Overall, the Discovery Health Classic Smart Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and unlimited hospital cover to up to 3 Family Members. The Discovery Health Classic Smart Medical Aid Plan starts from R2,412 ZAR.
|🔎 Medical Aid Plan||🥇 Discovery Health Classic Smart|
|🌎 International Cover||R5 million|
|👤 Main Member Contribution||R2,412|
|👥 Adult Dependent Contribution||R1,903|
|🍼 Child Dependent Contribution||R963|
|🔁 Gap Cover||✅ Yes|
|💙 Hospital Cover||Unlimited|
|💶 Medical Savings Account||None|
|👶 Maternity Benefits||✅ Yes|
|🎗️ Oncology Cover||R250,000|
The Discovery Health Classic Smart starts from R2,412 and is part of a series of comprehensive medical insurance plans offered by Discovery Health. The Discovery Classic Smart offers a wide range of benefits, including unlimited hospital cover, chronic medication cover, and day-to-day benefits such as GP visits and specialist consultations. Gap Cover is available on the Discovery Health Classic Smart, 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:
|👤 Main Member||👥 +1 Adult Dependent||🍼 +1 Child Dependent|
|☀️ Day-to-Day Cover||Unlimited Smart Network GP consultations with R60 co-payment.
One R60 network optometrist eye test.
One dental check-up at a dentist, dental therapist, or oral hygienist with an R115 co-payment.
Covered up to 100% of the Discovery Health Rate cover (DHR)
OTC medicine from network pharmacies, up to R790 per family per year.
Smart Network GP-prescribed acute medicine cover.
Schedule 3 and above medicine at network pharmacies is limited to R1,720 per member and R2,860 per family per year.
Sports injuries: basic x-rays, two specialist visits, and four physiotherapists, biokinetics, or chiropractor visits when referred by a Smart Network GP.
Limited to R115 per x-ray or visit.
When Discovery does not have a payment arrangement, visits will be covered at 100% of the Discovery Health Rate (DHR).
|💉 Chronic Dialysis||The cover is available if Discovery approves your treatment plan, and you use a network provider.
Discovery will cover 80% of the Discovery Health Rate if you go elsewhere (DHR)
|🎗️ Cancer||Any provider is covered according to the Discovery Health Rate (DHR)|
|🏥 Hospital Cover – Hospitals you can go to||Private Smart Hospital Network hospitals|
|💛 Cover for Healthcare Professionals in-hospital||Covered up to 200% 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 R3,470, and your Hospital Benefit will cover the remainder up to the Discovery Health Rate (DHR).|
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:
Any additional approved healthcare provider.
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 Prescribed Minimum Benefit (PMB) conditions list 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 to determine 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 WELLTH 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.
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The WELLTH Fund covers a comprehensive list of screening and prevention healthcare services to empower you to act based on your individual health requirements. This benefit is distinct from and in addition to the Screening and Prevention Benefit; it is available once per lifetime to all members and dependents who have completed their health checks. Your WELLTH Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.
The Discovery Health WELLTH Fund for Classic Smart covers the following:
|🩺 General Health||You can access 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 WELLTH 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 WELLTH Fund maximum is based on the size and composition of your family as stated in your policy:
Furthermore, the WELLTH Fund is available to all registered membership beneficiaries and will not cover healthcare services already covered by other defined benefits.
The basket of care includes the following:
How members of the Discovery Health Classic Smart 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.|
✅ Connected care for members at home
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.
✅ 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. 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 receive 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 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:
✅ 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
✅ Home Care Cover
✅ Home-based care for follow-up treatment after hospital admission
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.
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|🟥 Unlimited GP Consultations in the Smart GP Network||There is an R60 fee applied.
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 R60.|
|🟨 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 R115.
