Introducing the Discovery Health Medical Scheme Shari’ah Compliant Arrangement

Discovery Health Medical Scheme, in conjunction with leading Islamic scholars, have created the Shari’ah Compliant Arrangement for Discovery Health Medical Scheme. From 2021, members of Discovery Health Medical Scheme can elect to have their contributions and claims on any Discovery Health Medical Scheme plan managed in accordance with Shari’ah principles through the Shari’ah Compliant Arrangement.

ASSURING MEMBERS OF THE MUSLIM COMMUNITY OF COMPLIANCE WITH SHARI’AH PRINCIPLES

Compliance with Shari'ah principles

In accordance with all guiding principles, the Discovery Health Medical Scheme Shari’ah Compliant Arrangement was designed
end-to-end in line with Shari’ah principles, including:

  • In line with the principle of Shari’ah Law regarding interest, there will be no interest earned or paid on the Shari’ah Compliant Arrangement. Funds will be invested in a compliant manner thereby allowing members the opportunity to earn a profit on MSA balances.

  • Participating members gain the assurance that their contributions, and balances remaining after the settlement of claims and other relevant expenditure will be invested in Shari’ah compliant investments.

Independent verified compliance with Shari'ah principles

An independent Shari’ah Advisory Committee was established by Discovery Health to secure upfront and ongoing compliance of all products and services marketed as Shari’ah Compliant.

Members of this committee include three leading scholars: Mufti Ahmed Suliman, Mufti Yusuf Suliman and Sheik Mohammad Tauha Karaan who serve on Shari’ah Boards both locally and internationally and who have been instrumental in developing Islamic financial products in South Africa.

The Discovery Health Medical Scheme Shari’ah Compliant Arrangement will be subject to regular compliance reviews, and an annual compliance audit.

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WHAT DOES SHARI’AH COMPLIANCE MEAN?

Shari’ah is the religious concept of Islam – namely, its law. Shari’ah compliant financial arrangements are governed by the requirements of Shari’ah Law and the principles of religion.

Some of the requirements of Shari’ah Law in financial transactions are:

  • No interest: both parties need to take risk when profit is earned.
  • No ambiguity: contracts should be clear and transparent.
  • No investment or financing certain economic sectors that are deemed to be non-permissable, such as non-Halaal meat products, gambling companies, weapon production, etc.
  • Profit and loss sharing: both parties to the financial transaction must share in the risks and rewards.

To ensure Shari’ah compliance an external Shari’ah Board is contracted to review and audit contracts and operations to ensure that the arrangement remains compliant.

SIMPLE ELECTION PROCESS FOR MEMBERS

Existing members
  • In the plan renewal process, members will have the option to select the Shari’ah Compliant Arrangement.
  • By opting into the Shari’ah Compliant Arrangement, members will agree to all the additional terms applicable to the Shari’ah Compliant Arrangement.
  • The switch to the Shari’ah Compliant Arrangement is applicable on request only. Members are only subject to the Shari’ah Compliant Arrangement if they explicitly elect to be. The default for all members is to remain outside the Shari’ah Compliant Arrangement.
New members
  • New members, whether joining in their individual capacity or as part of an employer group, can elect to be part of the Shari’ah Compliant Arrangement through the member application form.
  • Members will only subject to the Shari’ah Compliant Arrangement if they explicitly elected to be during the application process. The default for all members is to remain outside the Shari’ah Compliant Arrangement.
Technical details
  • Existing Discovery Health Medical Scheme members will not be subject to Shari’ah Compliance principles.
  • Eligibility criteria: any member may select to join a Shari’ah Compliant Arrangement. All members join according to the existing DHMS membership rules, subject to the same waiting periods, exclusions and late joiner penalties.
  • Effective go-live dates: New and existing members will be able to select a Shari’ah Compliant Arrangement from 1 December 2020, with effective date of cover on Shari’ah Compliant Arrangement starting from 1 January 2021.
  • Benefits, contributions and Scheme rules:
    • A Shari’ah Compliant Arrangement would be offered for each of the 23 existing DHMS plans.
    • There is no change in contribution rate if members choose the Shari’ah Compliant Arrangement. The rates charged for each option will be according to the relevant year’s Contributions Table.

  • Underwriting implications: all members can join according to the existing DHMS membership rules, subject to the same waiting periods, exclusions and late joiner penalties.

2021 Discovery Health Medical Scheme Benefit updates

Introducing an Infertility and Assisted Reproductive Therapy benefit

The inability to fall pregnant is a stressful and emotional problem for many families across the world affecting over 100 million couples worldwide. But with medical advances in the infertility treatment field, the majority of infertility cases are treatable with therapies such as drug treatment, surgical repair and assisted reproductive techniques including intra-uterine insemination (IUI) and in vitro fertilisation (IVF). However, fertility treatment is highly individualised, with every patient’s case being unique and the treatment plan varying considerably from patient to patient. With an average cost of between R65 000 – R85 000 for a single IVF treatment cycle, the cost of infertility treatment can be prohibitive for many families. 
To support families affected by infertility, in 2021 DHMS is introducing a benefit to provide cover for Assisted Reproductive Technologies (ART) such as in vitro fertilisation (IVF), intra-uterine inseminiation (IUI), frozen embryo transfer (FET), and intracytoplasmic sperm injection (ICSI).

