Discovery Health Smart Series Medical Aid Plans(π2025)
Overall, the Discovery Health Saver Series Medical Aid Plans are a series of trustworthy and comprehensive medical aid plans that offers 24/7 medical emergency assistance and chronic medication to up to 3 Family Members. The Discovery Health Saver Series Medical Aid Plans start from R1,350 ZAR.
π Smart Series Plan | Classic Smart | Essential Smart | Essential Dynamic Smart | Active Smart |
π International Cover | R5 million | R5 million | R5 million | R5 million |
π€ Main Member Contribution | R2,822 | R2,021 | R1,681 | R1,350 |
π₯ Adult Dependent Contribution | R2,227 | R2,021 | R1,681 | R1,350 |
π Child Dependent Contribution | R1,127 | R2,021 | R1,681 | R1,350 |
π Gap Cover | β
Yes | βοΈ Yes | β
Yes | βοΈ Yes |
π₯ Hospital Cover | Unlimited | Unlimited | Unlimited | Neonatal admissions
limited to R70,000.
All other admissions:
Unlimited. Upfront
payment of R7,500
applicable to all elective
admissions. |
π Oncology Cover | R250,000 | R250,000 | R250,000 | Covered at a network
provider, limited to
Prescribed Minimum
Benefits. |
πΆ Prescribed Minimum Benefits | βοΈ Yes | β
Yes | βοΈ Yes | β
Yes |
β‘οΈ Screening and Prevention | β
Yes | βοΈ Yes | β
Yes | βοΈ Yes |

Discovery Health Smart Series – 21 Key Point Quick Overview
- βοΈ Discovery Health Smart Series Overview
-
- βοΈ Discovery Health Smart Series Plans Compared
- βοΈ Discovery Health Smart Series Benefits at a Glance
- βοΈ Discovery Health Essential Dynamic Smart Plan β a Digital-First
- βοΈ Discovery Health Smart Series Benefits and Cover Comprehensive Breakdown
- βοΈ Discovery WELLTH Fund
- βοΈ Discovery Health WHO Outbreak Benefit
- βοΈ Discovery Health Connected Care
- βοΈ Discovery Health Hospital At Home
- βοΈ Discovery Health Day-To-Day Benefits and Cover
- βοΈ Discovery Maternity and Early Childhood Benefit
- βοΈ Discovery Health Chronic Benefit Cover Summarized
- βοΈ Discovery Health Care Programmes
- βοΈ Discovery Health Hospital Benefit
- βοΈ Discovery Health Annual Limits
- βοΈ Discovery Health Smart Cover for Day Surgery Network Procedures
- βοΈ Discovery Health Smart Additional Benefits
- βοΈ Discovery Smart Series Value-Added Offers
- βοΈ Discovery Health Smart Series Exclusions and Waiting Periods
- βοΈ Our Verdict on Discovery Health Smart Series
- βοΈ Discovery Health Smart Series Frequently Asked Questions
Medical Aid Discovery Health Smart Series Overview
The Discovery Health Smart Series starts from R1,350 and is a series of comprehensive medical insurance plans offered by Discovery Health.Β The Discovery Smart Series provides an elevated level of coverage for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses.Β Gap Cover is available on the Discovery Health Smart Series, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery Health has a trust rating of 4.8.
The Discovery Health Smart Series consist out of the following plans:
It should be noted that all the plans that form part of theΒ Discovery Health Smart Series may be subject to aΒ late joiner fee.
Gap Cover is available on the Discovery Health Smart Series, along with 24/7 medical emergency assistance. According to the Trust Index, Discovery HealthΒ has a trust rating of 4.8.
π Download discovery-health-medical-scheme-smart-plan-guide 2025Β from Discovery Health Medical Scheme.

Discovery Health Smart Series Contributions
π Smart Series Plan | π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
1οΈβ£ Classic Smart | R2,822 | R2,227 | R1,127 |
2οΈβ£ Essential Smart | R2,021 | R2,021 | R2,021 |
3οΈβ£ Essential Dynamic Smart | R1,681 | R1,681 | R1,681 |
4οΈβ£Active Smart | R1,350 | R1,350 | R1,350 |

Medical Aid Discovery Health Smart Series Plans Compared
π Smart Series Plan | Classic Smart | Essential Smart | Essential Dynamic Smart | Active Smart |
π International Cover | R5 million | R5 million | R5 million | R5 million |
π€ Main Member Contribution | R2,822 | R2,021 | R1,681 | R1,350 |
π₯ Adult Dependent Contribution | R2,227 | R2,021 | R1,681 | R1,350 |
π Child Dependent Contribution | R1,127 | R2,021 | R1,681 | R1,350 |
π Gap Cover | β
Yes | βοΈ Yes | β
Yes | βοΈ Yes |
π₯ Hospital Cover | Unlimited | Unlimited | Unlimited | Neonatal admissions
limited to R70,000.
All other admissions:
Unlimited. Upfront
payment of R7,500
applicable to all elective
admissions. |
π Oncology Cover | R250,000 | R250,000 | R250,000 | Covered at a network
provider, limited to
Prescribed Minimum
Benefits. |
πΆ Prescribed Minimum Benefits | βοΈ Yes | β
Yes | βοΈ Yes | β
Yes |
β‘οΈ Screening and Prevention | β
Yes | βοΈ Yes | β
Yes | βοΈ Yes |

