Discovery Smart Comprehensive:
cancer, maternity and mental health (2025)

This page has information on: Costs, Maternity, Oncology, Mental Health for Discovery Classic Smart Comprehensive

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Terminology:

• PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
• DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
• Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2025)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Cancer/ Oncology benefits (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: Smart Comprehensive
Assume scheme pays all these costs, unless otherwise stated
Overall cancer coverage (in and out of hospital):	R375,000, then 20% co-payment applies for non-PMB treatment Innovative cancer medicine: Certain "innovative cancer medicine" is covered with a 50% co-payment Palliative Care: Unlimited cover for approved care at home Note: Most cancers are PMBs, and treatment is paid in full by scheme. More info here Most schemes require use of specific providers (DSPs) for oncology treatment.

Maternity benefits (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: Smart Comprehensive
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:	200% scheme rate Up to R2,700 per day for private ward Usually covered for 2 nights for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.
Consultations:	Consults: 12 consults with GP, Gynae or midwife Nuchal translucency or Non-Invasive Prenatal Test if you meet the criteria Devices: Up to R6,300 for registered devices (breast pumps, etc) with 25% co-payment Antenatal classes: R2,400 per family, from day-to-day benefit Certain blood tests Five antenatal or postnatal classes or consultations with a registered nurse up until two years after you have given birth After birth : One six week post-birth consult with midwife, GP or gynae One nutritional assessment Two mental health consults Breastfeeding consultation Savings on stem cell banking Assisted Reproductive Therapy (ART) : possible cover for one or two annual cycles of ART. If you are on the oncology program, you might have access to cryopreservation and egg and sperm storage for up to five years. R135,000 per person. and a minimum 25% co-payment.
Scans:	2 x ultrasound scans
Note:	If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don’t have medical aid.

Mental Health benefits (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: Smart Comprehensive
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:	Main Member: Adult: Child: Savings (per year): No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits. Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R17,958 R19,050 R2,824 "Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid the self payment gap. R30,000 R30,000 R7,500
FYI:	Mental Health PMB conditions are covered for in and out of hospital treatment, even on "hospital" plans. For a full list see here. Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts. Scheme will pay this in full, if you use a DSP.
In-hospital:	Major affective disorders, anorexia and bulimia: 21 days for admissions or 15 out-of-hospital consultations Attempted suicide or detoxification: 3 days admission Other mental health admissions: 21 days in-hospital Alcohol and drug rehab: 21 days in-hospital All admissions are covered in full at a network facility, or at 80% scheme rate at a non-network facility
Out-of-hospital:	See above Otherwise, paid from day-to-day benefit . Claims for psychologists and social workers fall into the supplementary benefit ie Limited to: Main Member= R24,600 M+1= R33,450 M+2= R40,750 M3+= R47,300
Other:	Traumatic event claims: 6 counselling sessions per person per year, for the year in which the trauma event occurred and the year after

Important!
• Unless specified, assume that all benefits are paid are paid at 100% scheme rate
• No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
• "Unlimited" benefits are still subject to authorisation, protocols and sublimits
• Assume that all benefits need to be pre-authorised