Medical insurance is not a medical scheme and is not a substitute for medical scheme membership. It pays defined, capped benefits, may apply waiting periods and underwriting, and carries no Prescribed Minimum Benefit obligation. Premiums and benefits shown are the 2026 published figures and may change — confirm current terms with the provider before deciding. Information only; not financial advice.
Who carries the risk
- Underwriter: Auto & General Insurance Company Limited (reg. no. 1973/016880/06)
- Administrator: Discovery Health (Pty) Ltd (reg. no. 1997/013480/07)
- Trauma Benefit — Discovery Insure Ltd (reg. no. 2009/011882/06)
- Funeral Benefit — Discovery Life Limited (reg. no. 1966/003901/06)
"Flexicare is not a medical scheme. The cover is not the same as that of a medical scheme and is not intended to be a substitute for medical scheme membership."
Can you combine it with other cover?
The short answers, straight from the 2026 documents.
- Can you add gap cover to Flexicare?No
- Can you take Flexicare in addition to a Discovery Health medical scheme plan?No
- Can you hold Flexicare while you are on a different medical scheme?Technically yes
- Does Flexicare replace a medical scheme?No
The numbers that matter
These are the key published figures to compare before you decide whether everyday medical insurance fits your needs.
Best for: defined, everyday healthcare benefits through a network.
Not a substitute for medical aid: planned hospital cover is not included.
2026 monthly premiums
Published rates, per person per month. There is no limit on the number of children.
| Option | Main member | Spouse | Adult dependant | Child |
|---|---|---|---|---|
| Flexicare Core | R459 | R459 | R459 | R286 |
| Flexicare Plus | R539 | R499 | R499 | R286 |
| Vitality Active (optional) | R159 per member per month | |||
There is no limit on the number of children allowed on the policy. Each child is charged separately and may stay on Flexicare while financially dependent. From the month after a child's 21st birthday, the adult dependant premium applies.
Core or Plus?
Flexicare Core
The cheapest way in. You get 4 direct GP visits a year, acute and chronic medicine for 6 conditions, X-rays and blood tests. Nothing for teeth, eyes or specialists.
- •Up to 4 direct face-to-face GP visits a year, plus further visits through a nurse referral or the Intercare online platform
- •Up to 2 primary care clinic nurse consultations a year
- •Chronic medicine cover for 6 listed conditions
- •No dentistry, optometry or specialist benefit
Flexicare Plus
For R80 a month more than Core, unlimited GP visits replace the 4-visit cap, the chronic list goes from 6 conditions to 27, and dentistry, optometry and one specialist visit a year get added. On premium-per-benefit, Plus is the stronger buy for anyone who sees a doctor more than four times a year.
- •Unlimited network GP visits
- •1 out-of-hospital specialist visit a year, R2 090 total benefit
- •Network dentistry and optometry benefits
- •Chronic medicine cover for 27 listed conditions
Full 2026 benefit schedule, Core vs Plus
Where a benefit does not exist on an option, we say so rather than leaving it blank.
Doctor visits
| Benefit | Flexicare Core | Flexicare Plus |
|---|---|---|
| GP consultations | Up to 4 direct face-to-face network GP visits per year. Further visits via nurse referral or the Intercare online platform. Pre-authorisation required from the 3rd visit. | Unlimited network GP visits. |
| Primary care clinic nurse | Up to 2 nurse consultations per year at 100% of the Agreed Rate. Authorisation needed after the 2nd. | No cover. |
| Specialist consultations (out of hospital) | No cover. | 1 visit per member per year. R2 090 total benefit limit: R1 465 for a network consultation (R1 360 fee plus R105 SOAP note) and R625 for related radiology or pathology. Costs above the limit are for the member's account. |
| Procedures in the GP's rooms | Defined list covered at a network GP — includes biopsies, wound care and stitching. | Defined list covered at a network GP — includes biopsies, wound care and stitching. |
Medicine
| Benefit | Flexicare Core | Flexicare Plus |
|---|---|---|
| Acute (day-to-day) medicine | Covered at 100% of the Agreed Rate when prescribed or dispensed by a network GP, or as part of the nurse clinic visit, and on the acute formulary. | Unlimited, at 100% of the Agreed Rate, when prescribed or dispensed by a network GP and on the acute formulary. |
| Over-the-counter medicine | R170 per policy per year, up to a R85 bi-annual limit. | R120 per quarter, to a maximum of R480 per member per year. |
| Chronic medicine | Covered at 100% when on the formulary, for 6 listed chronic conditions. | Covered at 100% when on the formulary, for 27 listed chronic conditions. |
| HIV programme | Unlimited HIV medicine from the date of chronic registration. Includes voluntary counselling and testing, antiretroviral therapy, monitoring pathology and post-exposure prophylaxis within 72 hours of exposure. | Unlimited HIV medicine from the date of chronic registration. Includes voluntary counselling and testing, antiretroviral therapy, monitoring pathology and post-exposure prophylaxis within 72 hours of exposure. |