Discovery Health Smart Series Benefits Summarized
π Smart Plan Option | π₯ Classic Smart (2025) | π₯ Essential Smart (2025) | π₯ Essential Dynamic Smart (2025) | πͺActive Smart (2025) |
1οΈβ£ Day-to-Day Cover | Unlimited Smart Network GP consultations with R70 co-payment. | Unlimited Smart Network GP consultations with R125 co-payments. | Unlimited Smart Network GP consultations with R125 co-payments. | Unlimited Smart Network GP consultations with R125 co-payments. |
2οΈβ£ Day-to-Day Cover | One R70 network optometrist eye test. | One eye test is covered per person per year with an upfront payment of R125 co-payment. | One eye test is covered per person per year with an upfront payment of R125 co-payment. | One eye test is covered per person per year with an upfront payment of R125 co-payment. |
3οΈβ£ Day-to-Day Cover | One dental check-up at a dentist, dental therapist, or oral hygienist with an R125 co-payment.
Covered up to 100% of the Discovery Health Rate cover (DHR) | One dental check-up at a dentist, dental therapist, or oral hygienist with an R190 co-payment.
Covered up to 100% of the Discovery Health Rate cover (DHR) | One dental check-up at a dentist, dental therapist, or oral hygienist with an R190 co-payment.
Covered up to 100% of the Discovery Health Rate cover (DHR) | One dental check-up at a dentist, dental therapist, or oral hygienist with an R190 co-payment.
Covered up to 100% of the Discovery Health Rate cover (DHR) |
4οΈβ£ Day-to-Day Cover | OTC medicine from network pharmacies, up to R875 per family per year. | OTC medicine from network pharmacies up to R585 per family per year. | OTC medicine from network pharmacies up to R585 per family per year. | OTC medicine from network pharmacies up to R585 per family per year. |
5οΈβ£ Day-to-Day Cover | Smart Network GP-prescribed acute medicine cover. Schedule 3 and above medicine at network pharmacies is limited to R1,905 per member or R3,180 per family per year. | Unavailable on these plans | Unavailable on these plans | Unavailable on these plans |
6οΈβ£ Day-to-Day Cover | Sports injuries: basic x-rays, two specialist visits, and four physiotherapists, biokinetics, or chiropractor visits when referred by a Smart Network GP. R125 per x-ray or visit. These visits and specialists, we do not have a payment arrangement, will be covered at 100% of the Discovery Health Rate (DHR). | Unavailable on these plans | Unavailable on these plans | Unavailable on these plans |
π Chronic Dialysis | Cover if we approve your treatment plan and you use a network provider. We cover 80% of the Discovery Health Rate if you go elsewhere (DHR) | State facilities cover you. | State facilities cover you. | State facilities cover you. |
βοΈ Cancer | Covered at any provider up to the
Discovery Health Rate, subject to a cover
limit of R250,000 | Covered at a network provider, subject to a cover
limit of R250,000 | Covered at a network provider, subject to a cover
limit of R250,000 | Covered at a network
provider, limited to
Prescribed Minimum
Benefits. |
π₯ Hospital Cover β Hospitals you can go to | Unlimited
Private hospitals in the Smart hospital network. | Unlimited
Private hospitals in the Smart hospital network. | Unlimited
Private hospitals in the Dynamic Smart hospital
network as referred by Ask Discovery. | Neonatal admissions
limited to R70,000.
All other admissions:
Unlimited. Upfront
payment of R7,500
applicable to all elective
admissions. |
π©ββοΈ Cover for Healthcare Professionals in-hospital | 200% of the Discovery Health Rate (DHR) | Covered up to 100% of the Discovery Health Rate (DHR). | Covered up to 100% of the Discovery Health Rate (DHR). | Covered up to 100% of the Discovery Health Rate (DHR). |
π MRI and CT scans | If your treatment is not related to your admission or for conservative back and neck treatment, you will be required to pay R3,850, and your Hospital Benefit will cover the remainder up to the Discovery Health Rate (DHR). | If not related to your admission, or for conservative back and neck treatment,
you will have to pay for it | If not related to your admission, or for conservative back and neck treatment,
you will have to pay for it | If not related to your admission, or for conservative back and neck treatment,
you will have to pay for it |

