Principle Member
From R1797
Dependant Member
From R1797
Child Dependant
From R1797
Essential Dynamic Smart
Essential Dynamic Smart
Principle Member
From R1797
Dependant Member
From R1797
Child Dependant
From R1797
Principle Member
From R2161
Dependant Member
From R2161
Child Dependant
From R2161
Essential Smart
Essential Smart
Principle Member
From R2161
Dependant Member
From R2161
Child Dependant
From R2161
Principle Member
From R3018
Dependant Member
From R2381
Child Dependant
From R1205
Classic Smart
Classic Smart
Principle Member
From R3018
Dependant Member
From R2381
Child Dependant
From R1205
⚠️ Deferral: Contribution increases are delayed from January to 1 April 2026
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 on the Active Smart Plan.
| 🔎 Smart Series Plan | Classic Smart | Essential Smart | Essential Dynamic Smart | Active Smart |
| 🌎 International Cover | R5 million | R5 million | R5 million | R5 million |
| 👤 Main Member Contribution | R3,018 | R2,161 | R1,797 | R1,350 |
| 👥 Adult Dependent Contribution | R2,381 | R2,161 | R1,797 | R1,350 |
| 💙 Child Dependent Contribution | R1,205 | R2,161 | R1,797 | R1,350 |
| 🔁 Gap Cover | ✅ Yes | ☑️ Yes | ✅ Yes | ☑️ Yes |
| 🏥 Hospital Cover | Unlimited | Unlimited | Unlimited | Neonatal admissions limited to R72,600. All other admissions: Unlimited. Upfront payment of R7,750 applicable to all elective admissions. |
| 📌 Oncology Cover | R250,000 | R250,000 | R250,000 | Covered at a network provider, limited to Prescribed Minimum Benefits. |
| 💶 Prescribed Minimum Benefits | ☑️ Yes | ✅ Yes | ☑️ Yes | ✅ Yes |
| ➡️ Screening and Prevention | ✅ Yes | ☑️ Yes | ✅ Yes | ☑️ Yes |
The Discovery Health Smart Series starts from R1,350 and is a series of comprehensive medical insurance plans offered by Discovery Health. The Discovery Smart Series provides an elevated level of coverage for in-hospital expenses, day-to-day benefits, chronic medication, and other medical expenses. 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 the Discovery Health Smart Series may be subject to a 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 Health has a trust rating of 4.8.
| 🔎 Smart Series Plan | 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| 1️⃣ Classic Smart | R3,018 | R2,381 | R1,205 |
| 2️⃣ Essential Smart | R2,161 | R2,161 | R2,161 |
| 3️⃣ Essential Dynamic Smart | R1,797 | R1,797 | R1,797 |
| 4️⃣Active Smart | R1,350 | R1,350 | R1,350 |
| 🔎 Smart Series Plan | Classic Smart | Essential Smart | Essential Dynamic Smart | Active Smart |
| 🌎 International Cover | R5 million | R5 million | R5 million | R5 million |
| 👤 Main Member Contribution | R3,018 | R2,161 | R1,797 | R1,350 |
| 👥 Adult Dependent Contribution | R2,381 | R2,161 | R1,797 | R1,350 |
| 💙 Child Dependent Contribution | R1,205 | R2,161 | R1,797 | R1,350 |
| 🔁 Gap Cover | ✅ Yes | ☑️ Yes | ✅ Yes | ☑️ Yes |
| 🏥 Hospital Cover | Unlimited | Unlimited | Unlimited | Neonatal admissions limited to R72,600. All other admissions: Unlimited. Upfront payment of R7,750 applicable to all elective admissions. |
| 📌 Oncology Cover | R250,000 | R250,000 | R250,000 | Covered at a network provider, limited to Prescribed Minimum Benefits. |
| 💶 Prescribed Minimum Benefits | ☑️ Yes | ✅ Yes | ☑️ Yes | ✅ Yes |
| ➡️ Screening and Prevention | ✅ Yes | ☑️ Yes | ✅ Yes | ☑️ Yes |
| 🔎 Smart Plan Option | 🥇 Classic Smart | 🥈 Essential Smart | 🥉 Essential Dynamic Smart | 🪙Active Smart |
| 1️⃣ Day-to-Day Cover | Unlimited Smart Network GP consultations with R75 co-payment. | Unlimited Smart Network GP consultations with R130 co-payments. | Unlimited Smart Network GP consultations with R130 co-payments. | Unlimited Smart Network GP consultations with R130 co-payments. |
| 2️⃣ Day-to-Day Cover | One eye test at a optometrist with an upfront payment of R75 per test. | One eye test is covered per person per year with an upfront payment of R130 co-payment. | One eye test is covered per person per year with an upfront payment of R130 co-payment. | One eye test is covered per person per year with an upfront payment of R130 co-payment. |
| 3️⃣ Day-to-Day Cover | One dental check-up at a dentist, dental therapist, or oral hygienist with an R130 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 R195 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 R195 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 R195 co-payment. Covered up to 100% of the Discovery Health Rate cover (DHR) |
| 4️⃣ Day-to-Day Cover | OTC medicine from network pharmacies, up to R905 per family per year. | OTC medicine from network pharmacies up to R605 per family per year. | OTC medicine from network pharmacies up to R605 per family per year. | OTC medicine from network pharmacies up to R605 per family per year. |
| 5️⃣ Day-to-Day Cover | Smart Network GP-prescribed acute medicine cover. Schedule 3 and above medicine at network pharmacies is limited to R1,970 per member or R3,300 per family per year. | Unavailable on these plans | Unavailable on these plans | Unavailable on these plans |
| 6️⃣ 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. R130 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 |
| 📉 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. |
| ⚕️ 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. |
| 🏥 Hospital Cover – 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 R72,600. All other admissions: Unlimited. Upfront payment of R7,750 applicable to all elective admissions. |
| 👩⚕️ 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). |
| 🔍 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 R4,000, 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 |
