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DISCOVERERTHE
This brochure is intended for financial advisers only, and is
presented by Discovery Health (Pty) Ltd, registration number
1997/013480/07, an authorised financial services provider, which is
the administrator of the Discovery Health Medical Scheme, in terms
of its contractual arrangements. This brochure is only a summary of
the key benefits and features of the Discovery Health Medical
Scheme plans, awaiting formal approval from the Council for Medical
Schemes. For detailed information on all Discovery Health Medical
Scheme plan options, please visit www.discovery.co.za for access to
plan brochures as well as a full copy of the proposed 2017 Scheme
Rules. Vitality is not part of the Discovery Health Medical Scheme.
Discovery PrimaryCare is administered by Prime Med Administrators
(Pty) Ltd, registration number 2011/001667/07, wholly owned by
Discovery Health (Pty) Ltd, an authorised financial services
provider. Discovery Gap Cover and Discovery Supplementary Gap Cover
are insurance products. This is not a medical scheme and the cover
is not the same as that of a medical scheme. These policies are not
a substitute for medical scheme membership. Discovery Gap Cover is
a short-term insurance policy, underwritten by Discovery Insure
Ltd, registration number 2009/011882/06, an authorised financial
services provider. Discovery Supplementary Gap Cover is a long-term
insurance policy, underwritten by Discovery Life Ltd, a registered
long-term insurer and an authorised financial services provider,
registration number 1966/003901/06. This is a separate long-term
insurance product and is not conditional on the purchase of the
short-term insurance Discovery Gap Cover product. Product rules,
terms and conditions apply. Discovery Limited. Subsidiaries of
Discovery Limited are authorised financial services providers.
Vitality is a separate product sold and administered by Discovery
Vitality (Pty) Ltd. Registration number 1999/007736/07, an
authorised financial services provider.
Enhancing benefits, without compromising affordability
Discovery Health continues to invest extensively in building a
better healthcare system, centred on the needs of members. This has
resulted in a sophisticated platform for the administration and
management of medical schemes and healthcare products. This
platform offers a comprehensive suite of healthcare professional
networks, patient-management programmes, proprietary digital
healthcare technology and state-of-the-art service capabilities,
all focused on the Discovery core purpose of making people
healthier and enhancing and protecting their lives.
Discovery Health Medical Scheme leverages this platform to
provide members with quality healthcare and peace of mind:
• Industry-leading financial stability, with more than R14
billion in member reserves
• The most comprehensive plan range available in the market,
with 23 plans to match members’ unique healthcare needs
• Contributions that are on average 15.1% below the market
average
• Cover ratios in excess of 96% throughout the plan range
• Member service channels that are consistently rated 8.9 / 10
by members, with 81% of queries resolved on the first interaction,
far above industry benchmarks
The strength of this platform also allows members to benefit
from a series of enhancements in 2018, without compromising
affordability.
L A U N C HS E P T
• Enhanced emergency healthcare services for a broad range of
traumatic events
• Access to the PrimaryCare Wellness Experience
• Access to Vitality Move
PrimaryCare 10
• Introduction of HealthyCompany Care, a proactive, relevant
employee assistance programme with a fully-integrated mobile
app
Discovery for Corporates 08
• Comprehensive, risk-funded maternity and post-birth
benefits
• Dedicated support on the Discovery app
Young Families 06
• Enhancements to the Discovery app that enable seamless access
to high quality medical information from doctors, as well as chat
and virtual consultations
Digital Health Technology 05
• Enhanced Global Treatment Platform to access medical treatment
outside South Africa
• Access to Vitality Purple
Executive Plan 04
• Weighted average contribution increase of 7.9% for 2018
• Plan-specific increases range between 7.3% and 8.3%
Contributions 02
• Introduction of Discovery Gap Core providing cover for
in-hospital shortfalls and cancer-related claims, from as little as
R90 per month
11Discovery Gap Cover
Enhancements for 2018
KeyCare Core Smart Saver Priority Comprehensive Executive
Healthcare delivery networks
Digital healthcare technology
Tracking andengagement
Clinical care and coordination Service
Clin
ical
and
actu
aria
l
data
analytics
-
The performance of a medical scheme should consider the quality
of the healthcare and service that members experience, while the
sustainability of the experience is measured by the growth and
financial performance of the medical scheme. In the case of the
Discovery Health Medical Scheme, there is a focus on constantly
improving both the healthcare and service experience, despite
already exceeding industry benchmarks. The growth of the Scheme has
been positive every year since inception, and the Scheme is
currently in the strongest financial position in its history.
Discovery Health Medical Scheme performance
The quality of service that Discovery Health Medical Scheme
provides to members and their advisers is critical to the ongoing
success of the Scheme, given the volume of service interactions
experienced on a daily basis.
Discovery Health continuously invests and innovates in service
initiatives that are relevant and meaningful to members, resulting
in world-class service levels.
0201
03 04
Discovery Health works to improve the cover for and quality of
healthcare available to members of Discovery Health Medical Scheme.
Increasing use of HealthID is benefiting both members and their
doctors by informing consultations with relevant, clinical
information. Discovery Health Medical Scheme covers R96.50 of every
R100 claimed from the Scheme for hospital admissions, while
hospital rating tools lead to demonstrable improvements in the
members’ hospital admission experience.