Discovery Health Smart Series Benefits and Cover Comprehensive Breakdown
Emergency Cover
In case of a traumatic incident or after a traumatic event, you can get help from a trained professional. Calling Emergency Assist will help you and your loved ones in need.Β Furthermore, family members can get help after a traumatic event at any time. The survivors of gender-based violence can receive counseling and other support as part of this service.
Discovery Health Emergency Cover covers the following medical services:
- β
The emergency vehicle (or other medical transport).
- β
The hospitalβs account of the incident.
- β
The observations of the physician who admitted you to the hospital.
- β
The anesthesiologist.
- β
Any additional approved healthcare provider.
πDiscover: 5 Top Limited Day to Day Cover Plans
Prescribed Minimum Benefits
All medical schemes are required by the Prescribed Minimum Benefit (PMB) provisions of the Medical Schemes Act 131 of 1998 and its Regulations to cover the costs associated with the diagnosis, treatment, and care of:
- β
A life-threatening medical condition
- β
A defined listing of 271 conditions
- β
A list of 27 chronic illnesses.
Your medical condition must be on the list of Prescribed Minimum Benefit (PMB) conditions to qualify for coverage. Furthermore, the necessary treatment must correspond to the treatments listed in the benefits. In addition, you are required to utilize designated service providers (DSPs) within the Discovery Health network.Β Once your condition has stabilized, you will be transferred to a hospital or other service providers in the Discovery Health network, if necessary, according to the schemeβs rules.Β Discovery Health will cover up to 80% of the Discovery Health Rate if you do not use a DSP (DHR). Your responsibility will be the difference between what Discovery Health will pay and the actual cost of your treatment.Β Furthermore, Discovery Health will pay according to your planβs benefits if these criteria are unmet.
Screening and Prevention
This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases.Β The Discovery Health wellness providers cover a variety of screening tests, including blood glucose, cholesterol, HIV, Pap smear or HPV test for cervical screening, mammograms or ultrasounds, and prostate screenings.Β After all your membership members have completed their health check, you can access additional screening and preventive healthcare services through the Personal Health Fund.
The Discovery Health Screening and Prevention covers the following:
- β
Screening for kids will assess the childβs growth and development, including weight, height and body mass index measurements, blood pressure, and more.
- β
Screening for Adults includes blood pressure, blood glucose, HIV, and more. Discovery also covers mammograms, breast ultrasounds, pap smears, and more.
Screening for Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.
Additional Testing
Clinical eligibility requirements may apply to these tests:
- β
Diabetes and cholesterol screening tests are defined.
- β
Breast screening MRI or mammography and one-time BRCA testing.
- β
Colonoscopy for the detection of colon cancer.
- β
HPV test or Pap smear for cervical screening.
Vaccines (there may be clinical entry requirements):
- β
Seasonal influenza vaccination for pregnant members, 65 years or older, registered with certain chronic conditions, and healthcare professionals.
- β
Pneumococcal vaccination for members aged 65 or older or those registered with certain chronic conditions.

Discovery Personal Health Fund
Following the success of the WEALTH Fund in 2023 and 2024, all new joining members will continue to get a once-per-lifetime benefit, built into the Personal Health Fund in 2025. New members who activate Personal Health Pathways and complete their once-off high-value action, will get up to R8,000 per family on the Classic plan and R4,000 on the Essential and Active plans. This is a once-per-lifetime benefit in addition to the annual Personal Health Fund allocation for completed actions.
The Discovery Personal Health Fund for the Smart Series covers the following:
π General Health | You have access to screenings for vision, hearing, dental, and skin conditions as part of your primary care.
Additionally, you are eligible for one GP screening consultation |
βοΈ Physical Health | Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations. |
π§ Mental Health | You have access to a mental health evaluation to promote mental health. |
β€οΈ Women and Menβs Health | You have access to various screening and prevention services for women and men.
These include, for instance:
Consultation with your doctor for gynecological, prostate, or cardiac issues
Bone density analysis |
π Childrenβs Health | A pediatrician, speech pathologist, or physiotherapist can evaluate your childβs progress toward important developmental milestones as part of a well-child check-up. |
β‘οΈ Medical Monitoring Devices | You have access to medical monitoring devices that assist in measuring, for instance, blood pressure, cholesterol, and blood sugar. |
The Personal Health Fund is available for two benefit years after all beneficiaries over two complete an age-appropriate health check with a Wellness Network provider.Β Furthermore, the benefit is available to new members in the joining year and subsequent years.Β The benefit is available once per lifetime per beneficiary. Cover for eligible healthcare services is limited to the Discovery Health Rate (DHR), subject to the overall benefit maximum.Β Your Personal Health Fund maximum is based on the size and composition of your family as stated in your policy:
On Classic Smart plans:
- β
R2,000 per adult dependant.
- β
R1,000 per child dependant.
- β
Up to a maximum of R8,000 per family per year Additional once-per-lifetime funds for all new Discovery Health Medical Scheme members.
On the Essential and Active plans:
- β
R1,000 per adult dependant
- β
R500 per child dependant
- β
Up to a maximum of R4,000 per family per year.
Get a Discovery Health Medical Aid quote from our Dedicated Medical Aid Specialists Broker

Discovery Health WHO Outbreak Benefit
The basket of care includes the following:
- β
COVID-19 vaccines and their administration according to the COVID-19 guidelines of the National Department of Health.
- β
Screening consultations with a network general practitioner (virtual, telephone, or in-person).
- β
COVID-19 PCR and Rapid Antigen screening tests if referred by a qualified medical practitioner.
- β
A set of defined pathology tests for COVID-19-positive individuals.
- β
A predetermined assortment of x-rays and scans for COVID-19-positive individuals.
- β
Members at risk who meet the clinical entry criteria will receive supportive care, including medication and a home monitoring device to track oxygen saturation levels.
When you are admitted to the hospital because of symptoms of COVID-19, you will be covered by the Hospital Benefit of the Smart Series and, if necessary, the PMBs.
Access to theΒ Long COVID Recovery Programme:
- β
A six-month support program for members whose COVID-19 symptoms persist beyond 21 days after acute diagnosis.
- β
According to the Schemeβs clinical entry criteria and treatment guidelines, the program includes the following:
- β
Up to two specialists and GP consultations.
- β
A defined basket of pathology tests.
- β
Allied healthcare professional support.
- β
A home monitoring device.
- β
A defined basket of x-rays and scans.
πPoll: 5 Affordable Medical Aids under R3000
How members of the Discovery Health Smart Series are covered in terms of Monkeypox:
- β
The treatment protocol for confirmed cases consists of a diagnostic PCR screening test
- β
Two visits to a dermatologist or general practitioner.
Formulary of supportive medications for pain management.

