minimum Benefit (PMB) rights
PMBs cover emergencies and listed chronic conditions by law, helping you challenge incorrect claim decisions when necessary.
9. Track claims using the Discovery mobile app
Submit claims, check authorisations, and monitor benefits in real time to reduce processing delays and stay informed.
10. Monitor annual benefit limits carefully
Dental, optical, and specialist benefits often have yearly caps; regular monitoring prevents running out of benefits prematurely.
11. Take advantage of Discovery Vitality benefits
Participating in Vitality activities can unlock additional funding and rewards, improving both health outcomes and plan value.
12. Understand waiting periods and exclusions
Some benefits have waiting periods, especially for new members or upgrades; knowing this avoids early claim disappointments.
13. Budget for possible co-payments
Even comprehensive plans may involve co-payments; always confirm fees with providers before treatment.
14. Keep all medical records and authorisations
Save invoices, referrals, and authorisation numbers to simplify follow-ups and dispute resolution.
15. Review your plan every year
Healthcare needs change, and Discovery updates benefits annually; reviewing ensures your plan still fits your medical and financial situation.
16. Consider future family planning needs
Choose a plan that supports maternity, paediatrics, and long-term affordability if you plan to add dependants.
17. Confirm provider charging rates
Some doctors charge above Discovery rates; checking in advance helps avoid unexpected out-of-pocket expenses.
18. Escalate unresolved issues properly
If customer service cannot resolve a query, request formal escalation or submit a complaint for faster resolution.
19. Use preventative screening benefits
Discovery includes screenings on many plans; early detection reduces health risks and long-term medical costs.
20. Seek professional advice when unsure
Discovery’s structure can be complex; a licensed advisor or broker helps you choose the most cost-effective and suitable plan.
Summary
Discovery Medical Aid remains one of South Africa’s most comprehensive private healthcare schemes, offering a variety of plans tailored to different lifestyles, family structures, and health needs. From entry-level KeyCare plans to full Comprehensive and Executive options, members can select coverage that balances affordability with robust hospital, specialist, and day-to-day benefits. Understanding how each plan operates, including Medical Savings Accounts, Above Threshold Benefits, and Vitality incentives, is crucial to maximize value and avoiding unexpected costs.
Effective management of your Discovery membership relies on proactive actions: registering chronic conditions, using network providers, tracking claims through the mobile app, and monitoring annual benefit limits. Participating in Discovery Vitality programs not only promotes healthier living but also unlocks rewards and additional funding through the Personal Health Fund. Additionally, knowing Prescribed Minimum Benefits, waiting periods, and exclusions helps members make informed decisions and avoid claim frustrations.
By following these tips, members can optimise their healthcare cover, reduce out-of-pocket expenses, and navigate the complexities of medical aid with confidence. Regular annual plan reviews, awareness of pre-authorisation requirements, and professional advice when needed ensure that your Discovery Medical Aid plan continues to meet your medical and financial needs while supporting a proactive, healthy lifestyle.
