Taking up the cudgels against preventable diseases, Discovery Health Medical Scheme is using unprecedented reserves to launch The Wellth Fund, giving all members one-off access to as much as R10 000 per family for an expanded range of screening and preventative healthcare over the next two years.
For the third year running, the medical aid scheme has deferred increases, promising that the average contribution increase to kick in from 1 April will not exceed 8.9%.
Because scheme members made fewer claims over the past three years, with many avoiding doctors and hospitals on the back of Covid concerns, a number of medical schemes have seen an increase in their scheme reserves, reports the Daily Maverick.
Discovery Health CEO Dr Ryan Noach says the deferral of the 2023 contribution increase had generated an additional R1.9bn in savings for members, bringing the cumulative member savings (returned to members from excess solvency) over the past three years close to R8.7bn.
Apart from these savings, the scheme is launching the Wellth Fund to use the excess reserves. Noach said Discovery Health’s data clearly showed screening rates among members remained worryingly below pre-pandemic rates. General health checks were down 50%, mammograms 15%, pap smears down 12% and prostate cancer screening checks down 10%.
“It’s time to focus our attention on reversing this trend,” he added. “For diseases like cancer or any form of chronic illness, early detection is fundamental to limiting serious complications and reducing long-term costs.
“On average, someone diagnosed at 40 with an early-stage breast cancer has a three times higher likelihood of surviving for five years post-diagnosis.”
The Wellth Fund gives all Discovery Health members one-off access to as much as R10 000 per family for an expanded range of screening and preventative healthcare to be used over the next two years, he said, and was the best possible use of the scheme’s excess solvency reserves. An improvement in 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.
How it works
The Wellth Fund can be activated by completing a health check at Dis-Chem, Clicks, Pick n Pay or Medirite pharmacies, where a qualified nurse will check your blood glucose level, cholesterol, BMI and blood pressure. These tests set the baseline for your health status.
Once the main member and all their dependants have completed their health checks, they will have access to up to R10 000 in their Wellth Fund – R2 500 per adult and R1 250 per child – for a range of additional screening and preventative healthcare. The quantum of the benefit for teenagers will be determined by their age as at the end of December 2024. If the child turns 18 on or before 31 December 2024, they will be able to access the adult benefit of R2 500.
Members have access to six broad categories of health screening and preventative healthcare services: general health, physical health, mental health, women’s health, men’s health and children’s health. Medical monitoring devices for certain health measurements are also covered. Services include one GP visit per year, one eye check-up, one hearing check-up, one dental check-up, a skin cancer screening and a heart consultation.
Claims paid from the Wellth Fund do not affect day-to-day limits. However, the fine print reveals that where healthcare services are also eligible for cover from another defined risk-benefit, for example, the Screening and Prevention Benefit, you claim from that benefit first, and then only from the Wellth Fund in instances where that benefit is depleted or unavailable.
Policy increase
Medical schemes usually increase contributions in line with the real and anticipated year-on-year increase in the cost of healthcare claims (medical inflation). Factors that influence medical inflation include:
• CPI: The inflation forecast for December 2022 was said to have eased to 7.2% from 7.4% in Global food prices rose by 1.8% m/m in December which will be a key driver as food prices comprise a notable portion of the CPI basket, while the petrol price saw a small uptick, which will add some additional pressure;
• Annual tariff or price increases for medical expenses (like the cost of a visit to the doctor), expected to increase by 0.5% above CPI this year;
• Demographic risk: As an increasing number of those using medical schemes are getting older, the resultant higher demand for healthcare means claims costs are expected to increase by 3% this year; and
• Supply-side factors such as the cost of new healthcare technologies increase the cost and volume of available healthcare services.
The Council for Medical Schemes has recommended that contribution increases for 2023 should be limited to 5.7%, in line with the Reserve Bank’s projected average inflation rate for this year.
See more from MedicalBrief archives:
Discovery cushions blow of 2022 premium increases for its members
Big jump in heart, cancer-related claims since COVID – Discovery
High levels of premium inflation ‘unavoidable’, says Discovery CEO