Discovery Health Comprehensive App and Virtual Benefits
Discovery Health Medical Scheme provides home-based access to health and wellness services. Connected Care is an integrated ecosystem of benefits, services, and digitally connected capabilities designed to assist you in managing your health and wellness.
π Health Monitoring Devices | Access to the most up-to-date medical examination, remote monitoring, and point-of-care devices to facilitate the delivery of quality care at home. |
π Electronic Prescriptions | Electronic prescribing for expedited access to medications. |
βοΈ Home Nurses | Hospital-related care is provided at home by registered nurses. |
β
Medicine Ordering and Tracking | Order and track the delivery of your medication from the dispensary to your door. |
β‘οΈ Online Coaches | At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19. |
βοΈ Condition-Specific Information | Educational content pertinent to your condition is readily accessible. |
Connected care for members at home
Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations.Β Thanks to the Home Monitoring Device Benefit, you can get various approved home monitoring devices for chronic and acute conditions. You will not see any changes to your regular benefits because of having cover approved for these gadgets.
Connected care for those with chronic conditions
Through Connected Care, you and your doctor can work together to keep your chronic condition under control while you are at home.Β Eligible members can use various digital services connected to smart remote monitoring, point-of-care devices, and individualized coaching consultations to monitor and control their chronic condition in the comfort of their homes.

Discovery Health Smart Hospital At Home
Hospital at Home patients receives specialized care from a dedicated medical staff in the comfort of their own homes. Each of these benefits and services contributes to your overall health and well-being. They all work together to make your healthcare more efficient and your life safer.Β Suppose you have a valid pre-authorization for hospitalization. In that case, Discovery Health will use your Hospital Benefit to cover any services provided as part of Discoveryβs Hospital at Home program.Β For those who meet the programβs clinical and benefit criteria, this unlocks cover for approved medical devices and services.
Furthermore, Discovery Health covers the following:
- β
24/7 clinical oversight from a care team virtually, including nurses, doctors, and allied healthcare professionals.
- β
24/7 real-time remote monitoring, which is supported by innovative healthcare technology.
Hospital-level diagnostics and intervention to manage post-surgical or medical care at home.
Acute Care at home
This includes cover and treatment for COVID-19, as well as post-discharge care. In addition, you are eligible for the Home Monitoring Device Benefit.
Home Monitoring Devices
- β
The Home Monitoring Device Benefit gives you access to a range of essential and registered home monitoring devices for certain chronic and acute conditions. Approved cover for these devices will not affect your day-to-day benefits.
Home Care Cover
- β
Discovery Home Care is a service that provides you with high-quality care in the comfort of your own home if your doctor recommends it as an alternative to hospitalization. Postnatal care, end-of-life care, intravenous infusions (drips), and wound care are provided. These services are covered by the Hospital Benefit, pending authorization.
- β
Discovery Home Care is the designated service provider (DSP) for intravenous infusion administration. Use Discovery Home Care for these infusions to avoid a 20% co-payment.
Home-based care for follow-up treatment after hospital admission
- β
Once discharged from the hospital, patients with clinically appropriate conditions such as chronic obstructive pulmonary disease, chronic cardiac failure, ischemic heart disease, and pneumonia have access to enhanced home-based care.
- β
If you meet the clinical entry criteria, you are covered for bedside medicine reconciliation before admission discharge, a follow-up consultation with a GP or specialist, and a defined basket of supportive care at home, including in-person and virtual consultations with a Discovery Home Care nurse.

Discovery Health Smart Day-To-Day Benefits and Cover
π©Ί Unlimited GP Consultations in the Smart GP Network | You pay R70 for Classic, R125 for Essential, and Essential Dynamic Smart and Active Smart.
The remaining consultation fee is covered at 100% of the Discovery Health Rate (DHR).
Up to the DHR, video consultations with your Smart Network GP are fully covered. |
π Eye tests at an optometrist within the Smart Optometry Network | One eye exam per person per year is covered for a one-time fee of R70 for Classic and R125 for Essential and Essential Dynamic Smart and Active Smart |
π¦· Defined dental check-ups at any dentist, dental therapist, or oral hygienist | One defined dental examination per person per year with an upfront payment of R125 for Classic, R190 for Essential and Essential Dynamic Smart and Active Smart.
The balance up to the Discovery Health Rate will be covered (DHR). |
π Over-the-counter (OTC) medicine obtained from any pharmacy in the MedXpress Network | You are covered for over-the-counter medicine up to R875 a family a year on Classic Smart,
R585 a family a year on Essential Smart and Essential Dynamic Smart, and R535 a family
a year on Active Smart. |
π Acute Medicine prescribed by a Smart GP and obtained from a pharmacy in the MedXpress Network (Schedule 3>) | On the Classic Smart Plan, you are covered for certain acute prescribed medicine categories
with a limit of R1,905 per person a year or R3,180 a family a year. The categories of medicine
we cover can be found on www.discovery.co.za. |
β‘οΈ Sports injury cover when activated, referred by a Smart Network GP | On the Classic Smart Plan, basic X-rays, two specialist visits, and four visits to a physiotherapist, biokinetics, or chiropractor related to a sports injury and referred by your Smart Network GP are covered.
You will be charged R125 per visit.
Discovery Health will pay up to the Discovery Health Rate (DHR) for these visits and for specialists with whom the scheme does not have a payment arrangement. |
Discovery Maternity and Early Childhood Benefit
With the Discovery Health Smart Series, you get coverage for healthcare services related to your pregnancy and treatment for the first two years of your babyβs life.Β This applies from the date of activation of the benefit for each pregnancy and for each child from birth until they are two years old. Discovery Health Maternity Benefit covers the following:
πYou might like: 5 Best Hospital Plans for BabiesΒ
During Pregnancy:
- β
Scans and Screenings
- β
Eight antenatal consultations with a midwife, GP, or gynecologist.
- β
2 x 2D ultrasound scans
- β
Nuchal translucency test
- β
3D and 4D scans up to the 2D scan rate.
- β
Non-invasive Prenatal Test (NIPT)
- β
One flu vaccination during pregnancy.
- β
Discovery Health will cover predetermined blood tests to confirm your pregnancy.
After giving birth, Discovery Health covers the following:
- β
GP and Specialist help for up to 2 years.
- β
Postnatal care, including complications during delivery, nutritional assessment, etc.
πYou might consider: 5 Best Medical Aids for Babies in South Africa
Discovery Health prenatal and postnatal care includes:
- β
Five antenatal or postnatal classes.
- β
One Breastfeeding consultation.

