Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Covered in full at the rate agreed with the hospital
Upfront Payments to hospitals:
An upfront payment applies for planned admissions outside of the Smart Plan Hospital Network or for a defined list of procedures performed outside of the Smart day surgery network R8 800
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy) You must pay the first R4 550 of the hospital account. The balance of the hospital account and related accounts will be paid from the Hospital Benefit.
Casualty / Emergency Visits:
We cover you in hospital for emergency hospital admissions.
Specialists:
Specialists we have a payment arrangement with Full cover Specialists we don’t have a payment arrangement with and other healthcare professionals 100% of the Discovery Health Rate (DHR)
Other healthcare professionals eg. Physio, Occupational, Dietician:
Other healthcare professionals, 100% of the Discovery Health Rate (DHR).
Radiology and pathology:
100% of the Discovery Health Rate (DHR)
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
You must pay the first R4 550 of the hospital account. The balance of the hospital account and related accounts will be paid from the Hospital Benefit. If done in the doctor’s rooms, you won’t have to pay an amount upfront.
MRI and CT scans:
If related to your admission, we cover your scan up to 100% of the DHR from the Hospital Benefit.
Dialysis:
have cover at a provider in a state facility.
Oncology / Cancer:
We will allocate you to a network provider
Joint Replacements:
Cover is limited to arthroscopies only.
Maternity Confinements:
You are covered for eight consultations with your gynaecologist, Smart network GP or midwife.
In Hospital Dentistry:
Hospital Younger than 13 R2 400 13 and older R6 200
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
21 days for admissions / 15 out-of-hospital consultations for each person for major affective disorders, anorexia and bulimia. 12 out-of-hospital consultations for acute stress disorder. 21 days for all other mental health admissions.
International Travel Benefit:
Cover for medical emergencies when travelling.
