Discovery Health announces contribution increases for 2025

Johannesburg - Discovery Health Medical Scheme has announced its contribution increases for 2025, along with a range of benefit enhancements for all members. Contribution increases will range from 7.4% to 10.9%, depending on plan choice, and all members will benefit from new risk-funded day-to-day benefits and a new personalised health programme.

Balancing affordability and sustainability

Dr Ron Whelan, CEO of Discovery Health Medical Scheme administrator, Discovery Health said: "In determining the Discovery Health Medical Scheme contribution increases for 2025, the priority is maintaining the industry-leading benefits enjoyed by Discovery Health Medical Scheme members, while ensuring contributions remain affordable in the short-term and sustainable in the long-term. To maintain the benefits available to Discovery Health Medical Scheme members, contributions must increase to match medical inflation and expected claims for healthcare by members in 2025."

Across the world, medical inflation is estimated to exceed consumer price inflation (CPI) by 6.4% in 2024. Medical inflation outpaces CPI due to ageing populations and a growing number of people being in poor health, which leads to a greater demand for healthcare services, over and above the increase in the cost of those services.

The components of medical inflation in Discovery Health Medical Scheme for 2025 include:

• Increases in the price of healthcare services, typically in line with CPI
• Increases in the demand for healthcare services, as a result of a gradually ageing membership, increasing prevalence of chronic illnesses, and an increasing proportion of high-cost claimants
• Increases in the supply of healthcare services through new medicine, new medical technologies, advances in medical procedures and increased need for specialised care

"At Discovery Health, a core part of our work is to mitigate the effect of demand- and supply-side factors that increase medical inflation. Through our risk management and managed care work we expect to reduce the increase in claims in 2025, and therefore reduce the required contribution increase by nearly 1%," explained Dr Whelan.

"In addition, engagement in the Vitality wellness programme makes participating medical scheme members healthier, reducing their health-related risks," adds Dr Whelan. "The expected impact of Vitality in helping make members healthier in 2025 is projected to reduce claims by a further 1%."

50% of Discovery Health Medical Scheme members will experience a contribution increase of 8.4% or less

Accounting for medical inflation on one hand and the mitigating effects of Discovery Health's risk management interventions and Vitality on the other, contribution increases for 2025 will range from 7.4% to 10.9%, to allow for the different levels of medical inflation on the various Scheme plans. The weighted average increase across the plans for 2025 is 9.3%, with 50% of members experiencing a contribution increase of 8.4% or less for the new year.

Discovery Health Medical Scheme gross contribution increases for 2025 across benefit plans are:

1. Keycare Smart: 7.4%
2. KeyCare Core: 7.4%
3. KeyCare Plus: 9.9%
4. Smart: 7.4%
5. Core: 9.9%
6. Saver: 8.4%
7. Coastal (Core/Saver) Plans: 10.9%
8. Priority: 9.9%
9. Comprehensive: 10.9%
10. Executive: 10.9%

Discovery Health Medical Scheme's new Active Smart plan is the most affordable plan in the open medical scheme market, with a bespoke benefit offering for young professionals starting their careers

Discovery Health Medical Scheme's Smart Series was launched in 2016 with the objective of providing affordable access to medical scheme cover for modern and digitally savvy healthcare consumers. Since 2016, the membership of plans across the Smart Series has grown to more than 200,000 lives. The innovative digital design, accessible networks, and compelling benefits of the Smart Series have resonated with the healthcare needs of healthy individuals seeking cost-effective medical scheme cover.

In 2025, the Smart Series will be expanded to include Active Smart. Active Smart is designed around the unique needs of young professionals starting their careers. Top of mind are affordability, flexible benefits for day-to-day healthcare, and immediate cover for emergency care in hospital. At R1,350 per month, and anchored against the unique digital features and dynamic hospital network of the Smart Series, Active Smart provides the most compelling medical scheme proposition for young professionals in this segment of the market.

Precise and personalised healthcare set to revolutionise formation of healthy habits and sustain behaviour change among Scheme members, driving medical inflation down even further for 2025/26

From January 2025, 2.2 million adult members on the Discovery Health Medical Scheme will gain access to Personal Health Pathways through the Discovery Health App and via a bespoke WhatsApp journey. Personal Health Pathways offers each member a precise and personalised health journey based on their unique healthcare needs, dynamically adapting as the member's health status evolves. Members are rewarded for completing personalised health and exercise actions and developing sustained healthy habits over time.

Personal Health Pathways is brought to Discovery Health Medical Scheme members by Discovery Health. This powerful offering is enabled by the combination of Discovery Health's healthcare capabilities and Vitality's behaviour change expertise. Personal Health Pathways is powered by sophisticated algorithms, machine learning and artificial intelligence that interprets lifestyle, clinical and behavioural insights based on 26.5 million life-years of Vitality engagement data, 48.7 million life-years of health-related utilisation and clinical data, 11.7 million life-years of condition data and additional data sources.

"The precise and personalised health actions delivered through Personal Health Pathways have the potential to revolutionise the health and wellbeing of Discovery Health Medical Scheme members. Members are provided with highly personalised health recommendations, unique to their needs and optimised toward increasing their health span and lifespan," adds Dr Whelan.

"Whether it's recommending specific preventive screening tests, encouraging physical activity at levels relevant to each person, or steps to take towards managing a chronic condition, Personal Health Pathways guides members towards actions with the greatest potential positive impact on their health status. We are incredibly excited about the potential of this ground-breaking programme in making healthcare more precise and personalised for members of the Discovery Health Medical Scheme," adds Dr Whelan.

Discovery Health Medical Scheme introduces a new benefit for all members in 2025, the Personal Health Fund, providing all members with additional risk-funded benefits of up to R10 000 per policy to spend on day-to-day medical expenses.

From 2025, all members of Discovery Health Medical Scheme will have access to an exciting new category of benefits through the Personal Health Fund. Through their Personal Health Fund and depending on the member's chosen plan and family composition, members can access up to R10,000 in risk-funded benefits for day-to-day medical expenses each year. Members can accumulate funds in their Personal Health Fund by completing health actions recommended in their Personal Health Pathway. The Personal Health Fund significantly enhances existing benefits that members have for day-to-day medical expenses, ultimately improving their access to care and their overall health status.

"Broadly speaking, the Personal Health Fund, closely linked to the groundbreaking Personal Health Pathways platform, significantly enhances the overall value of the Discovery Health Medical Scheme for its members for 2025," said Dr Whelan.