A motion to review access to healthcare for transgender and gender diverse members has been narrowly approved at the Discovery Health Medical Scheme (DHMS) AGM, receiving votes of 52% in favour of the motion, with 30.29% against it and 17.71% abstentions, reports Moneyweb.
DHMS’ rules govern how written proposals should be submitted to the scheme as well as how these are considered by its board.
All motions received by its principal officer were reviewed and one motion (this one) was put to this year’s meeting.
According to the motion, at a minimum, this review should include – among other requirements – “adequacy, fairness and transparency of current benefit design and funding criteria applicable to healthcare for transgender and gender diverse members, including hormone therapy and gender-affirming surgical interventions”, as well as “whether current … rules, clinical criteria, managed care protocols and decision-making processes are enabling or impeding fair access to clinically appropriate healthcare”.
The motion requests that the review “be guided by relevant clinical evidence and by South Africa’s constitutional values of equality, dignity, privacy and access to healthcare, and should include meaningful engagement with affected members and… qualified clinical, legal and human-rights experts with relevant expertise in human-rights-centred transgender and gender diverse healthcare”.
The board of DHMS must report back to members on the review’s findings as well as any recommendations arising from it.
Pilot programme
Discovery Health began a pilot programme in 2018 which pays for surgery as well as hormone replacement therapy (HRT) for transgender patients, according to a 2026 SA Journal of Human Rights paper.
Thus far, it has approved care for two of the five patients who applied to take part in the programme.
One report from 2021 said Discovery’s cover under this programme remains “limited” and references a “lifetime limit” (at that time) of “R200 000 in partial payment benefits”.
The pilot programme is only available to members on the Executive and Comprehensive plans.
Present landscape
The author of the January 2026 paper, Sophy Baird, surveyed six of the country’s largest medical schemes and found that the Government Employees Medical Scheme (GEMS), Fedhealth and Profmed all “require members on HRT to pay for chronic medication from their medical savings, and once that is exhausted, from their own pockets”.
Under the Medical Schemes Act, all schemes have to cover the cost related to the diagnosis, treatment and care of an emergency medical condition, a defined list of 271 diagnoses, and a defined list of 27 chronic conditions, as prescribed minimum benefits (PMB). This includes lifelong conditions like asthma, diabetes or hypertension.
Currently, medical aids in South Africa typically classify HRT as non-PMB or “elective” care.
The Medical Schemes Amendment Bill (the draft of which was published in 2018) proposes scrapping PMBs in favour of a more comprehensive package of conditions and services to be included in cover.
Other resolutions
The three other resolutions voted on at the AGM were passed with votes in favour of more than 75%. These were for the approval of trustee remuneration (75.72%), a non-binding vote on remuneration policy (75.14%) and the appointment of Deloitte as auditors for 2026 (94.83%).
DHMS did not disclose how many members voted, but at the start of the AGM, board Chair Michelle Norton confirmed that 91 principal members were logged onto the meeting (which was more than the requirement of 50 for quorum).
See more from MedicalBrief archives:
Transgender patients in SA face 10-year state surgery clinic backlog
Global human rights award for SA psychologists’ LGBTQIA+ research
HPCSA and UCT investigate doctor over ‘curing’ of transgender children