Since 2006, Discovery Health Medical Scheme has added more than
800,000 beneficiaries to its membership, growing its open medical
scheme market share from 36.9% to 55.3%
In 2016, the Scheme produced an operating surplus, while 7 of
the next 9 largest open medical schemes produced an operating
deficit. The sustained surplus of Discovery Health Medical Scheme
in recent years has increased the reserve and solvency levels,
ensuring long term financial stability of the Scheme for the
benefit of members.
Comprehensive levels of coverIn-hospital claims cover ratio*
Improving patient experience through hospital rating tools
Patient Satisfaction Score (PaSS)**
** Discovery Health Medical Scheme members rating of their
hospital admission experience
2010 2013 2014 2016
58%
56.40% 56%
59.30%
Started sharing results with
hospitals
Started sharing results publically
* Cover ratio = Claims paid / Claims received
201696.5%
51%GP visits
4,300Doctor users
+1.3 million Member consents
6 906 000 General Practitioner visits in 2016
703 000 Hospital admissions in 2016
Leading service metrics
Independent benchmarking: McKinsey service comparison 2016
Dimension Data’s Global Contact centre benchmarking
Discovery Health Medical Scheme 2016
First Call Resolution Member Based
Research Survey
73%
81%80%
89%
Discovery Health Medical Scheme membership growth 2006 -
2016
Open medical scheme market share
2016
2006
55.3%
36.9%
Beneficiaries covered (millions)
2006 2016
1.88
+800 0002.71
R1.3bn Net surplus 2016 Operating surplus (including investment
returns)
R14.2bn Member reserves Reserves available to cover unexpected
claims costs, as at 31 December 2016
AA+ Credit ratingHighest credit rating that can be afforded to a
medical scheme in South Africa
26.3% Solvency ratioMember reserves as a proportion of gross
contributions exceed 25% statutory minimum
A day in the life of the Scheme
Calls handled
36 600
Claims processed
250 900
Discovery app logins
87 000
LOG IN
Social media conversations
115
Healthcare cover and experience
Healthy, sustained growth Financial stability
Member service
PG 2
HEALTH DISCOVERER
-
Lower than average contribution increases maintained in 2018
2018 Contribution increases
The 2018 contributions reinforce the competitive advantage that
the Discovery Health Medical Scheme has built over time through
contribution increases that have been consistently lower than
competitors. This advantage is illustrated through the Discovery
Health Medical Scheme inflation differential, shown below
Annualised increases since 2007 relative to CPI*
5%
4%
3%
2%
1%
0%2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Discovery Health Medical Scheme actual
Next 7 largest open schemes actual CPI +4%
* Assuming historic contribution increases relative to CPI for
competitors in 2018
Estimated
differential16.3%
Lower average contributions for DHMS members (family of
three)
R6 000
R7 000
R5 000
R4 000
R3 000
R2 000
R1 0002008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Discovery Health Medical Scheme
Next 7 largest open schemes
Estimated
The significant financial strength of the Discovery Health
Medical Scheme provides a foundation to maintain and enhance
benefits for 2018, whilst offering contribution increases that are
expected to be well below the industry average.
The contribution increases for 2018 are linked to medical
inflation.
Over the 12-month period of August 2016 to July 2017, average
CPI was 5.9%. This suggests that the average medical inflation over
this period was 8.9%, if CPI + 3% is used as an indication of
medical inflation.
In comparison, the weighted average contribution increase for
Discovery Health Medical Scheme is 7.9% for 2018.
For each plan, explicit allowance has been made for the
differences in demand-side and supply-side driven inflation
factors, as well as the expected impact of plan- specific benefit
changes. This results in the following plan-specific contribution
increases for 2018:
Medical inflation is driven by CPI and three other factors
unique to healthcareTariff inflation, which is correlated with CPI,
and reflects increases in the price of healthcare services01
Demand-side factors that reflect an ageing demographic, adverse
selection and increased burden of disease02
Supply-side factors due to advances in medical technology and
procedures, opening of new facilities and fragmentation of
care03
Drivers of claims inflation for Discovery Health Medical Scheme
2006-2017
6.1%
11.3%
2.8%
1.8%
0.5%
TariffsCPI Demand-side utilisation
Supply-side utilisation
Medical inflation
2018 contribution increases are linked to medical inflation
Contribution increases by plan
8.9% average CPI+3%
Aug 2016 – Jul 2017
% of total membership
7.9%weighted average
increase in gross
contributions
Jul 2
016
4.6%
Jun
2016
5.1%5.4%
May
201
6
5.3%
Apr
2016
6.1%
Mar
201
6
6.3%
Feb
2016
6.6%
Jan
2016
6.8%
Dec
201
6
6.6%
Nov
201
6
6.4%
Oct
201
6
Sep
2016
6.1%
Aug
2016
5.5%
19%13%2%8%1% 12% 45%
Exec
utiv
e
7.3%
Com
preh
ensi
ve
8.3%
Prio
rity
8.3%
KeyC
are
8.3%
Save
r
7.6%Co
re7.6%
Smar
t
7.3%
5.9% average CPI Aug 2016 - Jul 2017
(CPI+3% medical inflation range)
0%
10%
Discovery Health Medical Scheme actual
Next 7 largest open schemes actual
3 PG
2017
-
Executive Plan EnhancementsThe Executive Plan currently offers
more than 23 000 members the most comprehensive benefits in the
Discovery Health Medical Scheme, at a contribution that is 28%
lower than that of comparable plans in the market. The extensive
benefits of the Executive Plan provide members with absolute peace
of mind that the healthcare needs of their families, regardless of
their current state of health, are comprehensively catered for. In
2018, the Executive Plan will offer enhanced benefits for treatment
overseas and restructured day-to-day and in-hospital benefits.
