Overall, the Discovery Health Essential Smart Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and does provide coverage for chronic medication, but it may be limited. The Discovery Health Essential Smart Medical Aid Plan starts from R2,021 ZAR.
π Medical Aid Plan | π₯ Discovery Health Essential Smart (2025) |
π€ Main Member Contribution | R2,021 |
π₯ Adult Dependent Contribution | R2,021 |
πΌ Child Dependent Contribution | R2,021 |
π Gap Cover | None |
π Hospital Cover | β Yes |
βοΈ Screening and Prevention | β Yes |
πΆ Medical Savings Account | None |
πΆ Maternity Benefits | β Yes |
π Home Care | β Yes |
π The Discovery Health Essential Smart starts from R2,021 and is part of a series of comprehensive medical insurance plans offered by Discovery Health. Discovery Essential Smart is a good option for those who require comprehensive coverage for essential healthcare needs but are on a tighter budget.
π While it does have some limitations compared to the more comprehensive Classic Smart Plan, it still provides essential cover for hospital stays, chronic medication, and day-to-day healthcare needs. The Discovery Health Essential 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:
π Download the Smart Series Guide for 2025
π€ Main Member | π₯ +1 Adult Dependent | πΌ +1 Child Dependent |
R2,021 | R2,021 | R2,021 |
π΄ Day-to-Day Cover | Unlimited consultations with GPs in the Smart network, with a R125 co-payment for each consultation |
π Chronic Dialysis | State facilities cover you. |
π‘ Cancer | Covered at a network provider, subject to a cover limit of R250,000 |
π’ Hospital Cover β Hospitals you can go to | Private Smart Hospital Network hospitals |
π΅ Cover for Healthcare Professionals in-hospital | Covered up to 100% of the Discovery Health Rate (DHR). |
π£ MRI and CT scans | 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:
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:
To qualify for coverage, your medical condition must be on the Prescribed Minimum Benefit (PMB) conditions list. 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 schemeβs 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 planβs 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.
Every two years, for members between 45 and 75 years, we pay for a bowel cancer screening test. 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.
π POLL: 5 Best Medical Aids under R2000
The Personal Health 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 Personal Health Fund can be used up to its maximum for screening and prevention services. However, the cover is subject to the Schemeβs clinical entry requirements, treatment protocols, and guidelines.
The Discovery Personal Health Fund for Essential Smart covers the following:
π©Ί 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 |
π 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. |
πΊ 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 |
πΌ 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. |
βοΈ 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.
Your Personal Health Fund maximum is based on the size and composition of your family as stated in your policy:
Following the success of the WELLTH 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.
Furthermore, the Personal Health 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 Essential 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.
β€οΈ 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. |
π Home Nurses | Hospital-related care is provided at home by registered nurses. |
π Medicine Ordering and Tracking | Order and track the delivery of your medication from the dispensary to your door. |
π Online Coaches | At-home consultations with a coach to help you better manage your chronic and acute conditions, including COVID-19. |
π Condition-Specific Information | Educational content pertinent to your condition is readily accessible. |
β 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.
β 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.
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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 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. For those who meet the programβs clinical and benefit criteria, this unlocks cover for approved medical devices and services.
β Discovery Health covers the following:
β 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.
β Home Monitoring Devices
β Home Care Cover
β 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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π₯ Unlimited GP Consultations in the Smart GP Network | You pay R125 on Essential, Essential Dynamic Smart and Active Smart of the consultation fee with the balance of consultation fee covered at 100% of the Discovery Health Rate. Video consultations with your Smart Network GP are covered in full up to the DHR |
π§ Eye tests at an optometrist within the Smart Optometry Network | One eye test is covered per person per year with an upfront payment of: R125 on Essential, Essential Dynamic Smart and Active Smart |
π¨ Defined dental check-ups at any dentist, dental therapist, or oral hygienist | One defined dental check-up per person per year with an upfront payment of: R190 on Essential, Essential Dynamic and Active Smart The balance will be covered up to the Discovery Health Rate. |
π© Over-the-counter (OTC) medicine obtained from any pharmacy in the MedXpress Network | You are covered for over-the-counter medicine up to R585 a family a year on Essential Smart. |
π¦ Acute Medicine prescribed by a Smart GP and obtained from a pharmacy in the MedXpress Network (Schedule 3>) | Not available on these plans |
πͺ Sports injury cover when activated, referred by a Smart Network GP | Not available on these plans |
With the Discovery Health Essential Smart, 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 each child from birth until they are two years old.Β Discovery Health Maternity Benefit covers the following:
β During Pregnancy:
β After giving birth:
Discovery Health’s prenatal and postnatal care includes Five antenatal or postnatal classes and One Breastfeeding consultation.
