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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)
Assume scheme pays all these costs, unless otherwise stated
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non-Network Specialists: |
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network Specialists: |
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non-Network GPs: |
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network GPs: |
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Hospital Choice: |
- Long stay: Smart Plan Network
- Day procedure: Smart Day Surgery Network
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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
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Penalty for using other hospital: |
- non-Network hospital: R11,650 co-payment
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Other Co-payments: |
- Defined day procedures performed outside of day surgery network: R11,650
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: R7,350 co-payment, or R6,100 if done by a doctor who is part of "value-based network".
- You must use a facility from Day Surgery Network, or pay an additional R6,650-R7,350
If gastroscopy and colonoscopy are performed in same admission:
- Day clinic: R5,250 co-payment
- Hospital: R9,150 co-payment, or R7,600 if done by a doctor who is part of "value-based network".
- You must use a facility from Day Surgery Network, or pay an additional R11,650
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Specialised Radiology: |
- MRI and CT scans, part of approved admission: Covered by scheme
- MRI and CT scans, not part of approved admission: No benefit
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Supplementary Services: (Physio, etc) |
- Covered in full for professionals with payment arrangement with Discovery
- Otherwise, 100% scheme rate
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Transplants: |
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Dialysis: |
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Exclusions: |
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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
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Casualty: |
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Other: |
- International Second Opinion for life-threatening and life-changing condition: members can obtain second opinion from Cleveland Clinic, with a 25% co-payment
- Internal Nerve stimulators: R185,550
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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
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♦️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)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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- 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.
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- GP in Smart Plan Network, in person: Unlimited, with R120 co-payment per consult
- GP in Smart Plan Network, video: 100% scheme rate
- Virtual Urgent Care: 4 sessions per family
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- GP/Paediatrician/ENT consults: 2 consults, for 0-2yrs
- Child assessment: height, weight, head circumference and health and milestone tracking
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- 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
|
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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.
Medication Benefit for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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Chronic: |
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- Oncology Innovation Benefit:: Cover for defined list of innovative medicine, with 50% co-payment
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- 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.
|