Discovery has launched an affordable health insurance product, Flexicare, which provides primary care cover to those who do not have medical aid.

While medical aid schemes in South Africa have 8.9 million beneficiaries, research shows that there are between five million and eight million people in formal employment who do not have medical aid. It says, “they already utilise the private healthcare sector for their primary healthcare needs and are paying out-of-pocket for each consultation and for prescribed medication”.

Flexicare is intended to fill this gap and follows last year’s entry into the same market by both Dis-Chem and TymeBank.

Discovery will leverage Clicks’s network of around 800 stores in the country for distribution. The offering is not new – it has been available to the retail sector and corporate employers for the last five years and is a way for them to provide a level of healthcare cover for staff who cannot afford medical aid. Almost 100 000 employees across 450 employer groups already have this cover. (It doesn’t explicitly state this in any of its marketing material, but this is a compelling option for households with full-time domestic staff).

The announcement from Discovery positions this as a ‘partnership’ between Discovery Health, Clicks and Auto & General Insurance. One can understand why, when one considers that the administrator of the country’s largest medical scheme couldn’t exactly launch health insurance on its own, given its limited distribution – never mind the confusion in the market.

It is an insurance policy underwritten by Auto & General Insurance and administered by Discovery Health. A more decided move into this space by Discovery is not surprising. Medical aid membership in South Africa has been flat for some time, with its growth coming from closed schemes and at the expense of smaller open schemes.

Cover

Cover is typically limited to providers across Discovery’s doctor, dentist, optometry, pathology, and pharmacy networks. Consultations at professionals outside the various networks will not be paid for by the cover. One benefit of Discovery’s integration with its networks is the seamless settlement of claims. With many competing products, members have to still pay for their consultation or medication and then claim back from the insurer.

Acute (prescribed or short-term) medicine is covered at 100% of the agreed rate if it is on the formulary for acute medicine and there is no co-payment. There is no limit to the amount of cover in this category. Chronic medicine is covered in full for a specified list of conditions. A modest amount of cover for OTC medicine is also included, with a limit of R105 per quarter. All medicine needs to be dispensed by a network pharmacy (or dispensing network GP). Members also get one free flu vaccination per year.

Additional cover for trauma does provide access to private emergency healthcare for specific events. These include: burns, head injuries, chest injuries or severe fractures as a result of a fall, loss of an arm, hand, leg or foot, near-drowning, poisoning or a serious allergic reaction that may cause death, and injuries resulting from a crime, sexual assault, a car accident or an injury at work. This add-on has a cover limit of either R400 000 or R1 million.

Pricing

Pricing of Flexicare, at the R430 a month level, is strikingly similar to the plans offered by Dis-Chem (which purchased 25% of specialist insurer Kaelo Holdings in 2021).

Monthly premiums for main members are R435, with additional dependents costing R400 and children R229.

Adding the trauma benefit, will mean an additional monthly premium of R174 per adult and R65 per child for R400 000 of cover or R244 per adult and R108 per child for R1 million of cover. Vitality Active, a no-frills version of the main programme, is available for an additional R59 per person per month.

Clicks Clubcard members who purchase Flexicare on the retailer’s digital channels will get 10% back on their premiums each month (loaded onto their cards along with their other cashback every second month).