Discovery Health Chronic Benefit Cover Summarized
π
°οΈ Prescribed Minimum Benefit (PMB) Conditions | Under the Prescribed Minimum Benefits, you can receive treatment for a set of medical conditions (PMBs).
The PMBs cover the 27 chronic conditions included in the Chronic Disease List (CDL). |
π
±οΈ Medicine Cover for the Chronic Disease List | Discovery Health will pay for medications up to the Discovery Health Rate maximum (DHR).
The DHR for medication consists of the price of the medication and the dispensing fee.
The scheme will cover up to the cost of the cheapest equivalent drug on the formulary for medications, not on the list. |
Discovery Health Smart Series Full List of conditions covered:
- β
Addisonβs disease
- β
Asthma
- β
Bipolar mood disorder
- β
Bronchiectasis
- β
Cardiac failure
- β
Cardiomyopathy
- β
Chronic obstructive pulmonary disease
- β
Chronic renal disease
- β
Coronary artery disease
- β
Crohnβs disease
- β
Diabetes insipidus
- β
Diabetes Type 1
- β
Diabetes Type 2
- β
Dysrhythmia
- β
Epilepsy
- β
Glaucoma
- β
Hemophilia
- β
HIV
- β
Hyperlipidemia
- β
Hypertension
- β
Hypothyroidism
- β
Multiple sclerosis
- β
Parkinsonβs disease
- β
Rheumatoid arthritis
- β
Schizophrenia
- β
Systemic lupus erythematosus
- β
Ulcerative colitis
Chronic Medicine
Utilize our designated service providers (DSPs), MedXpress and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on your chronic medication.Β Through MedXpress, you can order or reorder your medication online and have it delivered to your place of business or residence.
Alternatively, you can:
- β
You can order your medication online and pick it up at a MedXpress Network Pharmacy or
- β
Fill a prescription as usual at any pharmacy in the MedXpress Network.
Medicine Tracker
You can set reminders and prompts to help you take your medication as prescribed and on time. For example, your approved chronic medication will be displayed automatically, and you will be prompted to take your medication and confirm each dose.

Discovery Health Care Program
Discovery Health will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions.Β You must be registered with these condition-specific care programs to access additional benefits and services. On a personalized dashboard, you and your Premier Plus GP can identify the next steps to manage your condition and maintain your health over time optimally.Β The cover is subject to the Schemeβs clinical entry requirements, treatment protocols, and guidelines.
π Discovery Health Disease Prevention Programme | Smart Premier Plus GPs can enroll you in the Disease Prevention Program if you have cardiometabolic risk syndrome.
GPs, dietitians, and health coaches coordinate care.
Consultations, pathology tests, and medicine are covered for enrolled members.
Health coaching will help you manage your condition daily. |
π Discovery Health Mental health Care Programme | Once enrolled by your network psychologist or Smart Premier Plus GP, you have defined major depression cover.
The program provides medication coverage, virtual and in-person psychotherapy, and additional GP visits for treatment evaluation, tracking, and monitoring.
Relapse prevention programs cover psychiatry consultations, counseling, and care coordination for qualifying members. |
π Discovery Health Diabetes Care Programme | Your Smart Premier Plus GP can enroll you in the Diabetes Care Programme if you receive the Chronic Illness Benefit (CIB) for diabetes.
The program covers extra glucometer strips and dietitian and biokinetics visits.
A nurse educator can help you manage your condition. |
βοΈ Discovery Health HIV Care Programme | Your Smart Premier Plus GP registers you on the HIV program, which includes social worker cover.
Confidentiality is guaranteed.
Avoid a 20% co-payment by getting your medicine from a DSP. |
β
Discovery Health Cardio Care Programme | If referred by your Smart Premier Plus GP and enrolled in the Cardio Care Programme, you can receive a defined basket of care and an annual cardiovascular assessment for hypertension, hyperlipidemia, or ischemic heart disease on the Chronic Illness Benefit (CIB). |
β‘οΈDepression Risk
Management Program | If you are identified as being at risk of depression, you will
have access to a 6-month long care programme with a defined
basket of care.
This includes a consultation with a Premier Plus
GP or network psychologist, coaching sessions with a social
worker to coordinate your care, consultations with a dietitian,
and a clinically appropriate digital mental wellbeing course.
Cover is subject to clinical entry criteria treatment guidelines
and protocols |
Comprehensive Cancer Cover
You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
πRead more: What is Cancer Cover?
π©Ί Discovery Health Prescribed Minimum Benefits (PMB) | PMB cancer treatment is always covered.
PMB treatment costs total the cover.
Discovery Health will fully cover PMB cancer treatment if it exceeds the cover amount. |
π§ͺ Discovery Health Oncology Benefit | After Discovery Health approves your cancer treatment, the Oncology Care Programme covers you.
Discovery Health will cover approved cancer treatment for 12 months.
The First R250,000 is covered.
Discovery Health will cover up to 80% of your treatment costs if they exceed the coverage amount.
The scheme network covers cancer treatment on Essential Smart and Dynamic Smart.
Discovery Health Rate covers 100% of cancer-related healthcare services (DHR).
If your doctor charges more, you may have a co-payment. |
π©Έ Discovery Health Oncology Innovation Benefit | Subject to the Schemeβs clinical entry criteria, the Oncology Innovation Benefit covers a subset of innovative cancer medicine.
The member must cover 50% of these treatments. This benefit is not available on the Active Smart Plan. |
π Discovery Health β Covering Medicine | To avoid a 20% co-payment, get your approved oncology medicine from a DSP on the Schemeβs medicine list.
Ask your doctor if they use the Schemeβs DSPs for your in-room or facility treatment. |
π Discovery Health advanced Illness Benefit | Members receive comprehensive palliative care.
This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services.
Your palliative care treatment plan includes GP consultations. |