03
01
02
Executive Plan A Global Treatment PlatformThe Global Treatment
Platform offers members access to medical treatment outside South
Africa.
International Second Opinion ServicesMembers and their treating
specialist can access a second opinion for life-threatening and
life-changing conditions from world-leading clinical experts at the
Cleveland Clinic, funded in full by the Executive Plan.
Overseas Treatment BenefitExecutive Plan members can access
advanced medical care outside South Africa. Members have R750 000
to cover the cost of medical treatment not available in South
Africa. Members also have R300 000 to cover the cost of voluntary
in-hospital medical treatment outside South Africa.
Both these benefits are subject to Scheme guidelines and managed
care protocols, and a 20% co-payment.
International Travel BenefitIn 2018, Executive Plan members will
have US$ 1 million per member to cover the cost of medical
emergencies while traveling outside SA.
In 2018, the Executive Plan will offer members cover for
day-to-day healthcare expenses through the following benefit
structure:
• A Medical Savings Account, equal to 25% of annual
contributions
• Once the MSA has been exhausted, members can self–fund through
the Self–payment Gap. The Day–to–day Extender Benefit will cover a
defined list of healthcare services during this Self–payment
Gap
• An unlimited Above Threshold Benefit
Currently, day-to-day benefits cover the cost of in-hospital
treatment by healthcare professionals. In 2018, these costs will be
covered by the Hospital Benefit, and the Medical Savings Account
will be exclusively for out-of-hospital medical expenses.
In-hospital treatment by specialists
In-hospital treatment by other healthcare professionals
In-hospital dental treatment
Out-of-hospital dental treatment
Paid from the Hospital Benefit, up to 300% of the Discovery
Health Rate.
Paid from the Hospital Benefit, up to 200% of the Discovery
Health Rate.
No overall annual limit. Paid from the Hospital Benefit, with an
upfront deductible and a limit of R26 200 per person per year for
dental appliances.
Paid from Day-to-day Benefits. A limit of R26 200 per person per
year for dental appliances.
Over-the-counter medicine benefit on the Smart Plan
In 2018, Smart Plan members will have cover for Schedule 0 – 2
medicine from a network pharmacy, subject to an annual limit:
• Classic Smart Plan: R600 per family per year
• Essential Smart Plan: R400 per family per year
Day-to-day Extender Benefit
In 2018, once a member has spent their annual MSA allocation,
the Day-to-day Extender Benefit will cover casualty visits for
children under the age of 10 at a network facility, and GP
consultations through HealthID-enabled GPs that meet the digital
criteria in the Discovery GP network. Cover depends on selected
plan. Cover for pathology, acute medicine and external medical
items through the Day-to-day Extender Benefit will be
discontinued.
Chronic Illness Benefit
Chronic Drug Amounts and Chronic Medicine formularies will
remain unchanged for 2018.
Limits, co-payments, deductibles and income bands
• For 2018, all benefit limits will be increased in line with
the plan-specific contribution increase, with the exception of
oncology threshold, External Medical Items (EMI) and internal
prosthesis limits
• As a result of the successful implementation of full cover
through a preferred supplier, the hip and knee prosthesis limit
will reduce for 2018
• All co-payments and deductibles will increase in line with the
plan-specific contribution increase with the exception of 0%
increases for co-payments on MRI and CT scans
• KeyCare income band thresholds are increased by 5.6%.
Premier Plus GP network as Designated Service Provider for
HIVCare Programme
In 2018, the Premier Plus GP network will become the Designated
Service Provider (DSP) for Priority, Saver, Smart, Core and KeyCare
members registered on the HIVCare programme.
This change will be effective immediately for new members
registering on the HIVCare programme from 1 January 2018, while the
change will only be effective from 1 July 2018 for members already
registered on the HIVCare programme.
2018 changes
Restructuring cover for day-to-day and in-hospital healthcare
expenses
2018 Discovery Health Medical Scheme benefit updates
PG 4
HEALTH DISCOVERER
-
Introducing Discovery DrConnect
• When members have asked a question, the library of curated
content will provide answers to commonly asked questions that have
been answered by doctors
• If the answer is not immediately available, the question will
be answered by available doctors
• Other doctors will be able to agree with the answers given or
will provide additional information
• The highest rated answers to questions will be shown first, so
members always have access to high quality peer-reviewed medical
advice anywhere, anytime.
• If the member’s doctor is available for follow-up virtual
consultations, these can be booked and conducted using the app
• Virtual follow-up consultations can only be conducted with a
doctor that the member has visited in the past 12 months
• These consultations will be paid from the member’s available
day-to- day benefits
• Members need to download the Discovery DrConnect app once and
then the DrConnect funtionality will be available, and accessed
directly from the Discovery app.