Diagnostics
| Benefit | Flexicare Core | Flexicare Plus |
|---|---|---|
| Radiology (X-rays) | Unlimited black-and-white X-rays and soft-tissue ultrasounds on the approved code list, at 100% of the Agreed Rate, when requested by a network GP. | Unlimited black-and-white X-rays and soft-tissue ultrasounds on the approved code list, at 100% of the Agreed Rate, when requested by a network GP. |
| Pathology (blood tests) | Approved code list only, at 100% of the Agreed Rate. Must be requested by a network GP and done by a network pathologist. | Approved code list only, at 100% of the Agreed Rate. Must be requested by a network GP and done by a network pathologist. |
Dentistry & optometry
| Benefit | Flexicare Core | Flexicare Plus |
|---|---|---|
| Dentistry | No cover. | Network dentist only: 1 full-mouth examination a year, 1 clean, scale and polish a year, a maximum of 3 restorations a year, extractions capped at 1 per quadrant per 365 days plus 1 additional per quadrant per 365 days, up to 7 oral X-rays a year, plus pain and sepsis treatment, infection control, oral hygiene advice and local anaesthetic. |
| Optometry | No cover. | Network optometrist only: 1 eye test a year and 1 pair of glasses every 24 months (standard single-vision or bi-focal lenses, 1 approved frame). No contact lenses. A non-approved frame costs the member the difference. |
Maternity
| Benefit | Flexicare Core | Flexicare Plus |
|---|---|---|
| Maternity | Cover when referred by a network GP: unlimited GP visits during pregnancy, unlimited acute medicine from the defined list, essential blood and screening tests, and 2 ultrasounds per pregnancy (weeks 10–14 and weeks 20–24). | Cover when referred by a network GP: unlimited network GP visits during pregnancy, unlimited acute medicine from the defined list, essential blood and screening tests, and 2 ultrasounds per pregnancy (weeks 10–14 and weeks 20–24). |
In-hospital
| Benefit | Flexicare Core | Flexicare Plus |
|---|---|---|
| Planned hospital admission | The published benefit schedule contains no planned hospital admission benefit. | The published benefit schedule contains no planned hospital admission benefit. |
| Emergency and evacuation | Available only by adding the optional Discovery Emergency Cover, at an extra premium, with a limit of R400 000 or R1 000 000 per event. | Available only by adding the optional Discovery Emergency Cover, at an extra premium, with a limit of R400 000 or R1 000 000 per event. |
Wellness
| Benefit | Flexicare Core | Flexicare Plus |
|---|---|---|
| FlexiFund (health check reward) | Up to R500 a year per adult member, based on how many of 5 health-check measures are in range. | Up to R1 000 a year per adult member, based on how many of 5 health-check measures are in range. |
| COVID-19 | Covered when referred by a network GP. | Cover for 1 positive test plus out-of-hospital management, chest X-rays and prescribed medicine. |
How the medicine benefits actually work
Every medicine benefit is formulary-based. Acute, chronic and over-the-counter medicine is only covered if the item appears on Discovery's medicine list, is prescribed by a network GP (or the nurse during a primary care clinic visit) and is dispensed by a dispensing network GP or a network pharmacy. Medicine prescribed by a non-network doctor, or bought from a non-network pharmacy, is not covered.
Chronic conditions covered
Core covers 7 conditions; Plus covers 27. Medicine must be on the formulary and the condition registered.
Flexicare Plus (27)
Cover designed for the care you use most
The published schedule focuses on defined, capped benefits such as network GP visits, prescribed medicine and diagnostics. Use the tables above to check the exact Core and Plus limits before deciding whether this policy fits your needs.
Explore related cover guides
Useful next steps from the information on this page.
Chronic conditions guide
Read condition-by-condition information and see the wider chronic cover index.
Discovery medical aid plans
Compare Discovery Health medical scheme plans when hospital and PMB cover matter.
Hospital plans
See hospital-focused medical aid options and the cover they are designed to provide.
Gap cover
Understand gap cover for registered medical scheme members.
Medical insurance overview
Return to the plain-English comparison of medical insurance, medical aid and gap cover.
Medical aid calculator
Use the calculator to compare plan options using your household details.
FlexiFund
FlexiFund claims are paid automatically once a member's normal day-to-day benefits are used up. It covers GP consultations, specialist visits, prescribed medicine, over-the-counter medicine, vaccines and contraceptives.
| Health measures in a healthy range | Core, per year | Plus, per year |
|---|---|---|
| 5 of 5 | R500 | R1 000 |
| 3 to 4 | R250 | R500 |
| 2 or fewer | R125 | R250 |
The five measures: Weight status, Blood pressure, Blood glucose, Cholesterol, Smoking status.