Discovery Health Hospital Benefit
The Smart Series includes hospitalization cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
- β
If you require hospitalization, Discovery Health will cover your hospital bills.
- β
There is no annual overall hospital limit on any of the plans. However, there are maximum reimbursement amounts for certain treatments.
- β
Discovery Health may not cover the expenses if you do not contact the scheme before being discharged.
The following table summarizes how Discovery Health pays for approved hospital admissions within the Smart Series.
π Healthcare Providers and Services | What Discovery Health pays on the Smart Series |
β‘οΈ The Hospital Account | Discovery pay the full account, at the rate agreed on with the hospital.
For Classic and Essential Smart, you will pay an upfront payment of R12,200
for planned admissions to hospitals not in the Smart Plan Hospital Network.
For Essential Dynamic Smart and Active Smart, you will pay an upfront payment of
R14,750 for planned admissions to hospitals that are not in the Essential Dynamic
Smart Hospital Network.
For Active Smart, you have a limit of R70,000 for neonatal in-hospital cover |
Upfront payment for elective
non-emergency admissions | ” On Active Smart, you will have an upfront payment of R7,500
On Classic, Essential, and Essential Dynamic, no upfront payment applies.” |
π Upfront Payment for a defined list of procedures that are performed outside the Day Surgery Network | On Classic and Essential Smart, you will have an upfront payment of R12,200
On Essential Dynamic Smart and Active Smart, you will have an upfront payment
of R14,750 |
π A defined list of procedures that are performed in a specialistβs room | Covered according to the Scheme-approved rate. |
βοΈ Specialists with whom Discovery Health has an arrangement | The entire account will be paid according to the agreed-upon rate. |
β³οΈ Specialists with whom Discovery Health does not have an arrangement | Classic: We pay up to twice the Discovery Health Rate (200%)
Essential, Essential Dynamic Smart and Active Smart: We pay up to the Discovery
Health Rate (100%) |
βοΈ Radiology and Pathology | Covered up to 100% of the Discovery Health Rate (DHR). |
β
MRI and CT scans | We pay up to the the Discovery Health Rate (DHR) if the scan is related to your
current and approved hospital admission from your Hospital Benefit.
Classic: If the scan is not related to your admission or is for conservative back
and neck treatment, we pay the first R3,850 from your available day-to-day benefits
and the rest from your Hospital Benefit, up to the DHR. For conservative back and
neck scans, cover is limited to one scan per spinal and neck region
Essential, Essential Dynamic Smart and Active Smart: You will have to pay if not
related to your admission or if for conservative back and neck treatment. |
πCataract Surgery at a network provide | We pay the full account at the agreed rate at a network facility for cataract surgery.
We pay the hospital account at up to 80% of the Discovery Health Rate at any
other facility. |

