Discovery Smart Comprehensive:
in-and-out of hospital benefits (2024)

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Classic Smart Comprehensive.

We also have information on: Dentistry, Optometry, Wellness and Preventative, Other, Maternity, Cancer, Mental Health and Prosthetics benefits.

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Monthly Costs:

Smart Comprehensive 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R7,163
  • R6,611
  • R1,671
  • Only pay for 3 children
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)
  • R15,922
  • R16,918
  • R2,500
"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
Children Rates:
  • Under 21 yrs old
  • Only pay for 3 children
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Discovery plans, with costs and brief summary
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In-hospital Procedures for 2024:

(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
non-Network Specialists:
  • 200% scheme rate
network Specialists:
  • Covered in full
non-Network GPs:
  • 200% scheme rate
network GPs:
  • Covered in full
Hospital Choice:
  • Long stay: Smart Network
  • Day procedure: Day Surgery Smart Network
Day Hospitals:
  • Certain procedures are covered in full at Day Hospital
  • Note: You are also covered for certain procedures, like scopes, performed in specialist rooms
Penalty for using other hospital:
  • non-Smart Network hospital: R11,650 co-payment
Other Co-payments: Scopes (Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
    No co-payment if:
  • Done in doctor's rooms
  • Part of confirmed PMB condition
  • Patient is under 12yrs
    Otherwise:
  • Day clinic: R4,300 co-payment
  • Hospital: R6,250 co-payment, or R5,000 if done by a doctor who is part of "value-based network".
  • You must use a hospital from Day Surgery Network, or pay an additional R11,650

If gastroscopy and colonoscopy are performed in same admission:
  • Day clinic: R5,250 co-payment
  • Hospital: R7,750 co-payment, or R6,300 if done by a doctor who is part of "value-based network".
  • You must use a hospital from Day Surgery Network, or pay an additional R11,650

  • In-hospital dentistry: co-payment required for some admissions. See dentistry benefit for details
Specialised Radiology:
  • MRI and CT scans, Part of approved admission: Covered by scheme
  • MRI and CT scans, Not part of approved admission R3,670 co-payment
Supplementary Services: (Physio, etc)
  • Covered in full for professionals with payment arrangement with Discovery
  • Otherwise, 200% scheme rate
Transplants:
  • Covered
Dialysis:
  • Covered
Exclusions:
Alternatives to hospitals:
  • Palliative care at home: Unlimited, as approved
  • Physical and virtual 24-hour care for services such as postnatal care, end-of-life care, IV infusions (drips), COVID-19 and wound care.
  • Home monitoring device: up to R4,500 per person
Casualty:
  • If in self payment gap: children under 10yrs get two free ER consults
Other:
  • International Second Opinion for life-threatening and life-changing condition: members can obtain second opinion from Cleveland Clinic, with a 50% co-payment
  • Overseas Treatment Benefit: R500,000 for treatment not available in South Africa, with 20% co-payment
  • Specialised medicine and technology: R200,000 per person with a 20% co-payment
  • Internal Nerve stimulators: R185,550
Note:
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Discovery plans, with costs and brief summary
.
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.

Out-of-hospital Procedures for 2024:

(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)
  • R15,922
  • R16,918
  • R2,500
"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
PMBs out of hospital:
  • All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
  • This can include consults with specialists, blood or other tests, radiology and medicine
  • The benefit is paid by the scheme, and not out of your savings account
  • If you have no day-to-day funds, you still have cover for PMBs
  • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
  • See our Guide to PMBs for more information.
General info:
GP consultations:
  • If in Self-Payment Gap:
    • video call consultations with a network GP,
    • unlimited network pharmacy clinic consultations
    • unlimited consultations with a network GP when referred by the pharmacy clinic virtual GP .
      • Virtual Urgent Care: 4 sessions per family
      • Otherwise, from day-to-day benefit
Childcare:
  • GP/Paediatrician/ENT consults: 2 consults, for 0-2yrs
  • Child assessment: height, weight, head circumference and health and milestone tracking
  • If in self payment gap: 2 ER consults, for 0-10yrs
Specialists consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • MRI and CT Scans: R3,670 co-payment , from day-to-day benefit
  • Conservative back and neck scans: one scan per spinal and neck region
Supplementary Services: (Physio, etc)
  • From day-to-day benefits. Includes allied, therapeutic and psychology services. Limited to:
    • M= R23,500
    • M1= R31,950
    • M2= R38,900
    • M3+= R45,150
  • For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to Discovery directly
General Appliances:
  • External appliances: R64,200 per family from day-to-day benefit
1.1. Hearing Aids:
  • R29,850 per family paid from day-to-day benefit
1.2. Wheelchairs:
  • See above
Note:
  • PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Discovery plans, with costs and brief summary
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

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Medication Benefit for 2024:

(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)
  • R15,922
  • R16,918
  • R2,500
"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
Chronic: .
Acute (presrcibed) medication:
  • Schedule 3 and above
  • From day-to-day benefit, up to the limits below
  • M= R40,150
    M1= R47,050
    M2= R54,650
    M3+= R62,300
Over-the-counter:
  • From day-to-day benefit
  • These do not add up to the annual threshold, and are not paid for from it
Birth Control:
  • See "Acute Medicine" benefit
On Discharge:
  • See "Acute Medicine" benefit
Biological:
  • PMBs only
Note:
  • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
  • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
  • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Discovery plans, with costs and brief summary
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Also see these: