Discovery Health Medical Scheme's World

DHMS Members

The Scheme's purpose is to care for our members’ health and wellness by engaging the brightest minds and innovative solutions to provide access to affordable, equitable and quality, value-based healthcare that meets their needs now and sustainably into the future. We exist for our members.

Any member of the public can join DHMS [1] and choose from 23 benefit options designed to cater for a wide range of affordability and healthcare needs[2].

[1] Subject to any applicable Scheme Rules and restrictions of the Medical Schemes Act 131 of 1998, as amended (the Act).
[2] Members and potential members can discuss their unique needs with a financial adviser to select the most appropriate plan for them.

Discovery Health Medical Scheme

DHMS is a registered medical scheme, and like all other medical schemes in South Africa is a non-profit entity. The Scheme pools all members’ contributions to fund members’ claims. Any surplus funds are transferred to Scheme reserves for the benefit of members. The Scheme exists to serve its members’ interests through enabling the sustainable provision of high-quality, affordable and sustainable healthcare to all of its members.

Scheme Office

(Principal Officer and executive management team)
The Trustees appoint a Principal Officer, who is the chief executive officer of the Scheme and is accountable to the Trustees for the Scheme’s day-to-day management and the implementation of its strategy.

Supported by an executive management team, the Principal Officer plays a critical role in the effective operation of the Scheme. The Principal Officer and the management team collaborate closely with the Scheme’s Administrator and Managed Care Provider, Discovery Health, in implementing strategy and daily operations. The diverse management team’s skills and expertise include medical, actuarial, risk management, business management, strategic development, financial management, investment, legal, ethics, compliance and research capabilities.

Board of Trustees

The Trustees oversee the affairs of the Scheme in the best interest of members and stakeholders.

The Trustees are highly skilled individuals who offer their diverse knowledge and experience to the Scheme. They may be elected or appointed, but at any time at least 50% of the Board must be elected by Scheme members.

Discovery Health (Pty) Ltd [3]

[3] Discovery Health (Pty) Ltd is a separate entity to Discovery Health Medical Scheme. It is an authorised financial services provider, registration number 1997/013480/07, and administrator of medical schemes.

(Administrator and Managed Care Provider)
Discovery Health has been appointed by the Trustees to provide administration and managed care services to the Scheme. Administration services provided include:

  • Member and provider servicing;
  • Marketing, communication and advertising;
  • Financial services;
  • Risk management, regulatory compliance and internal audit;
  • Research and development;
  • Actuarial and business analytics;
  • Benefit design and development; and
  • Fraud and forensics investigations and recoveries.

Managed care is the provision of appropriate, affordable, quality healthcare services through rules-based, clinical and disease management programmes. Managed care services provided include:

  • Active disease risk management and support services;
  • Hospital benefit management services;
  • Managed care network, negotiations and risk management services; and
  • Pharmacy benefit management services.

Council for Medical Schemes

The CMS is a statutory body responsible for regulating the medical schemes industry in South Africa; it administers and enforces the Act.

Financial Advisers

Financial advisers (commonly referred to as “brokers”) provide members with independent advice about their health plan options based on individual medical and affordability needs.

Financial advisers are regulated by and must be registered with the Financial Services Board. In addition, they are accredited by the CMS to provide advice on private healthcare cover. The Scheme pays contracted financial advisers a legislated commission.

Healthcare Providers

Healthcare providers are the health professionals and organisations who deliver healthcare services. This includes doctors, nurses, dentists, specialists, hospitals, pharmacies and managed care organisations.

South African Society

The Scheme recognises a duty of ethical administration, social responsibility and good corporate citizenship. While it regards its members’ access to healthcare as its primary responsibility, it observes its Constitutional and other civic obligations to South African society at large.

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