Discovery Health Annual Limits
𦻠Cochlear Implants, Auditory Brain Implants, and processors | R244,000 per person per benefit |
βοΈ Internal Nerve Stimulators | R185,550 per person |
π§ͺ Major Joint Surgery | No limit for planned hip and knee joint replacements if you use a provider in the network, or up to 80% of the Discovery Health Rate (DHR) if you use a provider outside the network, up to R30,900 per prosthesis per admission.
Emergency and trauma surgeries are excluded from the network. |
π¦Ύ Shoulder Joint Surgery | If you use a provider outside the network, you can pay up to R45,550 for your prosthesis. |
π Alcohol and Drug Rehabilitation | Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission. |
π§ Mental health | Twenty-one days for admissions or 15 out-of-hospital consultations per person for major affective disorders, anorexia, and bulimia, and 12 for acute stress disorder with recent significant trauma.
Three days for attempted suicide admissions.
Other mental health admissions are 21 days.
Network facilities cover all mental health admissions.
If you go elsewhere, the Scheme will pay up to 80% of the Discovery Health Rate (DHR) for the hospital account. |
π Prosthetic Devices used during Spinal Surgery | The preferred prosthesis suppliers have no limit. If you do not use a preferred supplier, the first level is R18,350, and two or more levels are R36,700, limited to one procedure per person per year.
The spinal surgery network covers approved spinal surgery admissions.
The hospital account will receive up to 80% of the Discovery Health Rate (DHR) for planned admissions outside the Schemeβs network. |
π¦· Dental Treatment in the hospital | Dental Limit:
No overall dental limit.
However, you must pay for all dental appliances, prostheses, orthodontic treatment, and orthognathic surgery accounts. |
πͺ₯ Severe dental and oral surgery in hospital | Severe Dental and Oral Surgery Benefit covers a defined
list of procedures. You do not have to pay an upfront payment
for these, and there is no overall limit on the benefit. This
benefit is subject to authorisation and the Schemeβs Rules. |
π Basic Dental Trauma Benefit | Basic Dental Trauma Benefit covers treatment for sudden
and unexpected injury to the teeth and mouth.
Specifically, we
pay for urgent dental treatment after an accident or trauma
injury that affects the mouth.
Where you meet the clinical entry criteria, we pay up to a yearly limit of R68,250 per person for dental appliances and prostheses and for the placement of these.
This benefit is not available on the Essential Smart,
Essential Dynamic Smart, and Active Smart plans |
π· Dental Treatment in the hospital | Dental Treatment In-Hospital:
Dental admissions require prepayment of your hospital or day clinic bill, except for severe dental and oral surgery.
Age and treatment location determine this amount.
Your Hospital Benefit pays the hospital bill up to 100% of the Discovery Health Rate (DHR).
In addition, your Hospital Benefit covers related bills, including the dentistβs, up to 100% of the Discovery Health Rate (DHR).
Anesthetists receive 200% of the Discovery Health Rate (DHR).
Members 13 and older must pay for routine conservative dentistry like preventive care, fillings, and root canals. |
π Upfront payment for dental admissions | Upfront Payments for Dental Admission:
Hospital Account β R8,650 for members 13> and R3,350 for members <13
Day Clinic Account β R5,550 for members 12> and R1,500 for members <13 |

Discovery Health Smart Cover for Day Surgery Network Procedures
Discovery Health will provide cover for certain day surgery procedures. A day surgery may take place in a hospital, a day clinic, or an independent facility. Furthermore, these services are covered by your Hospital Benefit.Β Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications.Β If you utilize physicians, specialists, and other healthcare professionals with whom Discovery Health will have a payment arrangement, Discovery Health will cover the full cost of these services.
- β
On Classic plans, Discovery Health will pay up to 200% of the Discovery Health Rate (DHR).
- β
On Essential plans for other healthcare professionals, Discovery Health will pay up to 100% of the DHR.
If you visit a facility, not in your planβs Day Surgery Network, you will be required to pay a co-payment according to the table below.
π Discovery Smart Plan | β‘οΈ Day Surgery Network for Your Plan | πΆ Your Out-of-Network Upfront Payment |
1οΈβ£ Classic and Essential Smart | Smart Day Surgery Network | R12,200 |
2οΈβ£ Essential Dynamic Smart | Essential Dynamic Smart Day Surgery Network | R14,750 |
The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:
- β
Biopsies
- β
Breast Procedures
- β
Ear, nose, and throat procedures
- β
Eye Procedures
- β
Ganglionectomy
- β
Gastrointestinal scopes and procedures
- β
Gynecologic Procedures
- β
Orthopedic Procedures
- β
Nerve Procedures
- β
Removal of a foreign body
- β
Simple superficial lymphadenectomy
- β
Skin procedures
- β
Simple hernia procedures
- β
Urological procedures

Discovery Health Smart Additional Benefits
Claims relating to Traumatic Events
- β
Trauma Recovery Extender Benefit covers out-of-hospital trauma claims.
- β
The Trauma Recovery Extender Benefit pays claims for the rest of the year and the year after.
- β
For the year the trauma occurred, and the year after, you and your dependents on your health plan can receive six counseling sessions per person per year from a psychologist, clinical social worker, or registered counselor.
- β
To qualify, members must apply for this benefit.
Africa Evacuation Cover
- β
Emergency medical evacuations from sub-Saharan African countries to South Africa are covered.
- β
Excludes pre-existing conditions.
International Travel Benefit
- β
While traveling outside South Africa, you are covered for emergency medical costs up to R5 million per person.
- β
The cover lasts 90 days after leaving South Africa.
- β
This benefit excludes pre-existing conditions.
- β
Suppose the elective treatment is freely available in South Africa and covered by your plan. In that case, Discovery Health might cover it at equivalent local costs.
πRead more: What is Travel Cover?Β
International Second Opinion Services
- β
The Clinic by Cleveland Clinic provides second opinions for life-threatening and life-changing conditions through your specialist.
- β
Discovery Health will pay 75% for second opinions.
Spinal Care Program
- β
Conservative spinal treatment out-of-hospital includes virtual and face-to-face consultations with an appropriately registered allied healthcare professional.
In-Room Procedures
- β
The cover is limited to specialist room procedures.
- β
Hospital Benefit covers up to the Scheme-authorized rate.
Advanced Illness Benefit
- β
Members receive comprehensive palliative care.
- β
This program covers unlimited home care, care coordination, counseling, and supportive care for appropriate end-of-life clinical and psychologist services.
- β
Your palliative care treatment plan includes GP consultations.