The benefit will include cover for:

  • Members have cover for up to two cycles of ART if they meet the Scheme’s benefit and clinical entry criteria.

  • Cover includes a defined basket of care for the full member journey with cover for consultations, ultrasounds, oocyte retrieval, embryo transfers, admission costs including lab fees, medication and embryo and sperm storage.

  • An overall limit of R110 000 per person per year at the Discovery Health Rate (DHR) applies.

  • Members will be responsible for up to 25% of the costs and any excess above the Discovery Health Rate.

  • The benefit will be accessible at Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG) accredited centres only and subject to clinical pathways and protocols.

  • Members on Executive and Comprehensive Plans who have been members of these plans for at least 2 years and who are females between the ages of 25-42 years old will have access to the benefit.

Diabetes Care Programme

Discovery Health Medical Scheme offers a comprehensive programme for the effective management of diabetes, which has been enhanced for 2021 through the introduction of Connected Care for chronic conditions. Members registered for the Diabetes Care Programme benefit from risk-funded benefits for consultations with a dietician and biokineticist, and access to a nurse-led diabetic education programme.

The Scheme also created the Premier Plus GP network to support the Diabetes Care Programme. The network is currently the Designated Service Provider (DSP) for members with diabetes on the Priority, Saver, Core, Smart and KeyCare plans.

From 2021, the following changes will be introduced to the Diabetes Care Programme:

  • The Premier Plus GP network will become the DSP for members with diabetes on the Comprehensive plans. This is supported by the extensive coverage offered by the Premier Plus GP network, and the clinical outcomes achieved by the Diabetes Care Programme.
  • Members are enrolled in the Diabetes Care Programme by their chosen Premier Plus GP.  The Premier Plus GP that the member chose to enroll them for Diabetes Care will then become the member’s DSP for the ongoing management of diabetes as well as cardiovascular conditions.  Alternatively members may nominate a Premier Plus GP as their DSP. This ensures that the member’s care is coordinated by a single doctor, which has been shown to improve clinical outcomes for members with multiple chronic conditions.

Co-payments for endoscopic procedures

Currently the Scheme applies a co-payment of between R3 750 and R4 550 to in-patient gastrointestinal scopes on all of its plans, except for the KeyCare plans where endoscopic procedures are only covered as PMBs. No co-payment applies to gastroscopies, colonoscopies, proctoscopies and sigmoidoscopies performed in the doctor’s rooms and for confirmed PMB cases. In 2021, to ensure that scopes are performed in the appropriate setting and to promote improvement in quality outcomes the following updates to the co-payment structure apply:

  • DHMS will continue to apply no co-payment where scopes are performed in the doctor’s rooms and/or endoscopic suites.
  • A reduced co-payment of R3 650 on all plans (except for KeyCare) for scopes performed in day clinics.
  • A co-payment of between R5 300 and R6 250, depending on the chosen plan, will be applied for scopes performed in acute hospitals.
  • Where an out-of-network deductible also applies for scopes performed outside of the Day Surgery Network, the higher of the benefit deductible or the out-of-network deductible applies.
    Where both a colonoscopy and gastroscopy are performed in the same admission, a higher co-payment applies.

Day Surgery Network

The COVID-19 pandemic has highlighted the relevance of day surgeries, with many members and doctors choosing day surgeries over hospitals where appropriate, to avoid the risk exposure to COVID-19.

The Scheme currently covers a defined and clinically appropriate list of elective day surgery procedures in the Day Surgery Network for Priority, Saver, Core, Smart and KeyCare plans.

In 2021, the Day Surgery Network will be expanded to the Comprehensive plans, given the focus on provider and patient safety as a result of COVID-19.

A deductible of R5 700 will apply where members choose to have any of the listed procedure performed outside of the Day Surgery network, except where approved as part of a PMB or the clinical exceptions process outlined above. Where an out-of-network deductible also applies, the higher of the out-of-network deductible or the procedure specific deductible applies. In the case of an emergency, no deductible will be applied outside the network.

The Day Surgery Network will be expanded in 2021 to maintain appropriate coverage through the addition of new hospitals.  The Day Surgery Network list will be published by the end of October 2020.

Hospital Networks

To ensure continued optimisation of the Delta, Smart and KeyCare hospital networks, in 2021 new hospitals will be added and some existing hospitals will be replaced with region specific substitutions.

The DHMS hospital network lists will be published by the end of October 2020.

 

Chronic Illness Benefit

From 1 January 2021, certain formulary changes and Chronic Drug Amount updates will be applied. We have been communicating these changes with impacted members. These members will have until the end of 2020 to make changes to their treatment to avoid or reduce co-payments.

Limits, co-payments, deductibles and thresholds

Co-payments and deductibles will be increased by between 3.5% and 4.0% on 1 January 2021.

Benefit limits will be increased by 3.0% on 1 January 2021, with the exception of the following where there is no increase for 2021:

  • Oncology threshold
  • Specialised Medicine and Technology Benefit
  • International Travel Benefit
  • Overseas Treatment Benefit
  • KeyCare mobility benefit.

Thresholds for the Above Threshold Benefit on the Executive, Comprehensive and Priority plans will be increased by 4.0% on 1 January 2021.