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. 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:
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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:
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. 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 scheme’s rules. 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. Furthermore, Discovery Health will pay according to your plan’s benefits if these criteria are unmet.
This benefit covers certain diagnostic procedures that detect early warning signs of serious diseases. 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. 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:
Screening for Seniors (65>) includes risk screening assessments and referrals to Premier Plus GPs according to the screening results.
Clinical eligibility requirements may apply to these tests:
Vaccines (there may be clinical entry requirements):
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:
| 🔎 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 |
| ⚕️ Physical Health | Dieticians, biokinetics, or physiotherapists are available for physical well-being evaluations. |
| 🧠 Mental Health | You have access to a mental health evaluation to promote mental health. |
| ❤️ Women and Men’s 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 |
| 💙 Children’s Health | A pediatrician, speech pathologist, or physiotherapist can evaluate your child’s progress toward important developmental milestones as part of a well-child check-up. |
| ➡️ 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. Furthermore, the benefit is available to new members in the joining year and subsequent years. 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. Your Personal Health Fund maximum is based on the size and composition of your family as stated in your policy:
On Classic Smart plan:
On the Essential and Active plans:
Get a Discovery Health Medical Aid quote from our Dedicated Medical Aid Specialists Broker
The basket of care includes the following:
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 the Long COVID Recovery Programme:
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How members of the Discovery Health Smart Series are covered in terms of Monkeypox:
Formulary of supportive medications for pain management.
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.
| 📌 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. |
| 📍 Electronic Prescriptions | Electronic prescribing for expedited access to medications. |
| ☑️ Home Nurses | Hospital-related care is provided at home by registered nurses. |
| ✅ Medicine Ordering and Tracking | Order and track the delivery of your medication from the dispensary to your door. |
| ➡️ Online Coaches | At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19. |
| ⚕️ Condition-Specific Information | Educational content pertinent to your condition is readily accessible. |
Previously unimaginable access to medical professionals is now at your fingertips, thanks to the advent of online consultations. 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.
Through Connected Care, you and your doctor can work together to keep your chronic condition under control while you are at home. 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.
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. 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 Discovery’s Hospital at Home program. For those who meet the program’s clinical and benefit criteria, this unlocks cover for approved medical devices and services.
Furthermore, Discovery Health covers the following:
Hospital-level diagnostics and intervention to manage post-surgical or medical 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.
| 🩺 Unlimited GP Consultations in the Smart GP Network | You pay R75 for Classic, R130 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. |
| 📌 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 R75 for Classic and R130 for Essential and Essential Dynamic Smart and Active Smart |
| 🦷 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 R130 for Classic, R195 for Essential and Essential Dynamic Smart and Active Smart. The balance up to the Discovery Health Rate will be covered (DHR). |
| 💊 Over-the-counter (OTC) medicine obtained from any pharmacy in the MedXpress Network | You are covered for over-the-counter medicine up to R905 a family a year on Classic Smart, R605 a family a year on Essential Smart and Essential Dynamic Smart, and R555 a family a year on Active Smart. |
| 💉 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 R1,970 per person a year or R3,300 a family a year. The categories of medicine we cover can be found on www.discovery.co.za. |
| ➡️ 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 R130 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. |
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 baby’s life. 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:
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During Pregnancy:
After giving birth, Discovery Health covers the following:
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Discovery Health prenatal and postnatal care includes:
| 🅰️ 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). |
| 🅱️ 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:
Utilize our designated service providers (DSPs), MedXpress and MedXpress Network Pharmacies, to avoid paying a 20% co-payment on your chronic medication. Through MedXpress, you can order or reorder your medication online and have it delivered to your place of business or residence.
