An additional 500% cover is provided over and above the medical scheme tariff for approved oncology and in-hospital procedures/treatment.

This cover only applies to the individual practitioners providing their in-patient services. Any additional charges from the hospital or facility are excluded.

The 20% co-payment that arises after the oncology threshold is reached. This only applies to certain options on Discovery and Momentum medical schemes.

Cover applies to treatment approved by a member’s medical scheme for either traditional chemotherapy or modern biological drugs.

(Note: we do not cover oncology shortfalls where a member exceeds a benefit limit applied by their medical scheme or where certain cancer types are excluded by the medical scheme).

Where fixed value upfront payments are required for the following in-hospital treatment:

  • Endoscopes
  • Specialised scans (MRI/CT/PET)
  • Basic dentistry (eg fillings for young children, wisdom teeth extraction)
  • Surgical procedures defined by a medical scheme (eg Priority plans)
    (Note: where schemes apply upfront payments (including co-payments and/or deductibles) as percentages of the treatment cost, the policy benefit is limited to a maximum of R10,000 per event).

If a co-payment is applied for involuntary use of a non-DSP hospital or day clinic, we will cover one such co-payment per
annum per policy, subject to a maximum of R10,000.

We provide extra cover when benefit limits apply on internal prosthetic devices to a maximum of R38 000 per procedure.