2026 Rules Active
2026 Validated
Lower Premiums with Smart Hospital and GP Network and R75 GP Co-Pay
Actuarial Objective
For urban members comfortable with Smart hospital and GP networks, leveraging unlimited Smart-network GP visits with a small co‑payment and reduced contributions versus full Classic Comprehensive.
Running Actuarial Simulation...
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Bestmed
Beat2
Strategy: Network Savings Account Single Starter
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Discovery Health Medical Scheme
Classic Delta Core
Strategy: Classic Core Single Hospital-Only with PHF
Key Terms for this Strategy
- Elective Procedure Co-payment
- A mandatory upfront fee you must pay to the hospital for specific scheduled surgeries (like hip/knee replacements) that are not emergencies.
People Also Ask
What happens if I need to go to a hospital that's not in the Smart Network?
If you have a planned admission outside the Smart Hospital Network, you will have to pay R12,650 upfront, and the scheme will pay the rest at the agreed rate.
If I get diagnosed with cancer, what is my maximum cover before I start paying more?
Cancer cover is limited to R250,000 over a 12-month cycle at 100% DHR in network, and after that the plan pays up to 80% of DHR (so you may face a 20% shortfall on further approved treatment).
Do I really have to pay almost R10,000 upfront just to have scopes done?
Yes—if both a gastroscopy and colonoscopy are done in the same admission outside the Day Surgery Network, the stated upfront payment is R9,950 (R8,000 hospital + R4,650 day clinic, which can reduce to R8,250 if a value-based network doctor performs the scopes).
If I do scopes in a doctor's rooms at a non-network provider, is there still a co-payment?
Yes—when scopes are performed in-rooms at a non-network provider, the stated co-payment for bi-directional scopes is R3,100.
If I need an MRI that isn't linked to a hospital admission, do I pay first?
If the scan is not related to an approved hospital admission, you must pay the first R4,000 and the balance will be paid from your Hospital Benefit (up to DHR).
How much do I actually pay every month in 2026 as the main member?
From 1 April 2026 the main-member contribution shown for Classic Smart is R3,018 per month.
Do I get a Medical Savings Account on this plan?
No—the Smart plans do not include a Medical Savings Account. Instead, you have access to a Personal Health Fund (up to R8,000 base for adults on Classic Smart) which you can earn by completing your Personal Health Pathway actions.
If I need a planned hip or knee replacement, what's the risk if I go outside the scheme's network providers?
For planned hip and knee joint replacements outside the network, the plan's payment is limited (it pays up to 80% DHR, capped at R31,800 per prosthesis per admission), so there can be large shortfalls if providers charge more.
How much do I pay to see my Smart GP every time I go?
Unlimited consultations with GPs in the Smart GP Network are available, but you pay a R75 co-payment for each consultation (the balance is covered up to 100% of DHR).
How many antenatal visits and pregnancy scans are actually covered?
The Maternity Benefit states cover for up to 8 antenatal consultations and up to two 2D ultrasound scans.