Discovery, Dis-Chem and rivals’ low-cost health insurance policies compared

Until the respective entries by Discovery and Dis-Chem, the health insurance market was nascent with only a few providers in the space.

In theory, there exists a sizeable gap in the market.

Research shows there are between five and eight million people in formal employment who are not members of medical aid schemes. These workers, many of whom are in the retail or other lower-skilled sectors (even full time domestic helpers would fall into this bracket), simply cannot afford medical aid contributions – the least expensive plans start at R1 000 a month.

This is the gap these health insurance providers intend to fill.

And with Dis-Chem buying a stake in insurer Kaelo and Discovery leveraging Clicks’s distribution muscle, lower income consumers have a lot more choice.

Read:
TymeBank and Dis-Chem both enter health insurance market
Discovery launches affordable health insurance

It is important to highlight that all of these products are insurance policies. In other words, the providers and underwriters will profit off their sale. Medical schemes, by comparison, are not for profit and the funds within schemes are for the benefit of their members.

All the basic medical insurance plans available in the market are priced at around R400 to R450 per adult member per month.

TymeHealth has two even cheaper options (Connect at R139 and Premier at R299), but these are excluded from this comparison. It is telling that Discovery entered the market with its Flexicare product, underwritten by Auto & General, at R435, just below the R450 mark.

Benefits

These products are designed to provide a level of access to primary healthcare, such as doctors’ consults, dental check-ups, eye tests, health screening, and blood tests and X rays when required.

In general, cover is limited to network providers (doctors/dentists/pharmacies/specialists), which allows the administrator to contract an upfront rate for visits or events.

Read/listen:
Medical aid vs medical insurance – choosing the best for your needs

The exhaustive comparison below shows that basic benefits are generally consistent across different plans and providers. There are limits on certain benefits, depending on the plan, and many benefits require pre-authorisation.

In Oneplan’s case, all benefits have a strict rand limit per visit/event. This makes it the least appealing of the six plans compared.

Cover for acute or day-to-day medicine is included on all plans, ranging from generous (unlimited if prescribed by a network GP) to very limited (R160 per script on Oneplan Core).

All plans but TymeHealth’s include cover for over-the-counter medicine. Discovery, Dis-Chem MyHealth and TymeHealth all include cover for chronic medicine, limited to a defined list of chronic conditions that varies between plans. Affinity Health offers an optional benefit for chronic medicine at an additional R109 per month per condition.

