Discovery Health Active Smart Plan – 2026 Review
Overview
Overall, Discovery Health is one of South Africa’s most recognised medical aid schemes, with formal registration under the Council for Medical Schemes (CMS) as FSP No. 18564.Discovery Health Active Smart Plan Overview
The Discovery Health Active Smart Plan starts from R1,350 and forms part of the Smart hospital network options.
Members receive unlimited hospital cover in the Dynamic Smart network, cover for Prescribed Minimum Benefits, maternity benefits paid from available day-to-day cover, and access to screening and prevention benefits.
The plan also provides unlimited network GP visits with a co-payment, defined check-ups, limited OTC medicine, and funding through the Personal Health Fund.
Discovery Health Active Smart Plan Premiums 2026
| 🔎 Medical Aid Plan | 👤 Main Member Contribution | 👥 Adult Dependent Contribution | 🍼 Child Dependent Contribution |
| 🥇 Dicovery Health active smart saver plan (From 1 Jan – 31 March) | R1,350 | R1,350 | R1,350 |
| 🥇 Dicovery Health classic smart active plan (From 1 Apr – 31 Dec) | R1,350 | R1,350 | R1,350 |
Discovery Health Active Smart Plan vs Plans offered by Other Providers or Medical Aid Schemes
| Medical aid | Discovery Health Active Smart | Momentum Ingwe | Bestmed Rhythm 1 |
| 🟥 Prescribed Minimum Benefits (PMB) | ✔️ | ✔️ | ✔️ |
| 🟧 Screening and Prevention | ✔️ | ✔️ | ✔️ |
| 🟩 Medical Savings Account | ❌ | ❌ | ❌ |
| Maternity Benefits | ✔️ | ✔️ | ✔️ |
| 🟦Pre- and Postnatal Care | ✔️ | ❌ | ❌ |
| 🟥 Chronic Conditions | ✔️ | ✔️ | ✔️ |
| ⬜ Home Care | ✔️ | ❌ | ✔️ |
| 🟫 Oncology Cover | PMB only | PMB only | PMB only |
| ⬛ Extended Cover for Oncology | ❌ | ❌ | ❌ |
| 🟨 Hospital Cover | Unlimited in Dynamic Smart Network | Unlimited hospitalisation; No overall annual limit | Unlimited at DSP hospitals |
| 🟪 Optometry Benefit | ✔️ | ✔️ | ✔️ |
| 🟥 Dentistry Benefit | ✔️ | ✔️ | ✔️ |
| 🟧 Advanced Dentistry | ❌ | ❌ | ❌ |
| 🟩 Internal Prosthesis | ✔️ | ✔️ | ✔️ |
| 🟦 External Prosthesis | ✔️ | ✔️ | ✔️ |
| ⬜ Mental Healthcare Program | ✔️ | ❌ | ✔️ |
| 🟫 Diabetes Care Program | ✔️ | ❌ | ❌ |
| ⬛ HIV Care Program | ✔️ | ✔️ | ✔️ |
| 🟨 Cardio Care Program | ✔️ | ❌ | ❌ |
| 🟪 Spinal and Neck Program | ❌ | ❌ | ✔️ |
| 🟥 Disease Prevention Program | ✔️ | ❌ | ❌ |
| 🟧 Cover for Covid-19 / WHO Outbreak Benefit | ✔️ | ✔️ | ✔️ |
| 🟩 Annual Limit | No overall annual limit | No overall annual limit | No overall annual limit |
| 🟦 Above Threshold Benefit (ATB) | ❌ | ❌ | ❌ |
| ⬜ International Cover | ✔️ | ❌ | ✔️ R5,000,000 per family; USA R1,000,000 limit |
| 🟫 Main Member Contribution | R1,350 | From R1,079 | R1,740 |
| ⬛ Adult Dependent Contribution | R1,350 | From R2,158 (two adults) | R1,740 |
| 🟨 Child Dependent Contribution | R1,350 | From 1,380 (one adult, one child) | R715 |
| 🟪 Gap Cover | ✔️ | ✔️ | ✔️ |
Discovery Health Active Smart: Plan Benefits and Cover Comprehensive Breakdown
Active Smart offers hospital cover in the Dynamic Smart Hospital Network, with structured day-to-day benefits and extra funding through Personal Health Pathways and the Personal Health Fund. Most benefits work best where the relevant network and approval steps are followed, since payments are tied to Discovery’s rates and network arrangements.In-Hospital Benefits
| ⚕️Medical Event | ➕ Scheme Benefit |
| 🔎 Hospital admissions | Hospital cover applies in hospitals approved by the Scheme, within the Dynamic Smart Hospital Network, subject to preauthorisation and approval. |
| 📌 Hospital account | The hospital account is paid at the agreed hospital rate for approved admissions. |
| 📍 Elective admissions (non-PMB) | An upfront payment of R7,750 applies for elective, non-PMB admissions. |
| ➡️ Planned admission outside the network | A planned admission outside the Dynamic Smart Hospital Network triggers an upfront payment of R15,300. |
| 🅰️ Neonatal in-hospital cover | Neonatal in-hospital cover is limited to R72,600. |
| 🅱️ Specialists with payment arrangements | Specialist accounts are paid at the agreed contracted rate where a payment arrangement exists. |
| ☑️ Other healthcare professionals in hospital | Payment applies up to 100% of the Discovery Health Rate (DHR) for other in-hospital professionals, subject to Scheme rules and approval. |
| ✅ Radiology and pathology linked to admission | Approved radiology and pathology linked to the admission are paid up to 100% of the DHR. |