Discovery Smart Series Value-Added Offers
- β
Healthy Care at Clicks or Dis-Chem offers discounts on a wide range of personal and family care products. Healthy Care includes baby care, dental care, eye care, foot care, sun care, hand care, first aid, and over-the-counter medicine.
- β
Your planβs optometrists offer 20% off frames and lenses when you pay immediately.
- β
Expectant parents can cryogenically store their newborn babyβs umbilical cord blood and tissue stem cells at a discounted rate with Netcellsβ exclusive offer.
- β
Vitality, the worldβs leading science-based wellness program, rewards healthy living. As a result, Discovery Vitality members live longer and healthier lives.
- β
Discovery Health collaborates with myHealthTeam, a global leader in online patient communities. This gives members with diabetes, heart disease, and long-term COVID access to a digital community of patients to manage their conditions.
πPOLL: 5 Best Medical Aids for Foreigners Living in South Africa

Discovery Health Smart Series Exclusions and Waiting Periods
Exclusions include the following:
- β
Reconstructive surgical procedures and treatments, including cosmetic procedures and treatments.
- β
Otoplasty for bat ears, blepharoplasty, and port-wine stains (eyelid surgery).
- β
Breast reductions or augmentations and gynecomastia are considered cosmetic procedures.
- β
Obesity
- β
Unless included in Prescribed Minimum Benefits (PMBs) or Assisted Reproductive Therapy, infertility is not covered (ART) Benefit.
- β
Frail care
- β
Abuse of alcohol, drugs, or solvents.
- β
Willful and significant infraction of the law.
- β
Willful participation in a war, a terrorist act, a riot, a civil disturbance, a revolt, or an uprising.
- β
Injuries incurred or medical care rendered during travel to or within a country at war.
- β
Experimental, unproven, or unregistered treatments or practices.
- β
Rescue and search.
New Members 35 years or older may be subject to late-joiner penalties on Discovery Health Medical Aid Plans.Β
Additional exclusions that only apply to the Smart Series include hospitalizations caused by the following, among other things:
- β
Dentistry
- β
Nail disorders
- β
Skin conditions, such as benign growths and lipomas
- β
Investigations
- β
Functional nasal surgery
- β
Elective cesarean section, unless medically required
- β
Hiatus hernia and esophageal reflux surgery.
- β
Back and neck surgery or treatment
- β
Knee and shoulder operations
- β
Arthroscopy
- β
Hips, knees, shoulders, and elbows are among the joints that can be replaced.
- β
Cochlear implants, auditory brain implants, and internal nerve stimulators (including related procedures, devices, processors, and hearing aids) are included in this category.
- β
Healthcare services are provided outside of the hospital and for which hospitalization is not required.
- β
Hallux valgus (bunion) and Tailorβs bunion correction
- β
Removal of varicose veins
- β
Eye correction surgery
- β
Non-malignant breast disorders
Discovery Healthβs waiting periods are as follows:
- β
During your waiting periods, you will not have access to the Prescribed Minimum Benefits (PMBs) if you are subject to waiting periods due to never having belonged to a medical scheme or a break in membership of more than 90 days before joining Discovery Health Medical Scheme, including emergency admission cover.
- β
If you had less than a 90-day break in cover before enrolling in Discovery Health Medical Scheme, you might be eligible for Prescribed Minimum Benefits (PMBs) during waiting periods.

Our Verdict on Discovery Health Smart Series
The Discovery Health Smart Series provides unlimited coverage within the Smart Hospital Network and offers added benefits that cannot be found on entry-level plans, given that members use Smart Network providers.Β Furthermore, additional benefits can be found in this plan, including international travel cover, cover outside South Africa, and more. In addition, members can expect comprehensive day-to-day cover, screening and prevention, full cover in the hospital for related accounts, and more.
You might also like the following service Discovery has to offer:
Discovery Health Smart Series Frequently Asked Questions
What is the Discovery Smart Plan?
The Discovery Health Smart Series is a range of medical aid options offered by Discovery Health in South Africa. The series offers comprehensive medical cover focusing on preventative care and wellness.
Does Discovery Smart Plan cover blood tests?
Pathology can be performed in-hospital as part of a planned admission or outside the hospital as part of your regular benefits.
What are the benefits of the Discovery Smart Plan?
This benefit provides access to a defined basket of care per disease outbreak, including cover for vaccines (if applicable) and outpatient care. The Scheme has made payment arrangements with various healthcare professionals and providers so that you can receive full coverage without co-payments.
Does the Discovery Smart Plan cover mental health?
The Discovery Smart Series covers mental wellness check-ups and provides a care program for mental health.
Does the Discovery Health Smart Series include wellness benefits?
Yes, the Discovery Health Smart Series includes a range of wellness benefits, including access to a wellness program, preventative care services, and health screenings. These benefits are designed to encourage individuals to take an active role in maintaining their health and well-being.
How long does it take to process a claim for the Discovery Health Smart Series?
The processing time for a claim for the Discovery Health Smart Series depends on several factors, including the type of claim, the complexity of the claim, and the volume of claims being processed. On average, claims are processed within 14 days.
Are there any exclusions or limitations in the Discovery Health Smart Series?
Yes, the Discovery Health Smart Series has certain exclusions and limitations. For example, certain medical procedures could be excluded, and there could be limits on the coverage available for certain treatments. Therefore, it is important to carefully review the terms and conditions of your plan to understand the cover limitations and exclusions.
Can I join Discovery Vitality on the Smart Series?
The Smart Series offers members access to Discovery Vitality and several other benefits.