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The Chronic Disease List lists 27 conditions for which the Chronic Illness Benefit (CIB) provides cover (CDL).
β 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 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. |
β Discovery Health Essential Smart List of conditions covered:
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Members should utilize designated service providers (DSPs), MedXpress, and MedXpress Network Pharmacies to avoid paying a 20% co-payment on their 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 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.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 optimally maintain your health over time.
π΄ 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. |
π 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. |
π‘ 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. |
π£Depression Risk Management Programme | 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. |
π’ 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. |
π΅ 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 Schemeβs clinical entry requirements, treatment protocols, and guidelines.
π READ more about Discovery Vitality Program
You have access to comprehensive cancer treatment coverage. This includes access to expensive medications, innovative treatments, and extended coverage once certain thresholds are reached.
π Discovery Health Oncology Benefit | If you are diagnosed with cancer, we cover you on the Oncology Care Programme once we have approved your treatment. Discovery pay for approved cancer treatment over a 12-month cycle. Discovery cover the first R250,000. If your treatment costs more than the cover amount, we will cover up to 80% of the subsequent additional costs. On Essential Smart and Essential Dynamic Smart, we cover cancer treatment in our network. On Active Smart, you have Prescribed Minimum Benefit cancer cover at a network provider. All cancer-related healthcare services are covered up to 100% of the Discovery Health Rate. You might have a co-payment if your healthcare professional charges above this rate |
π₯° Discovery Health Advanced Illness Benefit | Members can access a comprehensive palliative care programme. This programme offers unlimited cover for approved care at home, care coordination, counselling services, and supportive care for appropriate end-of-life clinical and psychologist services. Discovery also pay for a GP consultation, to facilitate your palliative care treatment plan. |
π‘ Discovery Health β Covering Medicine | To avoid a 20% co-payment, you need to get your approved oncology medicine from a designated service provider. Speak to your treating doctor to confirm that they are using our designated service providers for your medicine and for any treatment that you are receiving in a doctorβs rooms or at a treatment facility. Oncology medicine is paid up to 100% of the Discovery Health Rate or up to the Oncology Reference Price, whichever is applicable. |
π¨ Discovery Health Oncology Innovation Benefit | We pay for a sub-set of the defined list of innovative cancer medicine covered by the Oncology Innovation Benefit, subject to the Schemeβs clinical entry criteria. You will have to pay 50% of the cost of these treatments. This benefit is not available on the Active Smart Plan. |
ποΈ Discovery Health Prescribed Minimum Benefits (PMB) | Cancer treatment that is a Prescribed Minimum Benefit is always covered in full. All Prescribed Minimum Benefit treatment costs add up to the cover amount. If your treatment costs more than the cover amount, we will continue to cover your Prescribed Minimum Benefit cancer treatment in full. |
The Essential 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 Essential Smart.
π΄ Healthcare Providers and Services | What Discovery Health pays on the Essential Smart |
π 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 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 | Discovery pay up to the agreed rate, where authorised by the Scheme |
π΅ Specialists with whom Discovery Health has an arrangement | The entire account will be paid according to the agreed-upon rate. |
π£ Specialists with whom Discovery Health does not have an arrangement | Essential, Essential Dynamic Smart and Active Smart: We pay up to the Discovery Health Rate (100% |
βͺ Radiology and Pathology | Covered up to 100% of the Discovery Health Rate (DHR). |
β« MRI and CT scans | 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 |
π€Cataract Surgery at a network provider | Discovery pay the full account at the agreed rate at a network facility for cataract surgery. Discovery pay the hospital account at up to 80% of the Discovery Health Rate at any other facility |
β Essential 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.
π₯ Medical Aid Plan | π§ Day Clinic Account | π¨ Hospital Account |
π© Admissions for scopes | R4,500 | R7,700. This co-payment will reduce to R6,400 if the scope is performed bya doctor who is part of the Schemeβs value-based network |
π¦ If a gastroscopy and colonoscopy are performed during the same admission | R5,500 | R9,600. This co-payment will reduce to R7,950 if the scopes are performed by a doctor who is part of the Schemeβs value-based network |
Furthermore, the following will apply to the scopes of the Essential Smart:
If scopes are performed in the doctorβs 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.
