Understand and use your medical scheme’s screening and prevention benefits

It’s all too easy to brush off that mild headache as being a by-product of a stressful day, too much coffee or too little water. But what if it isn’t? Sometimes seemingly insignificant niggles are signs of something else going on in the body. And sometimes, there aren’t any obvious signs at all.

In fact, some health conditions are even dubbed “silent killers” because by the time symptoms surface, a disease is already at an advanced stage.

Health screening and preventative healthcare, while often perceived as non-essential, are critical components of long-term health management. Without regular health screenings, the health of individuals may deteriorate without any preventative and timely treatment interventions.

“Regular health check-ups are important because they give you a baseline for how you are doing in terms of maintaining your health,” says Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health.

“They also give you the best chance at early detection of more severe or chronic health conditions, to allow for early intervention and prevent complications relating to late diagnosis. This, in turn improves your quality of life. Sometimes the results flag elevations in cholesterol or blood sugar levels which are easy enough to rectify with minor lifestyle adjustments but can have serious consequences when they are undiagnosed or unmanaged for long periods of time.”

How well do you understand your benefits?

“Most medical aids offer a host of screening and prevention benefits that are covered by the scheme’s risk cover and not from your day-to-day benefits or medical aid savings. It’s important to understand what these benefits are, and how often they are available to you, so that you can use them to your advantage.”

“For example, Discovery Health Medical Scheme (DHMS) provides members with several benefits to cover the cost of health screenings and preventative care. The Scheme offers the Screening and Prevention Benefit on all plans, covering the costs of a defined list of health screening and preventative healthcare services in accordance with treatment guidelines and best clinical practice. These include cancer screening benefits for breast, cervical, colon and prostate cancer and a defined list of clinically appropriate genetic tests such as the BRCA gene tests.”

Having these specific tests does not affect your day-to-day benefits, where benefit criteria are met. Some of these tests and treatments have set frequency limits. Once you have reached the frequency limit for the tests set out below, any additional screening and preventive tests and treatments will be paid from your available day-to-day benefits, where applicable.

• Day-to-day benefits are the available funds allocated to the medical savings account (MSA) and above threshold benefit (ATB), where applicable.

Tests covered by the DHMS Screening and Prevention Benefit

DHMS introduces WELLTH Fund and sees uptick in health checks

To encourage its members to do their health checks, DHMS introduced a ‘first of its kind’ WELLTH Fund benefit in January 2023, which is activated after a member (and their family members - where applicable) completes their health check. The WELLTH Fund is a once-in-a-lifetime benefit, available from 1 January 2023 to 31 December 2024. It aims to reset health awareness, remove funding hurdles, and enable the flexibility for all Scheme members to access a comprehensive list of screening and preventative healthcare services, over and above those already covered by the screening and prevention benefit. Any claims for screenings made against this fund will not impact a member’s medical savings account or above threshold benefit.

The WELLTH Fund gives members risk funding of up to R10,000 per policy (R2,500 per adult and R1,250 per child) to use for necessary screening to establish their health status and improve their long-term personal health outcomes.

“We are thrilled to report an uptick in the number of members using their screening and prevention benefits since the beginning of 2023 - with about 179 000 health checks completed, including for children, and about 160 000 policies have unlocked the WELLTH fund covering 263 000 beneficiaries.”

Nematswerani concludes: “This is why it is so vital to understand the nuts and bolts of your medical scheme cover and make use of its screening and prevention benefits. This understanding and regular screening could save your life!”