Yes. You will have to pay an upfront payment of R12,650 for planned admissions to hospitals not in the Smart Hospital Network. It is essential to use a Smart Hospital Network facility to avoid this significant out-of-pocket cost.

After you reach the R250,000 Oncology Benefit limit in a 12-month cycle, the Scheme continues to cover up to 80% of the Discovery Health Rate for subsequent additional cancer treatment costs (excluding PMB cancer treatment, which remains covered in full).

Yes. All cancer-related healthcare services under the Oncology Benefit are covered at a network provider. Using designated service providers for oncology medicine also helps you avoid a 20% co-payment.

Often yes. For a single scope in hospital, you pay R8,000 from day-to-day benefits (or upfront if insufficient funds). For both gastroscopy and colonoscopy in the same admission, you pay R9,950. These amounts reduce if your doctor is part of the Scheme's value-based network. No upfront payment applies if the scope is for a confirmed PMB condition, dyspepsia (when indicated and approved), the patient is 12 or under, or it's done in-rooms at a network provider.

You must nominate a Smart GP in the Discovery Health Network to be your primary care doctor, especially to manage chronic conditions. For full cover on GP consultations, you must visit your nominated primary care network GP. Seeing a non-nominated GP may result in a co-payment.

No. The Scheme pays up to the Discovery Health Rate from your Hospital Benefit only if the MRI is related to your current approved hospital admission. If it's not admission-related or is for conservative back/neck treatment, the first R4,000 is paid from your available day-to-day benefits (MSA/Personal Health Fund), with the balance from Hospital Benefit.

Medicine not on the medicine list formulary is covered up to the therapeutic reference price. You must use a network pharmacy to avoid a 20% co-payment on chronic medicine.

If you use a provider in the Scheme's network, there is no limit for planned hip and knee joint replacements. If you use a provider outside the network, the Scheme pays up to 80% of the Discovery Health Rate with a maximum of R31,850 for each prosthesis per admission (the network does not apply to emergency/trauma-related surgeries).

You get unlimited consultations with GPs in the Smart GP Network. You pay R75 per consultation as a co-payment, with the balance covered at 100% of the Discovery Health Rate. Video consultations with your Smart Network GP are covered in full up to the DHR.

The Maternity Benefit includes up to 8 antenatal consultations, up to two 2D ultrasound scans (or one 2D plus a nuchal translucency test), defined blood tests, one flu vaccination during pregnancy, and after birth, two visits to a GP/paediatrician/ENT for your baby under age 2, plus postnatal care services. You must activate the benefit by creating a pregnancy/baby profile or preauthorising your delivery.