Get personalised doctor-created checklists
Subscribe to health goals to manage chronic
conditions, pregnancy and other wellness goals
Conduct virtual follow-up consultations with doctors using
video,
voice or text
Access the DrConnect functionality through the Discovery app and
www.discovery.co.za
Your clients will automatically be prompted to download the
DrConnect app on their phone.
Ask a doctor a medical question anywhere, anytime.
5 billion doctor-created
medical answers
105 000doctors available worldwide to answer medical
questions
174countries
Every year over a billion people turn to the internet to get
information about their health and wellness. It is estimated that 1
in 20 of these searches are about health-related concerns but
unfortunately, these searches yield the correct answer less than
34% of the time.
Discovery Health has partnered with HealthTap Inc. in Palo Alto,
to provide DrConnect – a tailored offering for members of the
Discovery Health Medical Scheme. The DrConnect functionality
provides seamless access to high quality medical information from a
worldwide network of doctors and facilitates personalised
interactions between patients and their doctors.
Discovery DrConnect. Doctor Advice. On your device.
Discovery Health Medical Scheme members now have access to an
extensive library of doctor-created and peer-reviewed healthcare
content. The library provides a credible source of online medical
information to members, including doctor-created personalised tips
and checklists to help members meet their health goals. Members
also have access to doctors worldwide to get medical advice at no
additional cost.
Discovery Health has also integrated this technology into the
clinical case management systems, facilitating personalised care
pathways to optimise the management of members with specific
chronic conditions, as well as for mothers during and after
pregnancy. Members will be able to conduct virtual follow-up
consultations through voice, video or text consultation with their
doctors, paid from applicable day-to-day benefits.
5 PG
2017
-
Tailored offering to protect Young Families right from the
startIn 2018, Discovery Health Medical Scheme members will have
access to comprehensive maternity and post-birth risk benefits on
all plans, supported by access to 24/7 support, advice and guidance
through the My Pregnancy and My Baby programmes on the Discovery
app.
Comprehensive maternity and post-birth benefits
Access to 24/7 clinical support, advice and guidance
My Pregnancy and My Baby app features
Antenatal classes or consultations with a nurse
Members have covered for up to five pre- or postnatal classes or
consultations with a registered nurse
Private ward
Members have cover for up to R1 880 per day in a private ward
for delivery in hospital on the Executive and Comprehensive
plans
Blood tests
Cover for a defined list of routine blood tests
Antenatal consultations
Members are covered for up to 12 gynaecologist, GP or midwife
visits, based on plan type selected
Essential registered devices
Executive and Comprehensive plans have cover for up to R5 000
for essential registered devices e.g. breast pumps and smart
thermometers, with a co-payment of 25%
Ultrasound scans and prenatal screening
Members are covered for up to two 2D ultrasound scans and one
Nuchal Translucency or Non-invasive Prenatal Test (NIPT)
screening
Mental Health
Members are covered for up to two mental health consultations
with a counsellor or psychologist
Six week consultation
Members are covered for one six week post-birth consultation
with a midwife, GP or gynaecologist
Nutrition assessment
Members are covered for one assessment with a dietician
Lactation consultation
Members are covered for one lactation consultation with a
registered nurse or lactation specialist
My Pregnancy dashboard
Track pregnancy milestones and access an array of tools and
features personalised for each pregnancy.
Pregnancy health record
View all pregnancy related health information, in one place.
Maternity cost estimator
Get an estimate for the typical costs associated with pregnancy,
based on plan type, delivery type and choice of doctor and
hospital.
Pregnancy care checklist
View a personalised step-by-step guide of what to do each week
of pregnancy
Connect with doctors
Get trusted medical advice, on your device from doctors at any
time
My Baby dashboard
Activate the My Baby programme on the Discovery app and create
baby’s profile
Education cost estimator
Get an estimate of the total cost of education from pre-school
to university
Kids digital health record
View medical record, with a view of vaccinations, screenings,
milestones and development.
Digital vaccination card
Keep track of all vaccinations by setting reminders and having
access to the updated immunisation card.
Caring for mother and baby
Quality healthcare is critical during pregnancy. Prenatal care
and screening benefit both mother and baby. For the average healthy
pregnancy and birth, the estimated medical costs can be in excess
of R120 000. Expectant parents should be able to depend on
comprehensive health cover for complete peace of mind.
Raising a healthy child involves optimal health, nutritional and
physical wellbeing and future education needs. Average medical
costs for the first two years of a child’s life, including GP and
specialist visits can be as much as R80 000. In the unfortunate
event that a child is admitted to neonatal ICU, ultra-high cost
claims can be in excess of R4 million. Complete cover for the
health of a young family should provide access to comprehensive
healthcare, alongside access to vital clinical support and
knowledge.
