Benefits, Discovery Plan, in-hospital, out-hospital, Scheme Plans

Discovery Smart Comprehensive: in-and-out of hospital benefits (2027)

January 6, 2026

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

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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 Providers. Where stipulated, you must use 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

Discovery:Smart Comprehensive (2027)
	Main member:	Adult member:	Child member:
Total Cost pm:	R9,343	R8,628	R2,181
Savings:	R16,812	R15,528	R3,924
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R21,118	R22,402	R3,326
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	32260	32260	8060
Children Rates:	Under 21yrs Only pay for 3 children

Discovery:Smart Comprehensive (2026)
	Main member:	Adult member:	Child member:
Total Cost pm:	R8,576	R7,920	R2,002
Savings:	R14,292	R13,200	R3,336
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R20,518	R21,610	R3,314
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	R31,100	R31,100	R7,770
Children Rates:	Under 21yrs Only pay for 3 children

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In-hospital Procedures (2027):

Discovery: Smart Comprehensive
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	network Doctors: paid in full non-network Doctors: 200% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Long procedure: Smart Hospital Network Day procedure: Smart Day Surgery Network
Penalty for using other hospital:	Hospitals outside of Smart Network: R13,150 penalty Use of non-network day hospital: R13,150 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
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 Penalties: penalties payable if non-Day Network is used. See "Penalty for using other hospital", above Note: 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, especially if you don't use a DSP for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI and CT scans, part of approved admission: covered by scheme MRI and CT scans, not related to admission: R4,155 co-payment, paid from day-to-day benefit MRI and CT scans, for conservative neck or back treatment: R4,155 co-payment, paid from day-to-day benefit	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:	Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy: No co-payment if: Done in network doctor's rooms, or For dyspepsia Part of confirmed PMB condition, or Patient is under 12yrs Otherwise: Day clinic (network): R4,850 co-payment Day clinic (non-network): R7,550 co-payment Hospital: R7,100 co-payment, or R5,650 co-payment if done by a doctor who is part of "value-based network" In-rooms, non-network doctor, single scope: R1,880 co-payment In-rooms, network doctor: no co-payment If gastroscopy and colonoscopy are performed in same admission: Day clinic (network): R5,900 co-payment Day clinic (non-network): R8,750 co-payment Hospital (network): R8,750 co-payment, or R7,100 co-payment if done by a doctor who is part of "value-based network" In-rooms, non-network doctor: R3,220 co-payment In-rooms, network doctor: no co-payment	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	Covered in full for professionals with payment arrangement with scheme Otherwise, 200% scheme rate
Transplants:	Covered
Dialysis:	Covered
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
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. R4,850 per person, paid by scheme 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 Home-based virtual care for the elderly: available for 65yrs+, access to basket of care to manage conditions Virtual chronic care: out-of-hospital basket of care, including monitoring devices and virtual consults
Casualty/ER:	.	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	International Second Opinion for life-threatening and life-changing condition: members can obtain second opinion from MediGuide Overseas Treatment Benefit: R500,000 for treatment not available in South Africa, with 20% co-payment Internal nerve stimulators: R199,500 per person
PMBs = Prescribed Minimum Benefits (more info) \| DSP = Designated Service Provider

Out-of-hospital Procedures (2027):

Discovery: Smart Comprehensive

Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated

	Main Member:	Adult:	Child:
Savings:	R14,292	R13,200	R3,336
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R20,518	R21,610	R3,314
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	R31,100	R31,100	R7,770
Other Day-to-Day Funds:	Scheme awards you with money if you complete personalised health and lifestyle actions You need to activate the benefit on the app, and fulfill the personalised pathways These can be things like: get a mammogram, complete a dental checkup etc Personal Health Fund: up to R3,000 per adult and R1,500 for child. Maximum R12,000 per family Personal Health Fund Boost: up to an additional R1,500 per adult, per completed challenge. Maximum two challenges per adult, and R12,000 per family. Challenges take 5-10 weeks to complete, and are meant to build habits The fund money can be used for most out-of-hospital claims

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.

Smart GP Network, face-to-face: Unlimited consults, with a R80 co-payment
Smart GP Network, virtual: covered in full
Paid by scheme, or from Annual Threshold once reached

GP/Paediatrician/ENT consults: two consults, for children 0-2yrs. Paid by scheme
Child assessment: height, weight, head circumference and health and milestone tracking

Gap Cover:
Can pay for child ER visits
(Plans coming soon)

From day-to-day benefit

From day-to-day benefit

From day-to-day benefit

MRI and CT scans: R4,155 co-payment. No co-payment if scan is part of PMB protocol

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

Gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy:

No co-payment if:

Done in network doctor's rooms, or
For dyspepsia
Part of confirmed PMB condition, or
Patient is under 12yrs

Otherwise:

Day clinic (network): R4,850 co-payment
Day clinic (non-network): R7,550 co-payment
Hospital: R7,100 co-payment, or R5,650 co-payment if done by a doctor who is part of "value-based network"
In-rooms, non-network doctor, single scope: R1,880 co-payment
In-rooms, network doctor: no co-payment

If gastroscopy and colonoscopy are performed in same admission:

Day clinic (network): R5,900 co-payment
Day clinic (non-network): R8,750 co-payment
Hospital (network): R8,750 co-payment, or R7,100 co-payment if done by a doctor who is part of "value-based network"
In-rooms, non-network doctor: R3,220 co-payment
In-rooms, network doctor: no co-payment

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

From day-to-day benefit. Includes allied, therapeutic and psychology services. Limited to:
- Main member = R26,500
- Main+1 = R36,050
- Main+2 = R43,900
- Main 3+ = R50,950
For a defined list of conditions you get unlimited cover for biokineticists, acousticians, physiotherapists, occupational therapists, and speech and language therapists. Speak to scheme directly

External appliances: R64,200 per family from day-to-day benefit

R32,450 per family paid from day-to-day benefit
Bone-anchored hearing aids: R155,850 per person
Processor upgrades: R81,050 per person, every three years

See "General Appliances", above

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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 (2027):

Discovery: Smart Comprehensive

Assume scheme pays all these costs, unless otherwise stated

	Main Member:	Adult:	Child:
Savings:	R14,292	R13,200	R3,336
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R20,518	R21,610	R3,314
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	R31,100	R31,100	R7,770
Other Day-to-Day Funds:	Scheme awards you with money if you complete personalised health and lifestyle actions You need to activate the benefit on the app, and fulfill the personalised pathways These can be things like: get a mammogram, complete a dental checkup etc Personal Health Fund: up to R3,000 per adult and R1,500 for child. Maximum R12,000 per family Personal Health Fund Boost: up to an additional R1,500 per adult, per completed challenge. Maximum two challenges per adult, and R12,000 per family. Challenges take 5-10 weeks to complete, and are meant to build habits The fund money can be used for most out-of-hospital claims

27 PMB conditions: Covered. You can see the full PMB list here.

Schedule 3 and above
If you are not on formulary, there can be a 25%-50% co-payment
From day-to-day benefit, up to the limits below

Main member = R45,300
Main+1 = R53,100
Main+2 = R61,650
Main 3+ = R70,300

From day-to-day benefit
These do not add up to the annual threshold, and are not paid for from it

See "Acute Medicine" benefit

See "Acute Medicine" benefit, above

Oncology Innovation Benefit: certain sub-set of specialised medicine, scheme pays up to 50% of scheme rate

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

More benefits for this plan >>