Discovery Health Medical Scheme
Open scheme · Registered 1992 · 2,735,204 beneficiaries · Administered by Discovery Health (Pty) Ltd
Discovery 2027 contributions: what changed, option by option →
Overview
Discovery Health Medical Scheme (DHMS) is a registered, non-profit open medical scheme that any member of the public can join, subject to its Scheme Rules. It is governed by the Medical Schemes Act 131 of 1998 and regulated by the Council for Medical Schemes (CMS), and is the largest open medical scheme in South Africa.
According to DHMS's 2024 Integrated Report and the CMS Industry Report 2024, DHMS holds 58.0% of South Africa's open medical scheme market by beneficiaries.
Membership Profile
DHMS reported 1,359,379 principal members and 2,735,204 beneficiaries at 31 December 2024. Membership has contracted modestly for two consecutive years (principal members −1.05% in 2024 and −0.12% in 2023), while the average beneficiary age continued to drift upwards to 37.59 years.
Membership requirements
DHMS is open to any South African resident — no employer, industry, or professional restrictions apply. The Scheme applies the standard waiting periods permitted by the Medical Schemes Act: a general waiting period of up to three months and a condition-specific waiting period of up to twelve months for any condition for which the member has received medical advice, diagnosis, care or treatment within the twelve months prior to joining. Late-joiner penalties may apply to applicants over the age of 35 who have not previously belonged to a registered medical scheme.
Sources: DHMS 2024 Annual Financial Statements; Medical Schemes Act, section 29A.
Financial Health
DHMS recorded a statutory solvency ratio of 31.01% at 31 December 2024 (2023: 30.60%), comfortably above the 25% minimum required by Regulation 29(2) of the Medical Schemes Act. Accumulated funds stood at R29.35 billion, an excess of R5.7 billion over the statutory minimum.
Reliance on investment income
The Scheme generated a 2024 insurance service deficit of R350 million from operations, meaning contributions did not fully cover claims and directly attributable expenses. Investment income of R2.83 billion bridged that gap and added to reserves. The Scheme has publicly stated its aim to reach an operating break-even, excluding investment income, by 2026.
Contribution increases
The 2026 weighted-average contribution increase was set at 7.2%, with KeyCare and Coastal plans rising 7.9%. Two-thirds of members face an increase of 6.9%. According to DHMS's own benchmarking, its average contributions for 2025 were 12.7% lower than the average of the next seven largest open schemes on a plan-category, member-weighted basis.
Sources: DHMS 2024 Highlights of Results; DHMS 2026 Contribution Table; Moneyweb, "Discovery to hike top, low-end medical aid plans by 7.9% in 2026".
Plans & Options
DHMS offers one of the widest plan ranges of any South African medical scheme — 23 benefit options for 2026 organised across four product series: Executive, Comprehensive, Priority, Saver, Core, Smart, and KeyCare. Plans differ by hospital network width, day-to-day funding model, and chronic cover.
| Series | Day-to-day model | Hospital cover | Examples |
|---|---|---|---|
| Executive | MSA + Above Threshold Benefit | Any private hospital, 100–300% DHR | Executive Plan |
| Comprehensive | MSA + ATB | Any private hospital, 100–200% DHR | Classic / Essential Comprehensive, Classic Smart Comp |
| Priority | MSA (limited ATB) | Any private hospital, 100% DHR | Classic Priority, Essential Priority |
| Saver | MSA only | Any private hospital, 100% DHR | Classic / Essential / Coastal Saver |
| Core | None (hospital-only) | Any private hospital, 100% DHR | Classic / Essential / Coastal Core |
| Smart | Insured day-to-day (network) | Smart Hospital Network | Classic Smart, Essential Smart, Active Smart |
| KeyCare | Insured GP visits (network) | KeyCare Hospital Network | KeyCare Plus, Core, Start |
Source: DHMS 2026 Product Information Brochure; DHMS 2026 Contribution Table; DHMS 2024 Annual Financial Statements (Schedule of Membership).
Key Benefits & Differentiators
Three features distinguish DHMS's benefit design from most peer schemes:
Scale of integrated managed care. Because Discovery Health administers DHMS, the Scheme has access to large, vertically integrated programmes — Hospital at Home (a clinically supervised home-based admission alternative), Virtual Urgent Care telehealth, a Mental Healthcare Programme that the Scheme reports reduces hospital admissions by 24% for enrolled members, and from 2025 the AI-driven Personal Health Pathways programme that replaces the previous WELLTH Fund.