GP and specialist visits
Babies are covered for up to two visits with a GP, paediatrician
or an ENT. Cover depends on the plan selected
DURING PREGNANCY
Technical details
• The benefits do not affect a member’s day-to-day Medical
Savings Account benefits
• Healthcare services are covered through this benefit at the
Discovery Health Rate
• The benefits depend on the selected plan of the member
– The benefits only apply from 1 January 2018
– The benefits only apply after the benefits have been activated
by the member
• Technical details related to maternity benefits prior to
delivery:
– The benefits can be activated either by
- creating a pregnancy profile in the Discovery app; or
- creating a pregnancy profile at www.discovery.co.za; or
- preauthorising the delivery
– Members that preauthorised their delivery during 2017 will
have automatic access to the benefits from 1 January 2018
– The benefits do not cover healthcare services received prior
to the activation of the benefit
• Technical details related to the post-birth benefits:
– The baby has to be registered on the Scheme to activate the
benefits
– The benefits for babies born on Discovery Health Medical
Scheme prior to 1 January 2018 have to be activated through
www.discovery.co.za
TWO YEARS FROM BIRTH
PG 6 7 PG
2017HEALTH DISCOVERER
-
Introducing HealthyCompany Care
Utilising the data from the Screening programme, medical scheme
and Vitality, HealthyCompany Care seamlessly stratifies employees
according to their risk profile in three areas
of wellbeing, and proactively triggers relevant interventions,
which may include referral into existing healthcare and wellness
programmes
offered to employees.
Employees will have access to a multi-skilled coach to guide
them every step of the way, through a fully-integrated
mobile app. In addition, HealthyCompany Care offers a suite of
educational content
for all employees, including a library of doctor-generated
advice, assistance with financial
planning and access to a consultation with a legal expert.
HealthyCompany 2018
Discovery HealthyCompany is our cost-effective, integrated
wellness solution that combines and augments the health and
wellness management capabilities of Discovery Health and Discovery
Vitality. The platform provides a focused approach to meet the
needs of the employer, who is concerned with both the effectiveness
of interventions, and the return on investment of such
interventions.
HealthyCompany Insights
While each employee journey is unique, aggregated reporting is
crucial in providing insight into the risks having the greatest
impact on absenteeism and productivity at an organisational level.
This view not only assists employers in defining their health and
wellness strategy, but should enable measurement and continuous
improvement as well.
Aggregate corporate reporting informs health and wellness
strategy
HealthyCompany Screening
Employers have access to four screening solutions, tailored to
the needs of the company:
• Discovery Traditional Wellness Days • Discovery Premier Mobile
Wellness Experience • Discovery Premier Wellness Experience•
Discovery Executive Wellness
The results of these screenings are reported to each individual
employee, and the aggregated screening results are reported to the
employer. These seamlessly integrate with the reporting functions
provided by HealthyCompany Insights.
HealthyCompany Insights
HealthyCompany Insights integrates an employer’s data collected
from the Screening and Care programmes and provides employee- and
employer-relevant dashboards. These are developed to provide clear
and actionable insights for each individual employee, as well as
for the employer. In addition, an employees’ engagement with
healthcare and wellness management programmes is integrated to
dynamically update an employer’s risk stratification and
appropriately adjust the recommendations.
Physical Wellness
Emotional Wellness
Financial Wellness
HighRisk
Episode management
Medium Risk
Ongoing management
LowRisk
Prevention
HealthyCompany Care will be available from April 2018.
Phys
ical
Emotional
Legal Finan
cial
Education
and Planning
Prevention
Epis
ode
Man
agem
ent
Ongoing Management
Individual employee reporting
Integrated employer reportin
g
HealthyCompany Insights
HealthyCompany Care
Hea
lth
yCompany Screening
Discovery PrimaryCare
A unique healthcare product that provides affordable, quality
primary healthcare and emergency healthcare services for your
low-income employees.
John’s wellness day results show glucose levels which are
elevated beyond the desirable range, and that he is under a large
amount of stress. According to the financial wellness assessment,
John is not at immediate financial risk, but he could use some
insight into how to ensure that his protection needs are met.
Physical | Medium risk: Ongoing management
Emotional | High risk: Episode management
Financial | Low risk: Prevention
Legal
Enrolment on a care pathway with Discovery Health Medical Scheme
and Vitality
Up to 6 face-to-face sessions with a counsellor or
psychologist
Financial education modules enable on-demand learning
If John requires legal assistance at any point, he is able to
access a legal expert for a consultation
Through John’s Discovery Health Medical Scheme Classic Saver
Plan, he is enrolled in the DiabetesCare Programme which provides
him access to a GP, unlocks additional funding for allied
healthcare services, and gives him access to a monthly progress
dashboard. Since John is also a Vitality member, he is enrolled in
a personalised physical activity and weight-loss programme through
Vitality Active Rewards and Weight Loss Rewards.
John receives a personalised report, as well as access to a
dynamic health and wellness dashboard, which ensures that he not
only fully understands his risk profile, but can track his progress
as he engages with the support tools.
John attends the Discovery Premier Wellness Experience where he
is screened to determine how well he is according to three
dimensions: physical, emotional and financial wellness.
Hea
lthyC
ompa
ny
Scre
enin
gH
ealth
yCom
pany
Ca
reH
ealth
yCom
pany
In
sigh
tsH
ealth
care
an
d w
elln
ess
Discovery for Corporates
Employers that invest in the health and wellness of their
employees benefit from greater productivity through lower
absenteeism and presenteeism, which benefit employer and employee
alike. A typical employee health solution includes components such
as health screening, employee support, healthcare and wellness
programmes, and some reporting on each individual component.