π Discover what is hospital plans
𦻠Cochlear Implants, Auditory Brain Implants, and processors | R244,000 per person per benefit |
𧬠Internal Nerve Stimulators | R185,550 per person |
π©Ή Major Joint Surgery | If you use a provider in our network, you will not have a limit for planned hip and knee joint replacements. We pay up to 80% of the Discovery Health Rate if you use a provider outside our network up to a maximum of R30,900 for each prosthesis, for each admission. The network does not apply to emergency or trauma-related surgeries |
π¦Ύ Shoulder Joint Surgery | If you use a provider outside the network, you can pay up to R45,550 for your prosthesis. |
πΉ 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. |
β Prosthetic Devices used during Spinal Surgery | There is no overall limit if you get your prosthesis from one of our preferred suppliers. If you do not use a preferred supplier, a limit of R18,350 applies for the first spinal level and R36,700 applies for two or more levels. This benefit is limited to one procedure per person per year. We cover you in full for approved spinal surgery admissions if you use a provider in our spinal surgery network. We will pay up to 80% of the DHR for your hospital account if you have a planned admission outside our network. You also have cover for out-of-hospital conservative spinal treatment. |
π¦· Dental Treatment in the hospital | In-hospital dentistry is not covered on the Essential Smart, Essential Dynamic Smart and Active Smart plans. Except where you are approved for severe dental and oral surgery, you need to pay a portion of your hospital or day clinic account upfront for dental admissions. The amount that you pay varies, depending on your age and where you are receiving treatment |
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 planβs Day Surgery Network, you must pay a co-payment according to the table below.
1οΈβ£ Medical Aid Plan | 2οΈβ£ Day Surgery Network for Your Plan | 3οΈβ£ Your Out-of-Network Upfront Payment |
Essential Smart | Smart Day Surgery Network | R12,200 |
The following list provides the procedures that can be performed in a Discovery Health Day Surgery Network:
and many more.
β Claims Relating to Traumatic Events
β Africa Evacuation Cover
β International Travel Benefit
β International Second Opinion Services
β Spinal Care Program
β In-Room Procedures
β Advanced Illness Benefit
Your palliative care treatment plan includes GP consultations.
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.
Additional exclusions that only apply to the Essential Smart include hospitalizations caused by the following, among other things:
and many more.
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.
π Medical Aid Plan | π₯ Discovery Health Essential Smart (2025) | π₯ Medihelp MedVital Elect (2025) | π₯ Bankmed Basic (2025) |
π€ Main Member Contribution | R2,021 | R2,022 | R1,320 β R2,538 |
π₯ Adult Dependent Contribution | R2,021 | R1,470 | R987 β R1,902 |
πΌ Child Dependent Contribution | R2,021 | R852 | R332 β R636 |
π Gap Cover | None | None | None |
π Hospital Cover | Unlimited | Unlimited | Unlimited |
βοΈ Screening and Prevention | β Yes | β Yes | β Yes |
πΆ Medical Savings Account | None | None | None |
πΆ Maternity Benefits | β Yes | β Yes | β Yes |
π Home Care | β Yes | None | β Yes |
π The Discovery Health Essential Smart plan is good for those who want a more affordable medical aid plan that still provides comprehensive coverage for essential healthcare needs. The plan offers unlimited hospital coverage, chronic medication coverage, and day-to-day benefits such as GP visits, specialist consultations, and basic dentistry.
π One of the key benefits of the Essential Smart Plan is its affordability, with a lower monthly premium compared to the more comprehensive Classic Smart Plan. This makes it a good option for those on a tighter budget who still require comprehensive coverage.
Other Discovery Health Smart Series plans:
ππΏ You might also like: Discovery Health Classic Smart
ππΏ You might also like: Discovery Health Essential Dynamic Smart
The Discovery Health Essential Smart plan is a medical aid plan that provides comprehensive coverage for essential healthcare needs, including unlimited hospital coverage, chronic medication coverage, and day-to-day benefits such as GP visits, specialist consultations, and basic dentistry.
The Essential Smart plan is more affordable than other Discovery Health plans, offering comprehensive coverage for essential healthcare needs while keeping costs low.
Yes, the Essential Smart plan covers the chronic medication, ensuring members can manage their chronic conditions without worrying about the cost.
Yes, the Essential Smart plan includes basic dentistry coverage, providing members with essential dental care such as check-ups, fillings, and extractions.
The monthly premium for the Essential Smart plan starts from R2,021 for the main member per adult and child dependent.
Yes, the Essential Smart plan includes several maternity benefits in and out-of-hospital. Furthermore, Discovery Health also offers a maternity program to existing members when they declare their pregnancy.
Yes, the Essential Smart plan, like all other Discovery Health medical aid plans, includes a wellness program.
No, the Essential Smart plan does not cover major dental procedures such as orthodontics or implants. However, Discovery Health offers other plans that provide more comprehensive dental coverage.
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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