Discovery Health Medical Scheme · Specialised medicine and technology

Specialised Medicine and Technology Benefit (SMTB)

Additional cover for a defined list of high-cost medicines, new technologies and procedures for members meeting clinical entry criteria.

Clinical entry criteria applyAccess turns on a clinical threshold the scheme sets, assessed on your own case — not on choosing it.

How: Member applies; entitlement upon meeting clinical entry criteria (Annexure B 16.1)

“To access this benefit ... you must meet the benefit entry criteria which are developed using evidence-based medicine.”

At a glance

Scheme: Discovery Health Medical Scheme
Benefit area: Specialised medicine and technology ⚠️ our best match, not the scheme’s own label
Who it is for: Named options — listed below
Limit: R200 000 per person per year · 80% or 100% of DHR or Reference Price by treatment · each year
Who qualifies: Defined list of conditions/indications meeting entry criteria.
Where you may go: Scheme DSPs — difference payable where provider charges above DHR

“additional cover for a defined list of high-cost medicines, new technologies and procedures up to a limit of R200 000 for each person, each year”

“Where the provider charges more than the Discovery Health Rate (DHR), you will have to pay the difference.”

Which plans carry it

Executive Plan Classic Comprehensive

Named in the scheme’s own documents.

“This benefit is not available on the Classic Smart Comprehensive Plan.”

Where this comes from

Discovery 2026 -specialised-medicine-and-technology-benefit.pdf, p.1-2 · benefit_guide. Read from that document on 2026-08-29 for the 2026 plan year.

Every statement on this page is read from a Discovery Health Medical Scheme document and quoted so you can check it. Where a document says nothing, this page says so rather than filling the gap.

Check what your own plan leaves you to pay Your plan, your family, your conditions — the shortfall in rands before you choose a gap policy.

Programme rules are set by the scheme and change at renewal. This page renders what Discovery Health Medical Scheme’s own documents say, with the wording quoted so you can check it. Confirm with the scheme before you rely on it.