| 🩺 MRI and CT scans linked to admission | MRI and CT scans linked to the authorised admission are paid up to the DHR. |
| 💊 Procedures in specialist rooms | Approved procedures carried out in specialist rooms are paid at the agreed rate, subject to authorisation. |
| 🧠 Day surgery procedures | Listed procedures are expected to take place in the Day Surgery Network, with an upfront payment of R15,300 where a listed procedure is done outside that network. |
| 🏥 Hospital at Home | Hospital-level care at home is available through the Home-based hospital network for qualifying conditions, with an upfront deductible of R5,450 if the recommended network option is declined. |
Out-of-Hospital Benefits
| Medical Event | Scheme Benefit |
| 🟥 General Practitioner (GP) Visits | Unlimited GP consultations in the Smart GP Network, with a R130 co-payment per consultation; the remaining amount is paid up to 100% of the DHR. |
| 🟧 Video GP consultations | Video consultations with a Smart Network GP are covered up to the DHR. |
| 🟨 Eye test | One eye test per person per year in the Smart Optometry Network, with an upfront payment of R130. |
| 🟩 Dental check-up | One standard dental check-up per person per year, with an upfront payment of R195; the balance is paid up to the DHR. |
| 🟦 Over-the-counter medicine | Over-the-counter medicine from a network pharmacy is covered up to R555 per family per year. |
Medicine Benefits
Medicine funding is tied to Discovery’s medicine rules, the relevant medicine list (formulary), and network pharmacy use.- Chronic medicine for approved Chronic Disease List conditions is paid according to the medicine list rules, through network pharmacies.
- Chronic medicine not on the medicine list is paid up to the therapeutic reference price.
- Medicine is paid up to the Discovery Health Rate for medicine at network pharmacies, subject to the plan rules and approval steps.
- Oncology medicine is paid up to the Discovery Health Rate or the Oncology Reference Price, depending on the applicable rules.
Chronic Benefits
Chronic cover runs through the Chronic Illness Benefit (CIB) once the application is approved. A Smart GP in the Discovery Health Network must be nominated as the primary care doctor for ongoing chronic management, with up to three changes per year.
CDL
- Addison’s disease
- Asthma
- Bipolar mood disorder
- Bronchiectasis
- Cardiac failure
- Cardiomyopathy
- Chronic obstructive pulmonary disease
- Chronic renal disease
- Coronary artery disease
- Crohn’s disease
- Diabetes insipidus
- Diabetes type 1
- Diabetes type 2
- Dysrhythmia
- Epilepsy
- Glaucoma
- Haemophilia
- HIV
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Multiple sclerosis
- Parkinson’s disease
- Rheumatoid arthritis
- Schizophrenia
- Systemic lupus erythematosus
- Ulcerative colitis
Non-CDL
Non-CDL chronic conditions follow the plan’s normal benefit structure and Scheme rules, based on the type of treatment and where it takes place.PMB
Prescribed Minimum Benefits apply to emergency medical conditions, the list of 271 diagnoses, and the 27 CDL chronic conditions, with network rules applying outside emergencies.Preventative Care Benefits
| 🔴 Screening Test | What Active Smart pays for |
| 🟠 Annual Health Check | Annual screenings at a wellness provider, such as BMI, blood pressure, glucose, cholesterol, and HIV testing where relevant. |
| 🟡 Breast Screenong | Mammogram or breast ultrasound every two years. |
| 🟢 Cervical screening | Pap smear every three years, or HPV test (with self-sampling option) every five years. |
| 🔵 Mental wellbeing assessment | One assessment each year. |
| 🟤 Prostate screening | Annual PSA test. |
| 🔴 Bowel cancer screening | Screening every two years for members aged 45 to 75. |
| 🟠 Child growth and development | Height, weight, BMI, and blood pressure measurements at a wellness provider. |
| 🔵 Falls-risk screening (65+) | Age-appropriate falls-risk assessment at a pharmacy in the relevant network. |
| 🟢 Additional tests (clinical criteria apply) | Extra diabetes and cholesterol testing, breast MRI or BRCA testing, colonoscopy, and further cervical screening where criteria are met. |
| 🟡Vaccinations (clinical criteria apply) | Seasonal flu vaccine and pneumococcal vaccine for eligible members, with prescription rules where relevant. |
Day-to-day Cover
Day-to-day benefits are structured, with set co-payments and annual limits where applicable.