	Discovery Flexicare	Dis-Chem MyHealth Core	Dis-Chem MyHealth Plus	Affinity Health day-to-day*	Oneplan Core	TymeHealth Elite*
Monthly premium per adult member	R435	R450	R620	R759	R450	R399
GP consults	Unlimited in network at 100% of agreed rate	Up to 4 visits to doctors on the Prime Cure Network1	Unlimited to doctors on the Prime Cure Network2	Unlimited on network, subject to telephonic consultation referral	Up to R380 per visit (R1 800 per year)	Unlimited at National Healthcare Group (NHC) network GP
Procedures in doctor’s room	Cover for a defined list of procedures	Cover for a list of approved procedures	Cover for a list of approved procedures	Cover for list of approved procedures	Included in cover above	­–
Dentistry	Full mouth examination, cleaning, scaling, polishing, infection control and extractions at a network dentist	One examination and one preventative treatment per annum. Basic cover for restorations and extractions. Limits apply.	One examination and one preventative treatment per annum. Basic cover for restorations and extractions. Limits apply.	Full mouth assessment and scale and polish every 6 months. Infection control, 2 intraoral radiographs, 3 extractions and 3 fillings per member per year.	Up to R620 per visit (R1 545 per year). Max of 3 visits per year.	Consultations, fillings, extractions, infection control, cleaning and polishing.
After-hours dentistry	–	–	One visit per family per year at any dentist for pain and sepsis only.	–	–	–
Optometry	One eye test and one pair of glasses every 24 months	One eye test and one pair of glasses every 24 months	One eye test and one pair of glasses every 24 months	One eye test and one pair of glasses every 24 months at Spec-Savers	Up to R1 075 every 24 months.	One eye test and one pair of glasses (to the value of R500) every 24 months
Pathology	Covered at network pathologist if requested by network GP	Covered at network pathologist if requested by network GP. Limit of 8 visits	Covered at network pathologist if requested by network GP. Unlimited visits2	Covered if requested by network GP	Up to R460 per event (R1 530 per year)	Basic blood tests as required by NHC provider
Radiology	Covered at network radiologist if requested by network GP	Covered at network radiologist if requested by network GP. Limit of 4 visits1	Covered at network radiologist if requested by network GP. Unlimited visits2	Covered if requested by network GP	Up to 460 per visit (R1 530 per year)	As required by NHC provider
Specialist visits	–	–	Covered at cost, subject to pre-authorisation and limited to R2 000 per visit	Up to R1 700 per member or R3 500 per family per year, after referral by GP	–	Up to R2 600 per annum, after referral by network GP
Maternity	Two ultrasound scans for each pregnancy at a network provider	Two 2D sonar scans per pregnancy per annum at network provider	Two 2D sonar scans per pregnancy per annum at network provider	Two growth sonars when referred by network GP	Up to R620 per visit (R1 860 per year), three visits per pregnancy.	–
HIV management	Cover for treatment, counselling, ARVs, supportive medicine, blood tests	Cover for blood tests, ARVs, post-exposure prophylaxis and treatment of infections.	Cover for blood tests, ARVs, post-exposure prophylaxis and treatment of infections.	Members need to register for the chronic medication management programme	–	HIV Elisa blood test. Referral to state facility if required.
Covid-19	Cover for one positive Covid test per annum.	Cover up to R850 per annum if the test is positive.	Cover up to R850 per annum if the test is positive.	–	–	–
Acute/ day-to-day medicine	Cover for defined list if prescribed by GP	Eight scripts, if prescribed by network provider	Unlimited if prescribed by network provider	Unlimited if prescribed by GP	Up to R160 per script (R640 per year)	Unlimited if prescribed by NHC network GP
OTC medicine	Cover up to R420 per year at network pharmacy	Up to R420 per year (R105 per quarter)	Up to R440 per year (R110 per quarter)	Up to R500 per member or R1 000 per family per year, subject to pre-authorisation	Up to R160 per annum	–
Chronic medicine	Cover for defined list of 27 conditions at network pharmacy	Cover for 7 conditions at network pharmacy	Cover for 27 conditions at network pharmacy	Optional benefit for 24 conditions costing R109 per month per member per condition	–	Cover for up to 26 conditions
Flu vaccine	One per annum from network pharmacy	One per annum	One per annum	–	–	One per year
Health screening (blood pressure, glucose, cholesterol, BMI, HIV test)	One per year at network pharmacy/ wellness day	Two per year at network pharmacy clinic	Two per year at network pharmacy clinic	One per year at medical society centre	–	One test per year at Dis-Chem, Clicks, Medirite clinic
Emergency casualty cover	Included in additional Trauma Cover (below)	Up to R20 000 per event per insured party included in Accident Cover (below)	Up to R20 000 per event per insured party included in Accident Cover (below)	Available on Affinity Hospital Plan	Up to R5 150 for life-threatening emergency illness or accident. Excess applies.	Up to R18 000 per insured per annum
Hospitalisation for accidents	Trauma Cover for up to R400 000 per event at R160 per month per adult (extended cover available at R224)	Accident Cover for up to R380 000 cover per event at R198 per month per adult (extended cover available at R228)	Accident Cover for up to R380 000 cover per event at R198 per month per adult (extended cover available at R228)	Up to R250 000 cover for R119 per month. ICU booster for R119 per month	Up to R159 650 per insured event. Excess applies.	Up to R200 000 per insured per event.
Underwriter	Auto & General	Centriq Insurance	Centriq Insurance	Lion of Africa	Bryte	African Unity Life

1 Pre-authorisation needed from third visit per year
2 Pre-authorisation needed from fourth visit per year
* Waiting periods for most benefits apply.

Trauma and emergency 

Only TymeHealth and Oneplan include emergency casualty cover and hospitalisation for accidents, with limits in place for each event.

Discovery Flexicare offers Trauma Cover (via Discovery Insure) in basic and extended options (at either R160 or R224 per month per adult).

Dis-Chem MyHealth’s Accident Cover works in a similar way, with basic (R198 per month per adult) and extended cover (R228 per month per adult) available. The extended cover options in both instances have significantly higher limits.

Affinity Health offers additional accident cover (with various premiums depending on the limit) and an additional ICU booster.

This type of cover ensures that policyholders will have access to private hospitals in the case of a number of defined accidents.

In Discovery’s case, this includes “injuries resulting from a crime, sexual assault, a car accident or an injury at work” as well as incidents such as burns, head injuries, chest injuries or severe fractures as a result of a fall, the loss of an arm, hand, leg or foot, near-drowning or poisoning, or a serious allergic reaction that may cause death.

While this comparison provides a handy way for benefits to be compared, readers are advised to always read the fine print.

As with all insurance, there are definitions, exclusions and waiting periods that need to be carefully considered by any prospective purchaser.

Listen to Fifi Peters’s interview with Unu Health CEO Tania Joffe:

You can also listen to this podcast on iono.fm here.