The Discovery Health Medical Scheme (DHMS), the country’s largest, says the increase in medical contributions will come into effect from April 2023 instead of January. It says the scheme is “cost-optimal for expected requirements”.

This is the third year in a row that he has delayed an annual increase in membership fees. The exact increases will be known at the end of February.

Dr. Ryan Noach, CEO of Discovery Health, says, “At the moment, both consumer price inflation (CPI) and the outlook for health care utilization remain volatile. It is important that the increase in contributions accurately reflects the underlying changes in cost and use in 2023. The final increase will be in line with medical inflation, which is typically 3-4% above CPI.”

Discovery reports that due to the three-month grace period, members will experience real growth from CPI to CPI+2% over the course of the year.

Noach says the scheme’s “reserves have increased over regulatory solvency requirements due to the significant decline in non-COVID health claims recorded during the pandemic and into 2022” and that this “excess solvency has been used to the benefit of members “.

Read: Discovery: Profitable in the Pandemic

The three-month deferral next year will amount to 1.9 billion rand in member savings.

Including this amount, a total of R8.7 billion has been saved through delays since the onset of Covid-19, which has caused “related disruptions to the health system”. DHMS claims it is the only health scheme in the country to have deferred increases for members and that its “effective annual contribution increase … has been 50 basis points below market” over the past two years.

Read: How much DHMS pays Discovery to provide your health care

At the end of June, DHMS had an unverified solvency of 36%. The regulated level required by medical schemes is 25%. DHMS accounts for 57.6% of the open scheme market and approximately 40% of all schemes, including the Government Employees Medical Scheme (GEMS).

Wealth Fund

Noah says that starting in January, DHMS will “make its excess solvency reserves available to fund an expanded range of screening and preventive health care for members through the new Wellth Fund.”

It will complement this with “a new disease prevention program to proactively identify and support participants at increased health risks.”

Read: TymeBank and Dis-Chem enter the health insurance market

The Wellth Fund will use the additional capital at DHMS to provide a one-off grant of up to 10,000 Rand per family for an expanded range of screening and preventive health services that can be used over the next two years.

To activate this benefit, you must pass a life test this year.

This will set the participant’s base health level. Once this is done, members will be able to access up to R2,500 per adult and R1,250 per child for “six broad categories of health check-ups and preventive health services, including general health, physical health, mental health, women’s health, health men, and children’s health”.

Medical monitoring devices for certain health measurements will also be covered.

“The Wellth Fund represents the best use of the scheme’s excess solvency reserves,” says Nouch.

“It also makes good economic sense, given that improved health outcomes for program participants mean a long-term and sustained reduction in claims, with a nine-fold return on investment to fund the screening and prevention offered through the fund.”

In addition, participants identified as being at risk of diabetes or cardiovascular disease (using screening and medical records) “will be asked to see their GP to confirm their risk and be enrolled in a 12-month risk-adjusted treatment program for clinical support and treatment.”

“The program includes access to a therapist, nutritionist, pathology testing and 12 workouts.”

A smart rookie in the lineup

Discovery Health will introduce a new plan, the Essential Dynamic Smart plan, which is based on a dynamic hospital network.

It will use its own artificial intelligence algorithm to determine the most efficient hospital according to the participant’s requirements at a given point in time.

The plan offers full funding for “hospitalization and care within this preferred network, optimally balancing cost and quality choices.”

Network restrictions do not apply to emergencies.

“For many members, the trade-off between lower co-payments and hospital networks is compelling when choosing a health plan,” says Nouch. “The new Essential Dynamic Smart plan enters the market as the most affordable in the Smart range in 2023 at a compelling price of R1 450 per month, which also makes it the lowest cost per unit of benefit among comparable plans in open health schemes. »

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