Discovery Health Medical Scheme (DHMS) has announced that its members will only pay more for their membership from 1 April 2023, instead of 1 January 2023.
Members will have access to a range of new and enhanced benefits from the beginning of next year, it said.
This is the third time the scheme has deferred annual contribution increases to provide financial relief for its members, the financial services firm said.
The 2023 increase will be announced in February to ensure careful alignment with medical inflation
Dr Ryan Noach, CEO of Discovery Health, said: “We will formally announce April 2023’s exact contribution increase, close to the end of February next year.”
“For now, both the Consumer Price Inflation (CPI) and healthcare utilisation outlook remain volatile. It’s important that the contribution increase accurately reflects underlying price and utilisation changes for 2023.
“The eventual increase will be in line with medical inflation which is typically 3% to 4% above CPI, though members will experience a real annual increase of between CPI and CPI + 2%, considering the deferral. As always, DHMS aims to accurately balance its long-term sustainability with short-term affordability for its members.”
New WELLTH Fund and Disease Prevention Programme
Discovery has introduced two new benefits to support members’ health and wellbeing, said Dr Noach.
“Effective 1 January 2023, the Scheme will make its excess solvency reserves available to fund an expanded range of screening and preventive healthcare for members through the new WELLTH Fund.
“The Scheme will complement this introduction with a unique new Disease Prevention Programme to proactively identify and support members with elevated health risks.”
Dr Noach said that Discovery Health’s data shows screening rates among members are worryingly below pre-pandemic rates. To mention a few key tests, general health checks are down 50%, mammograms down 15%, pap smears down 12 % and prostate cancer screening checks are down 10%.
The WELLTH Fund is designed to help members resume and reset their understanding of their health status and empower them to manage and improve their long-term health.
Through deploying excess solvency within DHMS to the benefit of members, all members will have once-off access to up to R10,000 per family for an expanded range of screening and preventative healthcare to be used during 2023 or 2024, the medical aid scheme said.
The WELLTH Fund is activated by completing a Health Check during 2022 or 2023 (covered by the DHMS Screening and Prevention Benefit). This sets the baseline for a member’s health status.
Once the member and all their dependants have completed their Health Checks, they will have access to up to R10,000 in their WELLTH Fund – R2,500 per adult and R1,250 per child – for a range of additional screening and preventative healthcare.
Members have access to six broad categories of health screening and preventative healthcare services, including general health, physical health, mental health, women’s health, men’s health, and children’s health. Medical monitoring devices for certain health measurements are also covered.
Disease Prevention Programme
Diabetes and cardiovascular disease are two of the leading causes of death in South Africa.
“Since diabetes and cardiovascular disease can have a significant impact on life expectancy and years spent in good health, it is critical that we can predict, intervene and support those members who are at risk of developing these conditions, especially as the Scheme makes a significant investment in health screening in 2023,” said Dr Noach.
Members identified as at-risk, through powerful predictive analysis of screening outcomes and personal health records, will be prompted to consult with a GP to confirm their risk and enrol them in the 12-month management programme, with risk benefits in place for clinical support and treatment.
The programme includes access to a GP, dietitian, pathology testing and 12 coaching sessions.
Upon completion of the programme, members will either exit, remain on medication to keep their risk under control, or they will be able to register for the DHMS Chronic Illness Benefit.
Essential Dynamic Smart plan
In 2023, DHMS will another innovation in hospital network management – the first dynamic hospital network.
Members will be able to assess the most efficient hospital for their admission requirements at a specific point in time. This includes specialist requirements for tertiary care based on their location, health status and healthcare needs.
Dr Noach, said: “The new Dynamic Smart Hospital Network represents a step forward in offering a new-age network that delivers further value for members who wish to select hospital network plans.”
“Discovery Health has developed a sophisticated proprietary artificial intelligence algorithm which dynamically optimises the ideal network choice for members. The Dynamic Smart Plan offers funding in full for hospitalisation and care within this preferred network, optimally balancing cost, and quality choices.”
The Dynamic Smart Hospital Network will support the introduction of a new plan on 1 January 2023 – the Essential Dynamic Smart plan.
“The new Essential Dynamic Smart plan enters the market as the most affordable in the Smart Series in 2023, at a compelling price point of R1,450 per month, also making this the lowest cost per unit of benefit among comparable plans in open medical schemes,” said Dr Noach.