Discovery Health Medical Scheme

Why we use Discovery health Medical Scheme

We use Discovery Health Medical Scheme for medical aid cover.

They are by far the largest open medical scheme, which means they have the biggest risk pool. This also gives them leveraging ability when negotiating for pricing.

Discovery Health Medical Scheme has opened a lot of networks, which you can see on their different plans. This means they have agreements with providers on those networks, which in turn also lowers cost. When you join a network plan, effectively you are agreeing to use that network as well, which in turn, lowers costs on those plans, which means you can pay a lower premium.

There have been digital innovations previously on Discovery Health, however. the launch of ‘Connected care’ this year is innovative and will institute a whole new way of using medical aids from now onwards. We can see that technology will really be your friend.

The first picture i had in my head was of a sick child, with a harassed mother running around looking after the other children (not sick) and needing to get her child to the doctor and no time and so on. Instead. she does a virtual consult, using the Tyto home device and the doctor prescribes the medicine and it is delivered by MedxPress, saving a whole lot of bother. And, most importantly… a happy child (and relaxed mother).

Mental health is a big challenge these days, Discovery Health are responding to this.

Discovery Health also offer company membership, the benefits to this are many… use of Heathy Company, possible relaxed waiting periods and late joiner penalties for members joining in the company. The interlinking of their Group Risk and umbrella Pension Fund and so on. The use of Vitality to keep an eye on the health of your staff, enhanced company reporting and obviously easier payroll administration.

Discovery Health Medical Scheme- Plan types

Discovery Health plan types range from the Keycare Series (income based), to the Executive plan.

To most people, cost is the biggest factor in choosing a plan.

A few tips when choosing your plan:

PMB’s (prescribed minimum benefits) dictate that chronics are covered. This means that all the plans cover the most prevalent chronic conditions (but make sure you read how they are covered). The Classic Comprehensive and the Executive plan cover more chronic conditions- be aware if you are looking for additional chronics to be covered.
Networks- if you are happy to use a network, this will help to lower the cost of contributions of your plan type (look through the network list-~~network-list 2020-(click link)~~ and make sure a hospital is near you). I have moved the network list to “how to choose a plan” below, as there are 4 lists for 2021.
Centres of excellence. These are being used for procedures that are done often in specific hospitals. If this is important to you, read up about it (for example: spinal surgery- there is a centre of excellence, which does these types of surgeries often and therefore have better outcomes).
Be aware to speak with Discovery Health’s call centre when you are considering having any planned procedure- to make sure it is authorised and to be sure about what is covered. Day surgeries are being used for a lot of procedures, scans etc. now- be aware.
Watch the video on Discovery Health updates, to get an idea of changes to the scheme benefits for 2021, it will also give you a greater understanding.
Waiting periods and late joiner penalties may apply when you join the scheme.
If you can afford it, take gap cover in addition to your medical aid. This can help prevent some very nasty “suprises” when you have a hospital event.
Shariah compliant plan options (same plans but with Shariah compliant arrangements are also available now).
If you cannot afford medical aid. Have a look at a Health Insurance plan or look at the Discovery prepaid health (app).
And the BIGGEST tip of all. The plans are not simple. Make sure that you read your plan guide. Make sure that you download the Discovery app if you have a mobile phone and register on their website, so that you can see benefits and claims and so on.

How to choose a plan

Think about how often you use medical services. If you can come to a rand amount monthly – good.
Plans mostly use a medical savings account (MSA). So choose a plan that can cover your monthly day to day medical costs with the monthly MSA.
If you are a high day to day user, look at the Comprehensive plans. They use a threshold benefit. This means that you use up your MSA, then you pay for an amount from your pocket, until you reach “threshold”. After that , your day to day usage is covered from the “Above Threshold benefit”. Have an expensive chronic condition not on the 27 chronics list? Look at the top plans. It may be possible that joining one of them could actually save you money if the chronic is covered in relation to the plan type cost.
If you want an income based plan, look at the Keycare options.
Make sure you understand waiting periods. These are to prevent people joining a scheme only when they are sick and leaving when healthy.
Make sure you understand late joiner penalties. This can affect you when you are over 35. It can affect the premium/ contribution and therefore your plan choice.
Look and make sure a hospital near you is on the network list (just below this paragraph, you an download the lists for 2021).

dhms-hospital-network-list-2021

dhms-major-joints-network-list-2021

dhms-keycare-gp-network-list-2021

dhms-day-surgery-network-list-2021

I know that this is very summarised, as understanding all of these things can be difficult. Get a broker to help you. Remember to make sure you understand what is expected of you.

I have put the plan type videos from Discovery below, with the related written guides. If you still need help, use the contact form that is at the bottom of this page.