Alternatively, you can:
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 will cover preventative and condition-specific care programs that assist with managing diabetes, mental health, HIV, and heart-related conditions. 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. The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.
| 🔎 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. |
| 📌 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. |
| 📍 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. |
| ☑️ 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. |
| ✅ 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). |
| ➡️Depression 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 |
You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
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| 🩺 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. |
| 🧪 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. |
| 🩸 Discovery Health Oncology Innovation Benefit | Subject to the Scheme’s 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. |
| 💊 Discovery Health – Covering Medicine | To avoid a 20% co-payment, get your approved oncology medicine from a DSP on the Scheme’s medicine list. Ask your doctor if they use the Scheme’s DSPs for your in-room or facility treatment. |
| 😊 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. |
The Smart Series includes hospitalization cover. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
The following table summarizes how Discovery Health pays for approved hospital admissions within the Smart Series.
| 🔎 Healthcare Providers and Services | What Discovery Health pays on the Smart Series |
| ➡️ 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 R12,650 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 R15,300 for planned admissions to hospitals that are not in the Essential Dynamic Smart Hospital Network. For Active Smart, you have a limit of R72,600 for neonatal in-hospital cover |
| Upfront payment for elective non-emergency admissions | ” On Active Smart, you will have an upfront payment of R7,750 On Classic, Essential, and Essential Dynamic, no upfront payment applies.” |
| 📌 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 R12,650 On Essential Dynamic Smart and Active Smart, you will have an upfront payment of R15,300 |
| 📍 A defined list of procedures that are performed in a specialist’s room | Covered according to the Scheme-approved rate. |
| ✔️ Specialists with whom Discovery Health has an arrangement | The entire account will be paid according to the agreed-upon rate. |
| ✳️ 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%) |
| ☑️ Radiology and Pathology | Covered up to 100% of the Discovery Health Rate (DHR). |
| ✅ 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 R4,000 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. |
| 📌Cataract 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. |
| 🦻 Cochlear Implants, Auditory Brain Implants, and processors | R252,000 per person per benefit |
| ⚕️ Internal Nerve Stimulators | R192,000 per person |
| 🧪 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 R31,800 per prosthesis per admission. Emergency and trauma surgeries are excluded from the network. |
| 🦾 Shoulder Joint Surgery | If you use a provider outside the network, you can pay up to R46,000 for your prosthesis. |
| 💊 Alcohol and Drug Rehabilitation | Discovery Health will cover 21 days of rehabilitation per person per year. Three days for detoxification per approved admission. |
| 🧠 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. |
| 🔍 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 R18,900, and two or more levels are R37,800, 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 Scheme’s network. |
| 🦷 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. |
| 🪥 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 Scheme’s Rules. |
| 😊 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 R70,800 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 |
| 😷 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 dentist’s, 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. |
| 🚑 Upfront payment for dental admissions | Upfront Payments for Dental Admission: Hospital Account – R8,950 for members 13> and R3,470 for members <13 Day Clinic Account – R5,750 for members 12> and R1,550 for members <13 |
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. Discovery Health will pay for hospitalization-related services, including all authorized healthcare professionals, services, and medications. 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.
If you visit a facility, not in your plan’s Day Surgery Network, you will be required to pay a co-payment according to the table below.
| 🔎 Discovery Smart Plan | ➡️ Day Surgery Network for Your Plan | 💶 Your Out-of-Network Upfront Payment |
| 1️⃣ Classic and Essential Smart | Smart Day Surgery Network | R12,650 |
| 2️⃣ Essential Dynamic Smart | Essential Dynamic Smart Day Surgery Network | R15,300 |
The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:
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Exclusions include the following:
New Members 35 years or older may be subject to late-joiner penalties on Discovery Health Medical Aid Plans.
Additional exclusions that only apply to the Smart Series include hospitalizations caused by the following, among other things:
Discovery Health’s waiting periods are as follows:
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. 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:
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.
Pathology can be performed in-hospital as part of a planned admission or outside the hospital as part of your regular benefits.
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.
The Discovery Smart Series covers mental wellness check-ups and provides a care program for mental health.
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.
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.
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.
The Smart Series offers members access to Discovery Vitality and several other benefits.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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