Discovery Health has partnered with retail group Clicks and Auto & General Insurance to bring its Flexicare health insurance product to the mass market.
Flexicare has been available to the retail sector and corporate employees since 2018 but is now being made available to everyone.
Discovery Health said that its research shows there are five to eight million South African residents in formal employment who do not have medical aid, yet they make use of the private healthcare sector for their primary healthcare needs and pay out-of-pocket for each consultation and for prescribed medication.
The group now wants to target these individuals, seeing a gap in the market for affordable health insurance for day-to-day needs.
The product comes at a monthly cost of R435 and provides for unlimited GP consultations, medicine, dentistry, eye care, x-rays, flu vaccines, maternity, health checks, blood tests, procedures in GP rooms, HIV care and private ambulance. There is an optional add-on of trauma cover at a private hospital for an additional fee from R174.
Trauma cover provides additional private emergency healthcare services for the individual and all registered beneficiaries for a range of serious events, including burns, car accidents, and serious head or chest injuries, to name a few.
Flexicare is not a medical aid scheme – it is a long-term insurance product – and is not intended to be a substitute for medical scheme membership, Discovery said.
Medical aid schemes differ from private health insurance in that they are governed by national regulations that require all schemes to pay for a basic level of care for 27 chronic conditions and 270 diseases – a set of conditions called prescribed minimum benefits (PMBs).
This is not the case for health insurance, which is structured around more specific offerings. Flexicare is underwritten by Auto & General and administered by Discovery, while Clicks is the retail partner that offers loyalty benefits and rewards.
Clicks Clubcard members who purchase Flexicare can earn 10% cashback on their monthly premium as a loyalty benefit by paying the premium and ensuring the cover remains uninterrupted.
This is what the R435 monthly fee covers:
- Unlimited GP consultations: This includes online doctors’ consultations, with an allocated network doctor. Members are not required to make co-payments.
- Medicine: Cover for prescribed, chronic and over-the-counter medicine.
- Dentistry: Cover for dentist visits, fillings, and tooth removals at a network dentist.
- Optometry: Cover for one eye test every year and one pair of glasses every 24 months through a healthcare provider in the optometry network.
- Blood tests and X-rays are covered when accessed through a network provider.
- Maternity cover: This includes unlimited GP consultations, medicine, blood and screening tests and ultrasound scans.
- A suite of digital tools giving members a gateway to benefits, service and support on the go.
Additional benefits allow members to access trauma cover at a private hospital
An optional trauma benefit covers you for emergency private healthcare services at any hospital facility. There are two cover options for this benefit:
- Cover of R400,000 for each hospital admission: at an extra R174 a month.
- Cover of R1 million for each hospital admission: at an extra R244 a month.
Accidents and emergencies that are covered by the optional trauma benefit include:
- Burns
- Head injuries
- Chest injuries or severe fractures caused by a fall
- The loss of an arm, hand, leg or foot
- Near-drowning
- Poisoning or a serious allergic reaction that may cause death
- Injuries resulting from a crime, sexual assault or a car accident, or an injury at work.
All Flexicare members have access to ambulance services in the case of a medical emergency, only those with the trauma benefit will have the option of being transported to a private facility.