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||Up to R790 per family per year is covered for over-the-counter medications.|
|🟦 Acute Medicine prescribed by a Smart GP and obtained from a pharmacy in the MedXpress Network (Schedule 3>)||On the Classic Smart Plan, certain acutely prescribed medication categories are covered up to an annual maximum of R1,720 per person or R2,860 per family.|
|🟪 Sports injury cover when activated, referred by a Smart Network GP||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 on the Classic Smart Plan.
You will be charged R115 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 Classic Smart, 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 each child from birth until they are two years old.
Discovery Health Maternity Benefit covers the following:
✅ During Pregnancy:
✅ After giving birth:
Discovery Health’s prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.
The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL).
✅ Discovery Health Chronic Benefit Cover Summarized
|🅰️ 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 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 Classic Smart List of conditions covered:
and many more.
Members should utilize designated service providers (DSPs), MedXpress, and MedXpress Network Pharmacies to avoid paying a 20% co-payment on their 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:
✅ 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. 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 optimally maintain your health over time.
|❤️ Discovery Health Disease Prevention Program||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 Program||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 Program||Your Smart Premier Plus GP can enroll you in the Diabetes Care Program 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 Program||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 Program||If referred by your Smart Premier Plus GP and enrolled in the Cardio Care Program, 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).|
The cover is subject to the Scheme’s clinical entry requirements, treatment protocols, and guidelines.
You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
|🎗️ 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 Program 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.
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.
|🟨 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 Classic Smart includes hospitalization coverage. Furthermore, there is no limit on the total amount covered by the Hospital Benefit.
The following table summarises how Discovery Health pays for approved hospital admissions within Classic Smart.
|🟥 Healthcare Providers and Services||What Discovery Health pays on the Classic Smart|
|🟧 The Hospital Account||The full hospital-agreed account is settled.
For planned admissions to non-Smart Plan Hospital Network hospitals, there is an R11,000 upfront charge.
|🟨 Upfront Payment for a defined list of procedures that are performed outside the Day Surgery Network||R11,000 upfront charge.|
|🟩 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||Covered up to 200% Discovery Health Rate (DHR).|
|⬛ Radiology and Pathology||Covered up to 100% of the Discovery Health Rate (DHR).|
|⬜ MRI and CT scans||Discovery Health will cover your scan up to the Discovery Health Rate (DHR) (100%) from your Hospital Benefit if related to your admission.
If your treatment is not related to your admission or for conservative back and neck treatment, you will be required to pay R3,470, and your Hospital Benefit will cover the remainder up to the Discovery Health Rate (DHR).
Conservative spine and neck scans are limited to one per region.
✅ Classic Smart Scopes
You are responsible for the following amount depending on where your scope is performed. Your Hospital Benefit will cover the remaining hospital and related charges.
|🟥 Discovery Medical Aid Plan||🟧 Day Clinic Account||🟨 Hospital Account|
|🟩 Classic||R4,050||This co-payment will be reduced from R6,950 to R5,750 if performed by a doctor in the Scheme’s value-based network.|
|🟦 If a gastroscopy and colonoscopy are performed during the same admission|
|🟪 Classic||R4,950||This co-payment will be reduced from R8,650 to R7,200 if performed by a doctor in the Scheme’s value-based network.|
Furthermore, the following will apply to scopes on the Classic Smart:
If scopes are performed in the doctor’s office as part of a confirmed Prescribed Minimum Benefits (PMB) condition or if the patient is under 12 years old, no upfront payment is required. Furthermore, the Hospital Benefit covers the bill.
|🦻 Cochlear Implants, Auditory Brain Implants, and processors||R230,400 per person per benefit|
|🧬 Internal Nerve Stimulators||R175,200 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 R30,900 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 R45,550 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 R26,250, and two or more levels are R52,500, 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:
The Severe Dental and Oral Surgery Benefit covers procedures without upfront payment or limit.
This benefit requires authorization and Scheme Rules.
Basic Dental Trauma:
The Basic Dental Trauma Benefit covers unexpected dental injuries requiring emergency treatment after an accident.
