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. Strategy reference: ork-2026.

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). Strategy reference: ork-2026.

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). Strategy reference: ork-2026.

Yes—when scopes are performed in-rooms at a non-network provider, the stated co-payment for bi-directional scopes is R3,100. Strategy reference: ork-2026.

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). Strategy reference: ork-2026.

From 1 April 2026 the main-member contribution shown for Classic Smart is R3,018 per month. Strategy reference: ork-2026.

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. Strategy reference: ork-2026.

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. Strategy reference: ork-2026.

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). Strategy reference: ork-2026.

The Maternity Benefit states cover for up to 8 antenatal consultations and up to two 2D ultrasound scans. Strategy reference: ork-2026.