Discovery provides a comprehensive solution in each of these areas,
with the unique ability to integrate and report across all the
elements to augment the impact on the health and wellness of
employees.
Integrated health and wellness in actionJohn is a manager in a
large manufacturing firm that has partnered with Discovery
HealthyCompany. He is on a Discovery Health Medical Scheme Classic
Saver Plan and is a Discovery Vitality member
Hea
lthca
re
A range of healthcare cover to suit the diverse needs of
employees.
Discovery Health Medical Scheme
SA’s leading medical aid that provides quality, affordable
healthcare supported by industry-leading digital technology.
Discovery Gap Cover D
isco
very
Prim
aryC
are
Discove
ry Health Medical Scheme
Vitali
ty P
urpl
eVitality
Wellness
Vitality Move
HealthyCo
mpany Insights
Hea
lthyCo
mpany Screening
Healthcare
Health
yCompany Care
Vitality Active
Hea
lthyC
ompa
ny
HealthyCompany Screening
Advanced, clinically validated onsite wellness days, and bespoke
executive
wellness assessments.
HealthyCompany Insights
Dynamic reporting for employees and employer, across all
elements of
corporate wellness.
HealthyCompany Care
Pro-active, integrated employee assistance programme.
Discovery HealthyCompany is our comprehensive corporate wellness
solution
offering health screening, employee support tools and integrated
reporting.
Discovery Gap Cover
An innovative, cost-effective insurance solution that provides
additional financial protection against unforeseen medical
costs.
Discovery Vitality Vitality has four distinct wellness products
to provide relevant incentivised wellness for all employees in an
organisation.
Vitality is Discovery’s internationally recognised science-based
wellness programme, which encourages and incentivises healthy
behaviours.
Wellness
Fina
ncia
l
Emot
iona
l
Physical
managemen
t
mana
gem
ent
Prev
entio
n
On-going
Episo
de
Individ
ual e
mp
loyee
repo
rting
Integr
ated e
mploy
er re
porti
ng
Scree
ning
Discovery Hea
lth
Medical Schem
e
and
Discovery Vita
lity
PG 8 9 PG
2017HEALTH DISCOVERER
-
Discovery PrimaryCare 2018Providing access to quality healthcare
is essential to any company that wants to ensure that the health
and productivity of their workforce is sustained and optimised.
However, access to private healthcare through medical scheme
membership proves unaffordable for many employees with lower levels
of income. From as little as R158 per employee per month, employers
can now offer employees and their qualifying dependants access to
quality healthcare facilities and healthcare professionals in the
Discovery Health networks, for relevant primary and emergency
healthcare services.
Why Discovery PrimaryCare?
2018 PrimaryCare Pricing
Discovery PrimaryCare Essential
Indicative Fee Employee Spouse Child
Monthly fee (incl. VAT) 158 158 158
Trauma Benefit 50 50 25
Total 208 208 183
Discovery PrimaryCare Comprehensive
Indicative Fee Employee Spouse Child
Monthly fee (incl. VAT) 269 269 174
Trauma Benefit 50 50 25
Total 319 319 199
PrimaryCare starts from as little as R158 per month, and pricing
is dependent on the employer’s unique circumstances, including the
compulsory or voluntary nature of PrimaryCare membership, and the
site and demographic profile of employees.
Dependants are subject to a 6-month waiting period for access to
PrimaryCare services, if they are not added on the policy when the
employee joins.
There must be at least 10 members on a scheme administered by
Discovery Health and a minimum of 25 employees to be enrolled on
PrimaryCare Essential or PrimaryCare Comprehensive.
Employees and their families have access to quality private
primary healthcare services
and healthcare professionals.
Employees can access their employer’s wellness days, and have
access to Vitality Move.
Employers have the option to include access to private
healthcare facilities for traumatic events.
Pricing starts from as little as R158 per employee per month,
and is quoted based on the employer’s specific circumstances.
PrimaryCare Comprehensive provides cover for 27 Chronic Disease
List Conditions.
No exclusions and no waiting periods for employees.
01
04
02
05
03
06
A C C E S S T O P R I V A T E H E A L T H C A R E
A C C E S S T O W E L L N E S S
A C C E S S T O E M E R G E N C Y M E D I C A L S E R V I C E
S
A F F O R D A B L E , F L E X I B L E F E E S
T R E A T M E N T F O R A W I D E R A N G E O F C H R O N I C C
O N D I T I O N S
I M M E D I A T E A C C E S S F O R E M P L O Y E E S
2018 PrimaryCare Enhancements
Trauma Benefit
Employers can enhance PrimaryCare cover for their employees
through the Trauma Benefit, which provides access to emergency
private healthcare services for a broad range of traumatic events.
Members are covered in full for medical treatment at a hospital or
casualty facility in our network related to these events, up to a
limit of R100 000 per admission, and they will not have to pay
upfront for these medical services.
The following traumatic events are covered: burns, head
injuries, loss of an arm, hand, leg or foot, near drowning,
poisoning or a serious reaction that may cause death, injuries
resulting from a crime, sexual assault, a fall, a car accident or
an injury at work.
