Discovery Health - Essential Smart Plan Medical Aid Plan

Discovery Health - Essential Smart Plan

Cost-effective medical aid, combining full cover for private hospitalisation at a network hospital (with cover for in-hospital specialists at up to 100% of the Discovery rate); cover for chronic medication for conditions on the Chronic Disease List (CDL) subject to use of a MedXpress pharmacy; and a range of day-to-day benefits.

The plan features day-to-day cover for unlimited network GP visits, with a co-payment of R120 per visit. It also includes cover for one optometrist visit with a co-payment of R120 and one dental visit with a co-payment of R180, and some cover for over-the-counter medicine from a network pharmacy.

This is a good choice for entry-level consumers hoping for both hospital cover (subject to network limitations) and a way to manage day-to-day medical expenses.

In Hospital Benefits

Overall Annual Limit

Unlimited at 100% (Discovery Health Rate)

Provider

Network hospitals

GP's & Specialists

GP's & Specialists: Unlimited
Radiology & Pathology: Unlimited
Oncology: R250 000 (80% after)
Organ Transplants: Treatment Plan
Dialysis: Treatment Plan
Internal Prosthesis: Procedure based

Chronic

27 PMB's

Out of Hospital Benefits

Saving / Day to Day / OHEB

GP VISITS+ NETWORK

R 120 co-payment, 1 eye test with co-pay of R120, dental check up:1 with co-pay of R180, R560 OTC all at Network

Pooled Day to Day Benefit

Not applicable

Threshhold / Safety Net

Not applicable

Self-Payment Gap Before Threshold

Not applicable

Above Threshold Limits

Not applicable

Maternity Care

8 Consultations, 2 scans, certain blood tests and post natal visits

Contributions

Contributions

Member: R 1 881

Adult: R1 881

Per Child: R1 881

 

 

 

 

 

 

 

 


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