In-hospital: the optional Emergency Cover add-on
Discovery Emergency Cover is offered by Discovery Insure, is optional and is priced per member on top of the Flexicare premium. If activated it applies to the member and all registered dependants. It covers emergencies only — there is still no benefit for a planned admission or elective surgery, so it is not a hospital plan.
R400 000 or R1 000 000 limit per event — the member chooses one.
Emergency Core
Cover for emergency healthcare services, including casualty and in-hospital treatment, for a broad range of accidental and traumatic events.
What it covers
- •Burns
- •Head injuries, chest injuries or severe fractures as a result of a fall
- •Loss of an arm, hand, leg or foot
- •Near-drowning
- •Poisoning or a serious allergic reaction that may cause death
- •Injuries resulting from a crime, sexual assault, a car accident or an injury at work
R400 000 or R1 000 000 limit per event.
Emergency Plus
Cover for accidents and trauma, the stabilisation and treatment of any emergency condition in a casualty facility, including admission and treatment for heart attacks and strokes.
What it covers
- •In-hospital treatment of the defined accidental and traumatic events covered on Emergency Core
- •Any medical emergency condition in a casualty facility, including hospital admission for the treatment of confirmed heart attacks and strokes
- •R200 co-payment at a network casualty facility, R250 at a non-network facility — refunded if a heart attack or stroke is diagnosed
R400 000 or R1 000 000 limit per event.
Emergency Max
Cover for accidents and trauma, the stabilisation and treatment of any emergency condition in a casualty facility, and the admission and treatment of a defined list of emergency conditions including heart attacks and strokes.
What it covers
- •Everything covered on Emergency Plus, including casualty treatment and admission for heart attacks and strokes
- •Admission and treatment for nine further emergency conditions: acute appendicitis, acute asthma, ectopic pregnancy, acute inflammation of the gall bladder, a fit or seizure, acute pneumonia, kidney stones, acute renal failure and pulmonary embolism
R400 000 or R1 000 000 limit per event, with a R400 000 sublimit on the nine defined conditions.
Included on all three options
Medical evacuation · Counselling sessions · Take-home medicine · Premium waiver.
| Option | R400 000 · adult | R400 000 · child | R1m · adult | R1m · child |
|---|---|---|---|---|
| Emergency Core | R218 | R92 | R313 | R137 |
| Emergency Plus | R313 | R219 | R440 | R240 |
| Emergency Max | R439 | R302 | R626 | R302 |
Emergency treatment is provided through the Discovery hospital network, so it is worth checking which hospitals near you are in that network before you decide.
Check the Discovery hospital networkWaiting periods and underwriting
A 12-month condition-specific waiting period may be applied for any condition — including chronic illnesses and HIV — that existed before the membership start date. Newborns can join without waiting periods if added within 90 days of birth. A break of more than 30 days in membership resets all waiting periods.
What this policy does not cover
The 2026 benefit schedule lists no planned hospital admission or surgical benefit on either option.
PMBs are an obligation of registered medical schemes under the Medical Schemes Act. A health insurance policy is regulated as insurance and carries no PMB obligation.
No oncology benefit appears anywhere in the 2026 benefit schedule.
Radiology cover is limited to black-and-white X-rays and soft-tissue ultrasounds on the approved code list.
Benefits require a network GP, network pathologist, network dentist or network optometrist. Approved treatment outside the network is paid by the member.
A 1-month general waiting period applies to all benefits, with 3 months on dentistry and optometry and 12 months on maternity, HIV and chronic conditions.
Discovery Flexicare questions
What we could not verify
- •Minimum and maximum entry ages are not printed in the 2026 brochure or leaflet.
- •Discovery does not print an explicit rule on holding Flexicare alongside a NON-Discovery medical scheme. Our stated answer — that it is technically possible because Flexicare is insurance, not a scheme — is our reading of the published documents, not a Discovery quote.
- •The FSP licence number of the underwriter, Auto & General Insurance Company Limited, is not printed in the documents we read (only its company registration number).
- •The 2026 Core leaflet prints Vitality Active at R145 in one table and R159 in the premium table. We show R159, the figure in the main 'Flexicare monthly premiums' table of the 2026 Benefit Brochure.
- •No single aggregate annual rand limit across all benefits is published — limits are set per benefit category.
- •Rand benefit schedules for the optional Trauma and Funeral benefits are separate policies and were not part of the Flexicare benefit brochure.
Source
Discovery Flexicare 2026 Benefit Brochure — read 2026-09-01