Discovery Essential Smart:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Discovery Essential Smart. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

• View all the Discovery plans, with costs and brief summary.
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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.

In-hospital Procedures (2025):

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

Discovery: Essential Smart
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	network Doctors: paid in full non-network Doctors: 100% scheme rate
Hospital Choice:	Smart Network Day procedure: Smart Day Surgery Network
Penalty for using other hospital:	Use of non-network hospital: R12,200 penalty Use of non-network Day hospital: R12,200 penalty
Co-payments:	Scopes: Co-payment required if done outside of network doctor's rooms. See "Scopes" benefit, below. Dental: Co-payment required for some dental admissions. See "Dental Benefit". MRI and CT scans: Co-payment required in some cases. Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
Specialised Radiology:	MRI and CT scans, part of approved admission: Covered by scheme MRI and CT scans, not related to admission: No cover MRI and CT scans, for conservative neck or back treatment: No cover
Scopes:	Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy: No co-payment if: Done in network doctor's rooms, or Part of confirmed PMB condition, or Patient is under 12yrs Otherwise: Day clinic: R4,500 co-payment Hospital: R7,700 co-payment, or R6,400 co-payment 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 R12,000 penalty In-rooms, non network doctor: R1,750 co-payment In-rooms, network doctor: No co-payment If gastroscopy and colonoscopy are performed in same admission: Day clinic: R5,500 co-payment Hospital: R9,600 co-payment, or R7,950 co-payment 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 R12,000 penalty In-rooms, non network doctor: R3,000 co-payment In-rooms, network doctor: No co-payment
Supplementary Services: (Physio, etc)	Covered in full for professionals with payment arrangement with Discovery Otherwise, 100% scheme rate
Transplants:	Covered
Dialysis:	Covered, at state facility
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:	Hospital at home: Used in case of early hospital release, or as an alternative to admission. Includes physical and virtual care, monitoring devices and access to procedures and interventions to manage care at home. Monitoring devices: As approved, for chronic and acute conditions Palliative care at home: Unlimited, as approved Home Care As an alternative to hospital admission. Services such as postnatal care, end-of-life care, IV infusions (drips), and wound care.
Casualty/ER:	PMBs only
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 per person
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

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

Discovery: Essential Smart
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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.
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	GP in Smart Network, in person : Unlimited, with R70 co-payment per consult GP in Smart Network, video : Unlimited Virtual Urgent Care: 4 sessions per family, paid by scheme
Childcare:	GP/Paediatrician/ENT consults: 2 consults, for children 0-2yrs. Paid by scheme. Child assessment: height, weight, head circumference and health and milestone tracking
Specialists consultations:	PMBs only
Pathology:	PMBs only
General radiology:	PMBs only
Specialised radiology:	PMBs only
Scopes:	Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy: No co-payment if: Done in network doctor's rooms, or Part of confirmed PMB condition, or Patient is under 12yrs Otherwise: Day clinic: R4,500 co-payment Hospital: R7,700 co-payment, or R6,400 co-payment 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 R12,000 penalty In-rooms, non network doctor: R1,750 co-payment In-rooms, network doctor: No co-payment If gastroscopy and colonoscopy are performed in same admission: Day clinic: R5,500 co-payment Hospital: R9,600 co-payment, or R7,950 co-payment 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 R12,000 penalty In-rooms, non network doctor: R3,000 co-payment In-rooms, network doctor: No co-payment
Supplementary Services: (Physio, etc)	PMBs only
General Appliances:	No benefit
1.1. Hearing Aids:	No benefit
1.2. Wheelchairs:	No benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

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

Discovery: Essential Smart
Assume scheme pays all these costs, unless otherwise stated
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.
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. .
Acute (prescribed) medication:	No benefit
Over-the-counter:	R585 per family, from network pharmacies
Birth Control:	No benefit
On Discharge:	No benefit
Biological:	Oncology Innovation Benefit: : Cover for defined list of innovative medicine, with 50% co-payment
View other benefits for this plan: In-hospital | 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. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider