Product Information Brochure
Product Information Brochure
INFORMATION
24 BROCHURE
PRODUCT
INFORMATION BENEFIT AND
CONTRIBUTION
UPDATES FOR 2024
ENTER
Discovery Health Medical Scheme for 2024
ONTEN
Balancing affordability, Transforming members’ healthcare Creating personal health pathways
sustainability and value for members experience with the new Discovery for all qualifying members
in 2024 and beyond Health app In 2024, all Discovery Health Medical Scheme
Increases to contributions for 2024 will be plan Your gateway to a personalised, end-to-end members will have access to a personal health
specific and will range from 0% to 12.9%, to maintain healthcare journey. Conveniently access care and pathway that predicts the most important actions
contributions in line with expected claims experience, manage your health and health plan benefits in a they can take to improve their health.
while supporting affordability for members. single app. The new app also enables new benefits Members are encouraged to complete actions
Targeted plan and benefit updates for the for all members of Discovery Health Medical Scheme, through an intelligent, gamified experience, which
Comprehensive series and KeyCare series ensures including Virtual Urgent Care, Virtual Physical Therapy, we have personalised for every qualifying member
long-term sustainability of the benefits offered by the Mental Health Assessment Benefit and digital on the Scheme.
these plans. therapeutics for mental health.
GENERAL SCHEME UPDATES Both the content in this brochure and January 2024 contributions are awaiting formal approval from the Council for Medical Schemes.
In all instances, Discovery Health Medical Scheme Rules prevail.
PLAN-SPECIFIC CHANGES
TO YOUR HEALTH PLAN
Discovery Health Medical Scheme, registration number 1125, administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes. The Discovery Health app and Personal Health Pathways are brought
to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financialservices provider and administrator of medical schemes.
2024 Contribution
updates
2024
contribution
2024 Benefit
update
Ensuring high-value, affordable healthcare cover in 2024 and beyond. In 2023, Discovery Health Medical Scheme
has maintained its strong financial position and continues to deliver exceptional value for you, amidst challenging
economic circumstances.
The 2024 increase in Scheme contributions is aimed at supporting you with improved affordability, ensuring you
Personal Health
continue to enjoy high-value cover, while strengthening the long-term sustainability of the Scheme. Pathways
For specific information about the 2024 contributions on each health plan series, please view the
Contribution Tables and health plan guides on our Product Information Page
2024 Contribution
updates
2024 Benefit
update
2024 general
benefit updates
Discovery Health
app and digital
benefits
Personal Health
Pathways
Simple nomination CARE COORDINATION BY A SINGLE PRIMARY CARE GP IMPROVES HEALTHCARE OUTCOMES
2024 Contribution
process with a wide Primary care GPs manage your day-to-day healthcare needs. Your primary care GP establishes your health history, does your screening
and prevention tests, coordinates specialist referrals where necessary, and makes recommendations to improve your health and wellness.
updates
network of providers This coordination of care is particularly important for the effective management of complex health conditions. This includes the more
to choose from prevalent chronic illnesses, such as diabetes and cardiovascular diseases.
01 02
Members registered for a Prescribed
Minimum Benefit chronic condition must
nominate one of the 4,600 primary care
GPs participating in the Discovery Health Navigate to Get care Confirm primary
2024 Benefit
GP Network1. Discovery Health’s extensive on the Discovery Health care GP update
GP Network ensures that quality care app If you have visited a Discovery
is conveniently available.
Click on the primary care GP Health network GP before,
option on the Get care tab. you can simply confirm the
For all members registered for an nomination of the GP.
approved chronic condition on all health
plans except the Executive Plan, to make
sure you continue to receive full payment
for your chronic illness consultations, you
can follow the simple process to nominate Discovery Health
app and digital
a primary care GP through the Discovery benefits
03 04
Health app, the Discovery call centre or
your chosen network GP.
Hospital Network for the on KeyCare, Smart and Delta plans. The designated service providers include Discovery Home Health,
updates
programme
2024 Benefit
If you need to be admitted for one of the following You must meet the following criteria to be eligible for With the Home-based Hospital Network, treating doctors update
conditions, the Home-based Hospital Network would treatment through the Home-based Hospital Network: can choose which network facility their patient will be
be the designated service provider for the admission. admitted to at the time of pre-authorisation.
Be an adult member (18 years or older)
This is if you meet the additional eligibility criteria.
Need hospital-level care that can be given The following home-based providers are included
in a general ward on the network:
If you and your admitting doctor opt out of home-based care in cases where you meet
the eligibility criteria, then a deductible of R5,000 will apply to your hospital admission.
Seamless Discovery Hospital at Home patient experience 2024 Contribution
updates
01 02 03
CLINICAL ASSESSMENT DOCTOR REFERRAL CARE COORDINATION AND HOME SETUP
The doctor completes Within two to four hours The home monitoring kit includes:
You go to casualty or your
the Discovery Hospital of admission, the assigned
doctor’s rooms and get
at Home application nurse meets the patient
a comprehensive clinical 2024 Benefit
form and submits the at home, where they:
assessment from a doctor. update
referral to Discovery
After the doctor determines Help you settle in and
Health.
that you are eligible for assess you.
The doctor also shares Wearable Blood pressure cuff UPS backup Smartphone with dual sim
treatment at home, the Set up the monitoring
your personalised monitoring device and pulse oximeter for charging and preloaded data
doctor recommends
treatment plan with devices.
Discovery Hospital at Home
the Discovery Hospital Tell you how the You’ll get wearable monitoring devices with batteries that last up to 20 hours and a UPS
for your treatment.
at Home care team. Discovery Hospital at battery for charging in the case of loadshedding. You also get a smartphone with roaming
capabilities, a dual sim and data to make that you stay connected at all times.
Home processes work.
All monitoring devices seamlessly integrate to the Biofourmis mobile app that is
accessible through the provided smartphone. Discovery Health
app and digital
05 04 benefits
We’ll apply the yearly changes and Chronic Drug Amount From 2024, we’ll add a Therapeutic Reference Price – Overseas Treatment Benefit
updates on 1 January 2024. We’ll add generic reference for all biologic therapies across conditions covered by – Specialised Medicine and Technology Benefit
Discovery Health
app and digital
pricing, where there is a generic alternative for a Chronic on the Specialised Medicine and Technology Benefit
– Surgical and appliance items, including hip, benefits
Disease List (CDL) medicine in 2024. We pay medicine The reference price will apply to all new approvals
knee and shoulder joint prosthesis, and
on the medicine list in full. from 2024 onwards.
external medical appliances.
We pay medicine that is not on the medicine list up to Oncology
In 2024, spinal prosthesis limits will be updated
the Chronic Drug Amount (CDA) according to the chosen
In 2024, we’ll add generic reference pricing for by plan, where a non-network supplier is used.
plan type. The Discovery Health Rate (DHR) or Generic
chemotherapy and supportive oncology medicine,
Reference Price also apply, whichever is applicable.
where a generic alternative exits. We’ll pay approved
oncology medicine up to the maximum of the Discovery
Health Rate or the Generic Reference Price, whichever
applies, and depending on the Oncology Threshold. Personal Health
Pathways
2024 Contribution
updates
Discovery
Health
2024 Benefit
update
benefits
benefits
Personal Health
Pathways
Introducing the new Discovery Health app 2024 Contribution
updates
The new Discovery Health app is available to all members of Discovery Health Medical Scheme from 26 September 2023.
The app contains all past digital innovations Discovery Health introduced, while the design has been optimised for intuitive
navigation by members. The app also enables a number of new digital healthcare innovations and benefits for members and
creates a link into a connected digital health ecosystem that will continue to expand over time.
Discovery Health
app and digital
benefits
Available NOW
The Discovery Health app is brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07,
an authorised financial services provider and administrator of medical schemes.
Introducing Virtual 2024 Contribution
updates
Discovery Health has partnered with experienced and highly skilled doctors
from ER Consulting who are available 24/7 to diagnose and treat you and
dispatch an ambulance if they think it is necessary.
‘Speak to a doctor now’ on We pay for appropriate urgent care consultations from your risk benefits (Hospital Benefit)
the new Discovery Health app. up to the annual benefit limit on all Discovery Health Medical Scheme plans. If the consultation
is for non-urgent care, we pay from your available day-to-day benefits.
Note: KeyCare Start Regional members must access urgent care through the KeyCare Personal Health
Online Practice Pathways
The Discovery Health app is brought to you by Discovery Health (Pty) Ltd; registration number
1997/013480/07, an authorised financial services provider and administrator of medical schemes.
Introducing Virtual 2024 Contribution
updates
Physical Therapy
Evidence-based physical ANYTIME ACCESS TO EVIDENCE-BASED
VIRTUAL PHYSICAL THERAPY
rehabilitation - done online
through video and supported by
artificial intelligence technology
CONVENIENT RECOVERY FROM ANYWHERE
- which conveniently extends
the connection between The curated exercise and rehabilitation programme prescribed by your
patients and allied healthcare healthcare provider is easily accessible from anywhere, 24/7. 2024 Benefit
update
professionals into the comfort
of the patient’s home.
Discovery Health
COACHING SUPPORT app and digital
benefits
You have direct access to coaching for better recovery outcomes through
virtual consultations or through the chat function.
Available via the My health
tab on the new Discovery
Health app.
The Discovery Health app is brought to you by Discovery Health (Pty) Ltd; registration number
1997/013480/07, an authorised financial services provider and administrator of medical schemes.
Introducing the 2024 Contribution
Mental Health
updates
MENTAL HEALTH IDENTIFYING MEMBERS ACCESS TO IMMEDIATE
ASSESSMENT TO IMPROVE WHO ARE AT RISK OF RISK-FUNDED BENEFITS
Assessment YOUR AWARENESS OF
YOUR MENTAL HEALTH
DEVELOPING A MENTAL
HEALTH CONDITION
FOR DIAGNOSIS AND
REFERRAL
Benefit
Level of risk Benefits
therapeutics for
mental health ON-DEMAND, CLINICALLY PROVEN DIGITAL
THERAPEUTICS FOR MENTAL HEALTH
Personal Health
Pathways
The Discovery Health app is brought to you by Discovery Health (Pty) Ltd; registration number
1997/013480/07, an authorised financial services provider and administrator of medical schemes.
Comprehensive support along the full mental health journey 2024 Contribution
updates
The Mental Wellbeing Assessment and Silvercloud’s internet-based congnitive behavioural therapy platform
boosts the comprehensive and proactive support for mental health, from early identification to clinically relevant
treatment and ongoing management of more severe conditions.
2024 Benefit
update
GP consultations
Resillience Sleep
Access to digital therapeutics for
mental health for any member
Available to all members. Mental health risks are evaluated through If you are at-risk of depression, you have
re-assessment and clinical data. access to risk-funded interventions.
Personal Health
Pathways
The Discovery Health app is brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes.
2024 Contribution
updates
Creating
personal
2024 Benefit
update
Medical Scheme, to make people healthier, giving each qualifying member a personalised healthcare pathway through the new
Discovery Health app and an intuitive WhatsApp journey. This will make it easy for you to know what will have
everyone can be healthier the biggest effect on your long-term health.
PERSONALISED HEALTH
PATHWAYS TO NAVIGATE 2024 Benefit
MEMBERS TO BETTER HEALTH update
Personal Health
Pathways
Available to qualifying members in 2024
Personal Health Pathways are brought to you by Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes.