The following medical services are covered in the case of a
traumatic event:
| Medical Evacuation Cover for medical evacuation services to
the nearest private hospital facility in our network
| Casualty treatment Access to medical treatment in a casualty
facility in our network
| In-patient stabilisation and treatment Up to R100 000 per
admission for hospital and related accounts, at a private hospital
in our network. Once the limit is reached and further medical
treatment is required the member will be transferred to a public
hospital. The member will be responsible for any costs over this
limit if they choose to remain in the network facility.
The network of private hospitals and casualty facilities will be
published on www.discovery.co.za
PrimaryCare Wellness Experience
Members will have access to the PrimaryCare Wellness Experience,
providing a holistic set of wellness screenings (including BMI,
blood pressure, cholesterol, glucose and HIV testing), as well as a
one-on-one consultation with a wellness specialist and a lifestyle
and wellness assessment.
The PrimaryCare Wellness Experience is for employees only.
Minimum of 30 members at an employer site required.
Access to the PrimaryCare Wellness Experience is covered in full
once per year.
PrimaryCare clients have preferential access to HealthyCompany
Care
Access to Vitality Move
Members have access to Vitality Move, a Discovery Vitality
programme that rewards everyone for taking steps towards a healthy
lifestyle. Vitality Move members can win shopping rewards at Pick n
Pay, and can get up to R300 back monthly on shopping, gym and
movies.
PG 10
HEALTH DISCOVERER
-
Discovery Gap Cover 2018Unexpected medical costs, for treatment
related to approved admissions to hospital where healthcare
professionals charge more than what the medical scheme pays, or
where members have a life-changing severe illness, can place
significant financial strain on a family.
Discovery has now combined its insurance and healthcare
expertise to bring an innovative, cost-effective solution through
Discovery Gap Cover and Discovery Supplementary Gap Cover to
provide policyholders with significant cover for unforeseen medical
expenses related to a hospital admission or severe illness
diagnosis, through a unique and comprehensive benefit
structure.
Why gap cover from Discovery?
2018 Discovery Gap Cover premiums
A member’s Discovery Gap Cover premium depends on the option
selected, the medical scheme plan and the age that the oldest
member on your medical scheme plan will turn in the year of
applying for the policy.
Every person on a member’s medical scheme plan must also be on
your Discovery Gap Cover policy, subject to underwriting. If the
oldest person leaves or joins the Scheme, the gap policy will be
rerated.
Discovery Gap Core Discovery Gap Comprehensive
Discovery Health Medical Scheme Executive
and Classic Plans
Discovery Health Medical Scheme Essential
and Coastal Plans
Discovery Health
Medical Scheme Executive and Classic Plans
Discovery Health Medical Scheme Essential
and Coastal Plans
Age at entry of the oldest member on the Scheme plan
Single Member Family Single Member Family Single Member Family
Single Member Family
0 – 54 90 150 165 395 135 230 250 560
55 – 64 150 180 390 575 230 340 455 865
65+ 180 265 575 920 290 475 605 1135
2018 Discovery Gap Cover enhancements
Introducing Discovery Gap CoreYour clients can now choose from
two Discovery Gap Cover options to suit their needs. Discovery Gap
Core significantly enhances cover for in-hospital shortfalls and
cancer-related claims, from as little as R90 per month.
Enhanced Oncology Benefit ExtenderFrom 2018, the full value of
the Oncology Extender Benefit will be available immediately to
policyholders, regardless of policy duration subject to
underwriting and applicable waiting periods.
Benefit Discovery Gap Core Discovery Gap Comprehensive
In-hospital Specialist Gap Cover Additional 200% of DH rate
Additional 200% of DH rate
Hospital Admission Benefit Extender Up to R10 000 additional
cover for in-hospital shortfalls for specialist claims
Up to R20 000 additional cover for in- and out-of-hospital
shortfalls related to the admission
Oncology Benefit Extender Up to R75 000 for co-payments related
to your oncology treatment planUp to R100 000 for co-payments
related to your oncology treatment plan
Annual benefit per person
Plan type Discovery Gap Comprehensive Discovery Gap Core
Discovery Health Medical Scheme Executive, Comprehensive
plans
R100 000 R75 000
Other plans R40 000 R30 000
A D M I S S I O N – R E L A T E D S H O R T F A L L C O V E
R
C O M P R E H E N S I V E C O V E R F O R C A N C E R
O N E S I M P L E C L A I M S S U B M I S S I O N P R O C E S
S
Discovery Gap Cover provides additional funding to help cover
oncology co-payments.
Discovery Supplementary Gap Cover helps fund high-cost
treatments and gives access
to advanced genomic sequencing for certain cancers.
With Discovery Gap Cover clients have a simple claims submission
process, where gaps in cover are identified, assessed and paid
automatically once the medical scheme claim is processed, with no
additional documentation required.
01 02 03Discovery Gap Cover has two options to
suit the needs of your clients, which offer rich protection
against shortfalls in medical
scheme cover for specialist treatment received in-hospital.
Discovery Gap Comprehensive
provides pre- and post-hospitalisation cover for specific
shortfalls incurred out-of-hospital,
related to the admission.
