The discovery delays the 2023 increase in medical aid to April

Discovery Health Medical Scheme (DHMS), the largest in the country, says its increases in medical assistance contributions will only take effect from April 2023, rather than January. He says the scheme has “an optimal price for the expected complaints”.

This is the third consecutive year that the increase in annual membership fees has been postponed. The exact increases will be announced at the end of February.

Dr Ryan Noach, CEO of Discovery Health, says: “For now, both consumer price inflation (CPI) and the outlook for healthcare utilization remain volatile. It is important that the increase in contribution accurately reflects the underlying price and usage changes for 2023. Any increase will be in line with medical inflation, which is typically 3% to 4% above CPI. “

Discovery says that due to the three-month deferral, members will experience a real increase of between CPI and CPI + 2% during the year.

Noach says that “the regime’s reserves have strengthened relative to regulated solvency requirements due to the significant drop in non-Covid healthcare claims recorded during the pandemic and in 2022” and that this “excess solvency has been used to the benefit of members “.

The three-month deferral next year will amount to R1.9 billion in member savings.

Including this amount, a total of Rand 8.7 billion has been spared from the deferrals since the start of Covid-19, which has fueled “health-related disruptions”.

DHMS says it is the only medical scheme in the country to have deferred increases for members and that its “actual increase in annual contribution … has been 50 basis points below the market” for the past two years.

At the end of June, DHMS had an unaudited creditworthiness of 36%. The regulated level required by medical regimes is 25%. DHMS has a 57.6% share of the open schemes market and approximately 40% share of all schemes, including the Government Employees Medical Scheme (GEMS).

Wellth Fund

Noach says that from January, the DHMS “will make its excess solvency reserves available to finance an expanded range of screening and preventive health care for members through the new Wellth Fund.”

It will complement this with a “new disease prevention program to proactively identify and support members with high health risks.”

The Wellth Fund will use the extra capital in DHMS to provide a one-time benefit of up to R10,000 per family for an expanded range of screening and preventive health care that can be used over the next two years.

A health check must be completed to activate this benefit.

This will set the baseline for a member’s health status. Once this is done, members will have access to up to R2 500 per adult and R1 250 per child for “six broad categories of health screening and preventive health services, including general health, physical health, mental health, women’s health, men, and children’s health “.

Medical monitoring devices for certain health measurements will also be covered.

“The Wellth Fund represents the best possible use of the program’s excess solvency reserves,” says Noach.

“It is also economically smart, considering that improved health of program members means a long-term and lasting reduction in complaints, with a nine-fold return on investment in funding the screening and preventative health care offered through the bottom “.

Additionally, members identified as being at risk for diabetes or cardiovascular disease (through screening and medical records) “will be encouraged to consult a family doctor to confirm their risk and enroll them in the 12-month management program, with risk benefits in place. for support and clinical treatment “.

“The program includes access to a family doctor, dietician, pathology test and 12 coaching sessions.”

Smart newcomer to plan training

Discovery Health will introduce a new plan, the Essential Dynamic Smart plan, based on a dynamic hospital network.

It will use its proprietary AI algorithm to identify the most efficient hospital for a member’s admission requirements at a specific time.

The plan offers full funding for “hospitalization and treatment within this privileged network, optimally balancing costs and quality choices”.

Network restrictions do not apply to emergencies.

“For many members, the trade-off between a lower contribution and hospital networks is compelling when choosing a medical program,” says Noach.

“The new Essential Dynamic Smart plan enters the market as the most affordable of the Smart series in 2023, at an attractive price of R1 450 per month, also making it the lowest cost-per-unit benefit among comparable plans in open medical schemes. “

This article first appeared on Moneyweb and has been republished with permission. Read the original article here.