Discovery Smart Comprehensive:
prosthetic benefits (2024)

This page has information on: Costs and Prosthetics for Discovery Classic Smart Comprehensive

We also have information for: In-hospital, Out of hospital, Medicine, Dentistry, Optometry, Maternity, Cancer, Mental Health, Other/Extra Benefits and Wellness and Preventative

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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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Prosthetics benefits (2024):

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

Discovery: Smart Comprehensive
Overal Limit:
  • Covered, subject to authorisation
Prosthetics required for PMB conditions are always paid paid in full by scheme, with no co-payment, if you follow the protocols. More info here
Sub-limits:
  • Shoulder joint prostheses: no limit, unless you use non-network supplier, then R45,550 limit applies
  • Hip and knee joints surgery: no limit, unless you use non-network supplier, then 80% scheme rate and R30,900 per prosthesis limit applies
  • Prosthetic devices used in spinal surgery: no limit, unless you use non-network supplier, then R26,250 limit for first level and R52,500 for two or more levels. Limited to one procedure per person per year.
  • Spinal surgery: no limit, unless you use non-network supplier, then 80% scheme rate
Note:
  • PMBs: Prescribed Minimum Benfits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs 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
.
.
.
Always consult with your broker before making final decisions regarding your healthcare cover.

    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

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