Here’s what you get:
Unlimited private hospital cover in the Smart Hospital Network
Guaranteed full cover in hospital for specialists who we have a payment arrangement with, and up to 200% of the DHR on Classic and up to 100% of the DHR on Essential for other healthcare professionals
Full cover for chronic medicine on our formulary for all Chronic Disease List conditions on our medicine list when you use MedXpress or a MedXpress Network Pharmacy.
Cover for comprehensive pre- and postnatal healthcare services and maternity and early childhood
Day-to-day cover for your GP consultations, acute medicine cover for over-the-counter (OTC) medicine, eye and dental check-up and sports-related injuries, with fixed co-payments and/or limits. This cover depends on the plan you choose
Cover for medical emergencies when travelling
Our Smart Plan
| Classic | Essential | |
|---|---|---|
| Hospital cover | ||
| Unlimited private hospital cover at a network hospital | ||
| Full cover with a specialist we have a payment arrangement with | ||
| Specialists we don't have a payment arrangement with are covered at a percentage of the Discovery Health Rate | 200% | 100% |
| Other healthcare professionals are covered at a percentage of the Discovery Health Rate | 200% | 100% |
| Chronic illness cover | ||
| Chronic condition: Cover for 27 Chronic Disease List conditions (once approved) according to the Prescribed Minimum benefits | ||
| Chronic medicine: Full cover for approved medicine on our medicine list at a designated service provider pharmacy | ||
| Cancer cover | ||
| We cover a set amount in full over a 12-month period. Costs above this amount attract a 20% co-payment. Prescribed Minimum Benefit conditions are covered in full. On Essential Smart we cover cancer treatment in our network. | R200 000 | R200 000 |
| Day-to-day cover | ||
| Unlimited GP consultations with a fixed co-payment for each consultation | R55 | R110 |
| One eye test at an optometrist with a fixed co-payment for the test | R55 | R110 |
| One dental check-up with a fixed co-payment for the check-up | R110 | R165 |
| Cover for acute medicine categories, up to an annual limit | ||
| Cover for over-the-counter (OTC) medicine obtained from a network pharmacy | ||
| Cover for sports-related injuries: basic X-rays, two specialist visits and a total of four visits to either a physiotherapist, biokineticist or chiropractor when referred by a Smart Network GP. You will have to pay R110 for each visit | ||
This is only a summary of the key benefits. Please consult the health plan guide for more details. Discovery Health Medical Scheme Rules apply.