| Benefit | Classic Smart Cover |
| 🟥 General Practitioner (GP) Visits | Unlimited in the Smart GP Network, with a R130 co-payment per consultation; the remainder is paid up to 100% of the DHR. |
| 🟦 Video Gp Cosultations | Paid up to the DHR with a Smart Network GP. |
| 🟧 Eye Test | One per person per year in the Smart Optometry Network, with an upfront payment of R130. |
| 🟨 Dental check-up | One per person per year, with an upfront payment of R195; remaining amount paid up to the DHR. |
| 🟩 Over The Counter Medicine | Network pharmacy cover up to R555 per family per year. |
Care Programmes
Care programmes provide condition-focused support once enrolment is completed and clinical criteria are met. Enrolment is done through a Premier Plus GP or the relevant treating provider, depending on the programme.
| Programme | What it provides |
| 🔴 Discovery Health Disease Prevention Program | Coordinated care for members identified at cardiometabolic risk, including consultations and pathology where appropriate. |
| 🟠Diabetes Care Programme | Additional glucometer strips and access to dietitian and biokineticist consultations. |
| 🟤 Depression Risk Management Programme | Six-month programme with GP or psychologist consultations, counselling and digital support. |
| 🟢 Discovery Health HIV Care Program | Confidential support with additional access to social workers and designated medicine providers. |
| 🟡 Discovery Health Mental Health Program | Cover for psychotherapy sessions, prescribed medicine and coordinated relapse prevention where eligible. |
| 🔵 Discovery Health Cardio Care Program | Basket of care and annual cardiovascular assessment for enrolled members. |
Oncology Care Programme
Cancer treatment is managed through the Oncology Care Programme once treatment approval is in place, with network arrangements forming part of how payment works.
- Prescribed Minimum Benefit cancer treatment is covered in the Scheme’s oncology network, according to PMB rules.
- Approved oncology medicine is paid up to the Discovery Health Rate or the Oncology Reference Price, depending on the medicine category rules.
- The Advanced Illness Benefit provides palliative care support at home, with care coordination and counselling support, subject to approval.
Day Surgery Network
Day surgery funding links to the plan’s day surgery network rules and the list of procedures that require network use.
- Preauthorisation is required before admission.
- A listed day surgery procedure done outside the Day Surgery Network triggers an upfront payment of R15,300.
Maternity Benefits
Maternity support covers pregnancy care and services for the first two years of a child’s life once the benefit is activated. Payments for maternity-related healthcare services on Active Smart come from the plan’s available day-to-day benefits.
- Up to 8 antenatal consultations with a gynaecologist, GP, or midwife.
- Ultrasound scans during pregnancy: up to 2 2D scans, or 1 2D scan plus 1 nuchal translucency test.
- 1 chromosome test or Non-Invasive Prenatal Test (NIPT), subject to clinical entry criteria.
- 1 flu vaccination during pregnancy.
- A defined list of blood tests to confirm pregnancy.
- 1 postnatal consultation where complications follow delivery.
- Up to 5 antenatal or postnatal classes (including online classes) or nurse consultations, for up to 2 years after birth.
- 1 breastfeeding consultation with a registered nurse or breastfeeding specialist.
- 1 nutritional assessment with a dietitian.
- Up to 2 mental health consultations during pregnancy or after birth (counsellor or psychologist).
- 2 visits for a child under age 2 with a GP, paediatrician, or ENT specialist.
Maternity Care Programme
Activation steps are handled through the Discovery Health app or the website.- Create a pregnancy profile or baby profile on the app or website.
- Preauthorise the delivery.
- Register the baby as a dependant on the Scheme.
