For the next two years, Discovery Health Medical Scheme (DHMS) members will have access to a substantial amount of additional healthcare services in its once-off benefit, the Wellth Fund. It offers value of up to R10 000 per family (R2 500 limit per adult and R1 250 per child over two years old) until December 2024.
The benefit has been made available due to extra capital within the scheme. Discovery Health CEO Dr Ryan Noach says the “scheme’s reserves strengthened relative to regulated solvency requirements because of the significant decline in non-COVID healthcare claims recorded during the pandemic and into 2022” and that this “excess solvency has been used to the benefit of members”.
Already, it has delayed the increase in medical aid contributions for the third year running.
Increases for 2023 will only take effect in April due to the scheme being “optimally priced for expected claims”.
How to use the benefit
To activate the Wellth Fund, every member over the age of two on the DHMS scheme policy needs to complete an in-person Health Check at a provider in its network (this check is covered in full from the screening and prevention benefit across its different medical aid plans).
It says all health checks completed from 1 January 2022 will count towards unlocking the fund.
These health checks (effectively the Vitality Health Check, which earns a member up to 22 500 Vitality points) test and screen blood pressure, blood sugar, cholesterol, weight or body mass index (BMI), and there is a non-smokers’ declaration.
Importantly, these checks detect any possible health risks (ideally early), and help guide treatment and management of any conditions which are identified. This is of tremendous benefit to Discovery – and members – as it will lower healthcare costs over time (any savings will, in effect, be passed on to members in the form of lower annual contribution increases).
Once the checks are done, the Wellth Fund is unlocked. If your DHMS was activated before this year, the benefit is available until 31 December 2024.
New members who join this year or next will have access to the benefit until the end of the year in which they joined.
Discovery says that where healthcare services are also eligible for cover from another defined risk benefit (such as the Screening and Prevention Benefit), the claim is paid from “that benefit first” – and then only from the Wellth Fund “in instances where that benefit is depleted or unavailable”.
Healthcare services across five broad categories are available:
- General health – one consultation at a GP per person per year, dental check-up, eye check-up, hearing check-up, skin cancer screening, heart consultation and lung cancer screening for long-term smokers, as well as medical devices used to monitor blood pressure, blood sugar and cholesterol;
- Physical health – diet, nutrition and weight management at a dietitian, physical movement and mobility management at a biokineticist or physiotherapist, Fitness Assessment or high-performance fitness assessment in Discovery’s Wellness Network, and foot health at a podiatrist;
- Mental health – mental wellness check-up at a psychologist, paediatrician, nurse, social worker, registered counsellor or psychiatrist;
- Women’s and men’s health – gynaecological and prostate consultations with your doctor, and a bone density check; and
- Children’s health – children’s wellness visit, which includes growth and appropriate developmental assessments with an occupational therapist, speech therapist or physiotherapist.
Members need to be aware of four limitations:
- The limit of one GP visit per person per year is a hard limit, i.e. for all healthcare services. In other words, one cannot claim for a general check-up at a GP and then another visit for a gynaecological or prostate consultation. Any network rules also apply (i.e. Smart plan members must use GPs on that network, likewise for KeyCare Plus Plan members).
- Importantly, general scheme exclusions apply – meaning that if a member’s plan “excludes cover for specific services, the member may not claim for them from the WELLTH Fund”.
- Medication cannot be claimed for from the Wellth Fund.
- The Wellth Fund will pay claims for qualifying healthcare services up to a maximum of the Discovery Health Rate (subject to the overall benefit limit).
A dashboard on Discovery’s website (and in the app) will show how much of the once-off limit is available (this is not yet available but is imminent).
Noach says the Wellth Fund represents the best possible use of the scheme’s excess solvency reserves.
“It is also economically astute, considering that an improvement in the scheme members’ health means a long-term and lasting reduction in claims, with a nine-fold return on investment for funding the screening and preventive healthcare offered through the Fund.”