About Discovery Health Medical Scheme

The Scheme exists 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.

Dr Nozipho Sangweni (MBChB; MBA; PGDip Occupational Health; PGDip Civil Aviation Management) is the Principal Officer of DHMS

Who We Are

Discovery Health Medical Scheme (the Scheme or DHMS) is a registered open medical scheme which any member of the public can join, subject to its Rules.

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.

Covering 2 819 139 beneficiaries at 31 December 2018, DHMS is the largest open medical scheme in South Africa with an open medical scheme market share of 56.6% [1]

DHMS is a non-profit entity governed by the Medical Schemes Act[2] (the Act) and regulated by the Council for Medical Schemes (CMS). The Scheme belongs to its members and an independent Board of Trustees (the Board or the Trustees) oversees its activities.

[1] Based on beneficiaries, according to the Council for Medical Schemes Quarterly Reports for the Period ending 30 September 2018 (www.medicalschemes.com/Publications.aspx).
[2] Medical Schemes Act 131 of 1998, as amended.

The Scheme outsources its administration and managed care functions through a formal contractual arrangement with Discovery Health (Pty) Ltd.

Why Join DHMS?

Quality of care is key to our membership proposition

One of the Scheme's key strategic priorities is to drive value-based healthcare, a delivery model which places members at the centre of care. In such a model, providers are reimbursed based on health outcomes, not inputs. This ensures that it is the health results that matter, not the volume of services delivered. This approach gives our members access to programmes and providers that are committed to continuous improvement in quality healthcare.

Through Discovery Health, the Scheme is deeply engaged in many quality of care initiatives and ongoing monitoring to ensure our members have access to the safest, most efficient healthcare available in South Africa. The Scheme also empowers our members with information that is relevant to their needs.

Scheme rules

For members

To access the registered scheme rules approved by the Council for Medical Schemes, please log in. If you are not yet registered, please register.

Log in to view scheme rules

For non-members

To access the registered scheme rules approved by the Council for Medical Schemes, please come to our scheme office or email your request to compliance@discovery.co.za

87.9% of contributions received are used to fund member benefits

We make sure your investment in membership takes care of you

The Scheme's income is derived from member contributions and investment returns. The Scheme pools all members' contributions to fund members' claims, and any surplus funds are transferred to Scheme reserves for the security and benefit of members.

In setting member contributions for each year, the Scheme's objective is to ensure sufficient contribution income to pay all claims, and to return a modest surplus to meet regulatory requirements as well as to maintain a cushion against unexpected cost increases. This accords with the fundamental operating principles of a non-profit organisation that must meet the claims needs of its members and as well as maintaining a statutory level of reserves.

The Scheme's income is used to fund activities to support and benefit our members, as well as ensure the sustainability of DHMS through activities such as innovation, administration, managed care, financial advisers and the daily operations of the Scheme.

Apart from the reserves and these activities, the Scheme's entire income is used to fund claims.

 
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