Personal Health Pathways and Personal Health Fund
Personal Health Pathways links recommended health actions to extra day-to-day funding through the Personal Health Fund, once the required activation steps and next best actions are completed.
| 🔴 Personal Health Fund Component | Active Smart Limit |
| 🟠 Base allocation per adult | Up to R1,000. |
| 🟢 Base allocation per child | Up to R500. |
| 🔵 Maximum base per family | Up to R4,000. |
| 🟤 Boost per adult challenge | Up to R500 per challenge. |
| 🟡 Maximum boost per family | Up to R4,000. |
Discovery Health App Benefits and Services
The Discovery Health app supports plan management and access to virtual tools that sit alongside Active Smart’s benefits.
- Personal Health Pathways actions, challenges, and next best actions, linked to Personal Health Fund funding.
- Virtual Physical Therapy, where prescribed, with payment coming from the available Personal Health Fund value on this plan.
- Digital Mental Health Care tools, subject to clinical entry criteria and benefit rules.
- Virtual Urgent Care with four online urgent-care sessions per family per year, subject to clinical entry criteria and benefit rules.
- Symptom checking and guidance features.
- Online pharmacy ordering and delivery options.
- Emergency Assist support through the in-app panic feature.
- Plan administration tools such as provider search, claims tracking, and benefit monitoring.
Care At Home
Care-at-home benefits cover monitoring devices and home-based services, with network arrangements tied to how payments work.
| ❤️Service | Active Smart Cover |
| 🧡 Home Monitoring Device Benefit | Approved home monitoring devices for certain chronic and acute conditions, up to R4,850 per person per year. |
| 💛 Discovery HomeCare services | Home-based services such as IV infusions, wound care, postnatal care, and end-of-life care, paid from the Hospital Benefit subject to approval. |
| 💚 Discovery Hospital at Home | Hospital-level treatment at home for qualifying conditions, delivered through the Home-based hospital network providers listed in the brochure. |
| 💙 Home-based virtual care (65+ high risk) | A care basket that can cover virtual GP or nurse consultations and virtual coaching for eligible members aged 65+, based on risk identification. |
Extra Benefits
Active Smart provides extra support benefits that sit outside routine day-to-day consultations.
| 🟥 Benefit | What You Receive |
| 🟦 Emergency medical cover | Ambulance, hospital stay and approved provider services for emergencies. |
| 🟨 Trauma counselling | 24-hour access following traumatic incidents. |
| 🟧 International travel emergency cover | Emergency medical cover while travelling. |
| 🟩Shariah-compliant option | Available upon request. |
Discovery Health Active Smart Plan Exclusions and Waiting Periods
Active Smart offers structured hospital and day-to-day cover within a regulated framework. Some treatments and situations fall outside that framework entirely, regardless of network use or authorisation.
Discovery Health Active Smart Plan Exclusions
The following are not covered under the Scheme rules that apply to Active Smart:- Claims for services that are not recognised as medical treatment under the Medical Schemes Act.
- Treatment received without the required preauthorisation where authorisation is a stated requirement.
- Procedures or treatments that are experimental, unproven, or not supported by recognised clinical guidelines.
- Claims submitted for services rendered outside the Republic of South Africa, except where emergency travel cover applies under the plan rules.
- Cosmetic procedures or treatments performed for aesthetic reasons and not considered clinically necessary.
- Healthcare services that do not meet the criteria for Prescribed Minimum Benefits and are not listed as plan benefits.
- Services that are not medically necessary according to the Scheme’s clinical protocols.
- Any costs arising from treatment that falls outside the scope of the Scheme’s registered benefits and protocols.
Discovery Health Active Smart Plan Waiting Periods
Waiting periods are applied in line with the Medical Schemes Act and the Scheme Rules.- A general waiting period of up to 3 months may apply when you join, during which no claims are paid except for Prescribed Minimum Benefits.
- A condition-specific waiting period of up to 12 months may apply to pre-existing medical conditions.
- Pregnancy-related claims can be subject to a 12-month waiting period if the pregnancy existed before joining the Scheme.
- Late joiner penalties may apply if you join a medical scheme for the first time after age 35, depending on your previous cover history.
- Waiting periods may be imposed after a break in membership, subject to underwriting and the length of the gap in cover.
Our Verdict on the Discovery Health Active Smart Plan
Discovery Health Active Smart ranks among Discovery’s lower-cost hospital plans, but it is not light on rules. Hospital cover is unlimited within the Dynamic Smart Network, with specific upfront payments outside it.
There are a few day-to-day benefits, albeit with set co-payments and limits. Chronic cover follows the Chronic Illness Benefit, and several care programmes offer clinical support.
Active Smart suits members who are comfortable using networks and following authorisation steps. The trade-off for the lower contribution is restricted provider options and tighter benefit limits outside the approved channels.