A low-cost medical scheme targeting new entrants and young professionals is in the pipeline from Discovery Health Medical Scheme, which says it will be the most affordable option on the market.
Active Smart is pencilled for launch on 1 January 2025, subject to approval from and registration by the Council for Medical Schemes (CMS), reports Business Tech.
Dr Ron Whelan, CEO of Discovery Health, said the new plan, costing R1 350 per principal member, was “a tailored solution”.
“Discovery Health data analysis shows that for members aged 20-29, around 7% of their income goes toward medical scheme contributions, whereas for older adults, 4% or lower of their monthly income goes toward these contributions.
“Our research estimates that 109 000 uncovered young professionals would take up medical scheme cover if there were an affordable option and where contributions amount to roughly 5% of their income.”
Features of the new plan include:
• Hospital Coverage: Full coverage for emergencies in any private hospital, and access to planned hospital admission in the Dynamic Smart Hospital Network, subject to a fixed deductible per admission.
• Day-to-Day Benefits: Unlimited virtual and in-person consultations with a Smart GP, a dental check-up, an eye test, and over-the-counter medication.
• Personal Health Fund: Members can accumulate up to R1 000 per adult in addition to the day-to-day benefits, based on engagement in their Personal Health Pathway. The Personal Health Fund, also subject to approval by the CMS, can then be used for various expenses, including prescription medicines, physiotherapy, and contraceptives.
• Digital access: Access to the Dynamic Smart Hospital Network, underpinned by technology that advises members on high-quality healthcare providers and Smart network hospitals in their regions.
Priorities
• Preventive care: Coverage for routine health check-ups, pap smears, and annual flu jabs for at-risk members through the Screening and Prevention Benefit, and the Personal Health Fund. Discovery has seen a 23% increase in the prevalence of hypertension among younger members since 2019.
• Mental health support: Access to the Discovery Health Medical Scheme Mental Health Care Programme, including consultations with a Premier Plus GP, anti-depressant meds, psychotherapy, and online Cognitive Behavioural Therapy. Claims for mental health conditions have also jumped, with one in seven young adults now claiming for such conditions, compared with one in 20 in 2013.
• Emergency cover: Full coverage for emergencies in private hospitals and unlimited access for non-emergency admissions to the Dynamic Smart Hospital Network, subject to a fixed deductible.
• Dental and eye care: An annual eye test with a network optometrist for R125 and a yearly dental check-up for R190.
• Over-the-counter medicines: Over-the-counter meds and contraceptives through the pharmacy network. Members can also utilise their Personal Health Fund to supplement their medical expenses.
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