Dental appliances, prostheses, and placement are covered up to R61,500 per person per year if clinical entry criteria are met.
Dental Treatment In-Hospital:
Dental admissions require prepaying 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 Payments for Dental Admission:
Hospital Account – R7,800 for members 13> and R3,000 for members <13
Day Clinic Account – R5,000 for members 12> and R1,350 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. Utilise 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 must pay a co-payment according to the table below:
|1️⃣ Medical Aid Plan||2️⃣ Day Surgery Network for Your Plan||3️⃣ Your Out-of-Network Upfront Payment|
|Classic||Smart Day Surgery Network||R11,000|
The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:
and many more.
✅ Claims Relating to Traumatic Events
✅ Africa Evacuation Cover
✅ International Travel Benefit
✅ International Second Opinion Services
✅ Spinal Care Program
✅ In-Room Procedures
✅ Advanced Illness Benefit
Your palliative care treatment plan includes GP consultations.
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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.
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Additional exclusions that only apply to the Classic Smart include hospitalizations caused by the following, among other things:
The waiting periods are as follows:
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.
|🔎 Medical Aid Plan||🥇 Discovery Health Classic Smart||🥈 Bestmed Beat 2||🥉 Medihelp MedAdd|
|🌎 International Cover||R5 million||R500,000 – R3 million||None|
|👤 Main Member Contribution||R2,412||R2,090 – R2,323||R2,796|
|👥 Adult Dependent Contribution||R1,903||R1,624 – R1,804||R2,364|
|🍼 Child Dependent Contribution||R963||R879 – R978||R948|
|🔁 Gap Cover||✅ Yes||None||None|
|💙 Hospital Cover||Unlimited||Subject to scheme rules||Unlimited|
|💶 Medical Savings Account||None||✅ Yes||✅ Yes|
|👶 Maternity Benefits||✅ Yes||✅ Yes||✅ Yes|
|🎗️ Oncology Cover||R250,000||100% of the scheme tariff||R262,000|
The Discovery Health Classic Smart Plan is a comprehensive medical aid plan offered by the Discovery Health Medical Scheme. The plan provides a wide range of benefits, including unlimited hospital coverage, chronic medication coverage, and day-to-day benefits such as GP visits, specialist consultations, and maternity benefits. The plan also offers a wellness program incentivizing members to adopt healthy lifestyle habits. One of the main benefits of the Classic Smart Plan is its unlimited hospital cover, which means that members can receive treatment for any condition in a private hospital without any financial constraints.
This is particularly important for those who require more expensive treatments or surgeries. Additionally, the plan covers the chronic medication, ensuring members can manage their chronic conditions without worrying about the cost. The Classic Smart Plan’s day-to-day benefits cover GP and specialist consultations, prescribed medication, and various diagnostic tests and procedures. The plan also includes maternity benefits, such as prenatal consultations and childbirth costs, making it a good option for families planning to start or grow their families.
However, the plan does not cover certain elective procedures and treatments, such as cosmetic surgery, which may be important for some members.
The Discovery Health Classic Smart Plan is a comprehensive medical aid plan offered by the Discovery Health Medical Scheme. It provides various benefits, including unlimited hospital cover, chronic medication cover, and day-to-day benefits, such as GP visits and specialist consultations.
The Classic Smart Plan’s contributions are R2,235 per main member, R1,763 per adult dependent, and R892 per child dependent (up to a maximum of three children).
Yes, the Discovery Health Classic Smart Plan provides chronic medication coverage, ensuring that members can manage their chronic conditions without worrying about the cost.
Yes, the Discovery Health Classic Smart Plan includes maternity benefits, such as prenatal consultations and childbirth costs.
The Discovery Health Classic Smart Plan does not cover certain elective procedures and treatments, such as cosmetic surgery. However, it does provide cover for a range of other diagnostic tests and procedures.
Yes, the Discovery Health Classic Smart Plan includes a wellness program that incentivizes members to adopt healthy lifestyle habits.
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