11 PG
2017
-
Seri
esPl
anCo
ntri
buti
ons
Cont
ribu
tion
s to
Med
ical
Sav
ings
Acc
ount
Tota
l con
trib
utio
ns
Mai
n m
embe
rAd
ult
Child
*M
ain
mem
ber
Adul
tCh
ild*
Mai
n m
embe
rAd
ult
Child
*
Exec
utiv
eEx
ecut
ive
Plan
4 46
34
463
851
1 48
71
487
283
5 95
05
950
1 13
4
Com
preh
ensi
ve
Clas
sic
Com
preh
ensi
ve3
662
3 46
473
11
220
1 15
424
34
882
4 61
897
4
Clas
sic
Del
ta C
ompr
ehen
sive
3 29
93
122
656
1 09
91
040
218
4 39
84
162
874
Clas
sic
Com
preh
ensi
ve Z
ero
MSA
3 66
23
464
731
No
Med
ical
Sav
ings
Acc
ount
3 66
23
464
731
Esse
ntia
l Com
preh
ensi
ve3
487
3 29
970
261
558
212
34
102
3 88
182
5
Esse
ntia
l Del
ta C
ompr
ehen
sive
3 14
02
967
631
554
523
111
3 69
43
490
742
Prio
rity
Clas
sic
Prio
rity
2 41
11
901
965
803
633
321
3 21
42
534
1 28
6
Esse
ntia
l Pri
ority
2 34
91
847
938
414
325
165
2 76
32
172
1 10
3
Save
r
Clas
sic
Save
r2
080
1 64
083
369
354
627
72
773
2 18
61
110
Clas
sic
Del
ta S
aver
1 66
11
312
668
553
437
222
2 21
41
749
890
Esse
ntia
l Sav
er1
873
1 40
575
133
024
713
22
203
1 65
288
3
Esse
ntia
l Del
ta S
aver
1 49
51
127
600
263
198
105
1 75
81
325
705
Coas
tal S
aver
1 72
81
297
696
432
324
174
2 16
01
621
870
Smar
tCl
assi
c Sm
art
1 64
71
298
658
No
Med
ical
Sa
ving
s Ac
coun
t
1 64
71
298
658
Esse
ntia
l Sm
art
1 18
01
180
1 18
01
180
1 18
01
180
Core
Clas
sic
Core
2 06
4 1
626
826
No
Med
ical
Sa
ving
s Ac
coun
t
2 06
41
626
826
Clas
sic
Del
ta C
ore
1 65
21
301
660
1 65
21
301
660
Esse
ntia
l Cor
e1
773
1 32
971
21
773
1 32
971
2
Esse
ntia
l Del
ta C
ore
1 41
71
065
569
1 41
71
065
569
Coas
tal C
ore
1 61
01
209
641
1 61
01
209
641
KeyC
are*
*
KeyC
are
Plus
0-8
550
990
990
359
No
Med
ical
Sa
ving
s Ac
coun
t
990
990
359
KeyC
are
Plus
8 5
51-1
2 20
01
386
1 38
638
91
386
1 38
638
9
KeyC
are
Plus
12
201+
2 06
42
064
553
2 06
42
064
553
KeyC
are
Acce
ss 0
-5 3
3069
769
730
6
No
Med
ical
Sa
ving
s Ac
coun
t
697
697
306
KeyC
are
Acce
ss 5
331
-8 5
5093
093
033
793
093
033
7
KeyC
are
Acce
ss 8
551
-12
200
1 34
41
344
378
1 34
41
344
378
KeyC
are
Acce
ss 1
2 20
1+2
018
2 01
854
62
018
2 01
854
6
KeyC
are
Core
0-8
550
792
792
205
No
Med
ical
Sa
ving
s Ac
coun
t
792
792
205
KeyC
are
Core
8 5
51-1
2 20
098
898
824
398
898
824
3
KeyC
are
Core
12
201+
1 52
51
525
345
1 52
51
525
345
* W
e co
unt a
max
imum
of t
hree
chi
ldre
n w
hen
we
wor
k ou
t the
mon
thly
con
trib
utio
n an
d an
nual
Med
ical
Sav
ings
Acc
ount
.
**
Inco
me
veri
ficat
ion
will
be
cond
ucte
d fo
r th
e lo
wer
inco
me
band
s. In
com
e is
con
side
red
as: T
he h
ighe
r of
the
mai
n m
embe
r or
reg
iste
red
spou
se o
r pa
rtne
r’s e
arni
ngs,
com
mis
sion
and
rew
ards
from
em
ploy
men
t; in
tere
st fr
om in
vest
men
ts; i
ncom
e fr
om le
asin
g of
ass
ets
or p
rope
rty;
dis
trib
utio
ns r
ecei
ved
from
a tr
ust,
pens
ion
and/
or
prov
iden
t fun
d; r
ecei
pt o
f any
fina
ncia
l ass
ista
nce
rece
ived
from
any
sta
tuto
ry s
ocia
l ass
ista
nce
prog
ram
me.
Dis
cove
ry H
ealth
Med
ical
Sch
eme
2018
con
trib
utio
ns
GM
_482
86D
HM
_12/
09/2
017_
V1
PG 12
HEALTH DISCOVERER