Above-PMB chronic and oncology cover. Across the Comprehensive, Priority and Executive ranges, DHMS funds significantly more chronic conditions than the 27 Chronic Disease List (CDL) conditions required by the PMB regulations, and its oncology programme funds up to defined Rand limits before transitioning to PMB cover. According to the Scheme, average risk claims for a beneficiary undergoing oncology treatment in the year to September 2024 were R140,473 per beneficiary.
Day-to-day funding flexibility. DHMS uses multiple day-to-day models across its plan range: medical savings account (MSA) only on Saver plans, MSA combined with an Above Threshold Benefit (ATB) on Comprehensive and Executive plans, insured network day-to-day on Smart and KeyCare plans, and hospital-only on Core plans.
Mental health, maternity and prevention
All plans cover at least PMB-level mental health benefits; Comprehensive and Executive plans add outpatient psychology sessions beyond the PMB minimum. Maternity programmes are available across the plan range. The Scheme also runs a Depression Risk Reduction programme and an internet-based Cognitive Behavioural Therapy (iCBT) platform.
Source: DHMS 2024 Highlights of Results; DHMS Annexure 8a/8b — Oncology Treatment Programme; DHMS Annexure 7 — Prescribed Minimum Benefits.
Wellness & Loyalty
Discovery operates Vitality, the most widely subscribed wellness programme in South Africa, available as a separate paid product to DHMS members. Vitality integrates with medical scheme benefits through preventive-care funding (Wellness Screening, Vitality Health Check), and provides rewards-based incentives via partner ecosystems spanning gyms (Virgin Active, Planet Fitness), retail (Pick n Pay HealthyFood, Woolworths HealthyDining), travel (Discovery Miles, Vitality Travel), and digital fitness tracking.
Source: DHMS 2024 Integrated Report; Discovery Vitality 2026 programme overview.
Claims & Service
Members can submit claims via the Discovery app, the online portal at discovery.co.za, by email, and through provider direct-billing. Most claims from network providers are submitted electronically by the provider and adjudicated in real time.
Service details
DHMS reported that 94.89% of members did not change plan between December 2024 and January 2025, with 2.89% upgrading and 2.23% downgrading — the Scheme cites low plan churn as an indicator of member satisfaction and benefit-design stability.
Dispute resolution follows the standard CMS process: internal dispute committee → CMS adjudication. The 2024 Section 59 Investigation interim report found no evidence of intentional or explicit racial bias in DHMS's fraud, waste and abuse processes carried out by Discovery Health.
Source: DHMS 2024 Highlights of Results; CMS Industry Report 2024.
How the Scheme Is Set Up
DHMS's plan range is broad enough to serve almost any open-market segment, but the plan-by-plan financial data shows where the Scheme's membership naturally concentrates. The largest individual plan by membership is Classic Saver (344,957 members) — a middle-income family plan combining unlimited private hospital cover with a medical savings account. KeyCare Plus (181,078 members) anchors the lower end and is the largest network-based plan. Executive (7,123 members) sits at the top with average revenue of R12,786 per member per month.
Observationally, the Scheme tends to suit households who value (a) access to the widest hospital and specialist network in South Africa, (b) deeply integrated managed care for chronic conditions, and (c) optional Vitality rewards. The pensioner ratio (13.0%) sits above the industry restricted-scheme average but is consistent with a large open scheme that retains members through retirement. Younger, single, healthier applicants may find the Smart plans (network day-to-day) competitively priced versus traditional Savers.
Source: DHMS 2024 Schedule of Membership by plan.
Each plan in detail
One page per plan: contributions and what it covers, in Discovery’s own words, with the source for every line.
- Active Smart
- Classic Comprehensive
- Classic Core
- Classic Delta Core
- Classic Delta Saver
- Classic Priority
- Classic Saver
- Classic Smart
- Classic Smart Comprehensive
- Classic Smart Saver
- Coastal Core
- Coastal Saver
- Essential Core
- Essential Delta Core
- Essential Delta Saver
- Essential Dynamic Smart
- Essential Priority
- Essential Saver
- Essential Smart
- Essential Smart Saver
- Executive Plan
- KeyCare Core
- KeyCare Plus
- KeyCare Start
- KeyCare Start Regional
Programmes you have to ask for
10 of these 12 programmes do not start on their own. You have to register, apply or get authorisation before the benefit applies — and until you do, you are paying for cover you are not receiving.
Read from Discovery Health Medical Scheme’s own documents. Each page quotes the wording and names the source. Compare programmes across every scheme →