2024 Contribution
updates
changes to your
health plan
Discovery Health
app and digital
benefits
Personal Health
Pathways
Simplification of the We are consolidating the Comprehensive plans in 2024 to simplify
Comprehensive series. 2024 Contribution
Comprehensive We are combining the Comprehensive plan range into two options:
updates
series
Classic Comprehensive
Classic Smart Comprehensive
This makes the plans more competitive with the extensive day-to-day cover
that the Comprehensive series is known for, at a more affordable price point.
AFFORDABLE COVER
CONSOLIDATING THE COMPREHENSIVE SERIES INTO TWO PLANS FOR EXTENSIVE DAY-
TO-DAY BENEFITS 2024 Benefit
update
Comprehensive plans series Comprehensive plans series The Discovery Health Medical
If you are currently on the Classic Delta Comprehensive, Essential Comprehensive, or Essential Delta Comprehensive plan, to ensure that you
remain covered as a member of the Comprehensive series, we’ll move you to either the Classic Comprehensive or Classic Smart Comprehensive
plan from 1 January 2024 if we dont receive a plan option from you. These plans offer you the most similar benefits based on your Personal Health
current benefits and healthcare claims. Pathways
You do have the option to select a new health plan that is right for you any time before 31 December 2023. You can make this selection
with the support of your financial adviser, which we recommend, or you can decide for yourself by reading and understanding the
Comprehensive series health plan guide here.
Optimisation of day-to-day benefits on the Saver series in 2024 2024 Contribution
updates
2024 Benefit
Economic pressures from rising interest After careful consideration of the current economic climate, Discovery Health Medical Scheme aims to optimise update
rates, slow growth and high levels of affordability for its members by reducing the Medical Savings Account (MSA) contributions on the Saver series in 2024:
consumer price inflation have placed
Classic Saver and Classic Delta Saver
Coastal Saver MSA contributions will
Essential Saver and Essential Delta
substantial financial strain on affordability
MSA contributions will reduce from reduce from 20% to 15%. Saver MSA contributions will reduce
for members in 2024.
25% to 20%. from 15% to 10%.
To maximise value for members, the Scheme will be enhancing the risk-funded day-to-day benefit offering in 2024 for key categories
of healthcare where members would typically utilise MSA funds.
These enhancements include:
Discovery Health
app and digital
Mental health preventative screening and access to the
Urgent care cover through the virtual urgent care platform.
benefits
Cognitive Behavioural Therapy (iCBT).
In 2023, 7.3% of MSA funds were used to pay for mental health and casualty care. The allowance for these risk funded
benefits will help members extend the life of their MSA balances and increase the value of DHMS’ day-to-day benefit offering.
In addition, all new and existing members can continue to access valuable day-to-day benefits through the funds available in
their WELLTH Fund, which continues over 2024.
Personal Health
Pathways
2024 Contribution
BENEFIT CHANGES AND updates
NETWORK OPTIMISATION
We’re committed to improving the quality and coordination of your care. That’s
why we’ve made changes to your day-to-day cover for GP healthcare services,
so that you can continue to get the right support you need from the primary
KeyCare GP you have nominated.
From 1 January 2024, your day-to-day cover for the secondary KeyCare GP you
have nominated will be removed, but you’ll continue to have day-to-day cover
for visits to the primary KeyCare GP you have nominated, as well as the option 2024 Benefit
We will share the details of this new network with you in a separate
communication soon.
We have made changes to the KeyCare Hospital Network for 2024, and you
can find the list of KeyCare Hospital Network to make sure we offer the highest
quality of care, efficient healthcare delivery and value for members.
Discovery Health
app and digital
benefits
Personal Health
Pathways
*
Y
ou can easily find a network provider using the Find a healthcare provider function on the
Discovery Health app or website
Discovery
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Discovery Vitality is not part of the Discovery Health Medical Scheme. Vitality is a separate product sold and administered by Discovery Vitality
(Pty) Ltd.Registration number: 1999/007736/07. Limits, terms and conditions apply.
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