Better health, better value - a model for affordable, high-quality care

Discovery Health Medical Scheme’s approach is grounded in a simple principle: true affordability does not come from cutting benefits or shifting costs to members. It comes from improving health outcomes, managing risk carefully, and using financial strength to give value back to members. This principle is being applied consistently, and its impact is already visible in ways that matter to households.

1. Relief that people can feel immediately – without eroding benefits

This year’s national Budget brought welcome relief for medical scheme members through an increase in medical tax credits for the first time in two years. Individuals can now claim R376 for the first two beneficiaries and R254 for each additional dependant. At a time when every rand counts, this change puts meaningful monthly relief back into members’ pockets.

Alongside this, the Scheme implemented a three-month deferral of contribution increases for 2026, with increases taking effect only from 1 April 2026. Members therefore continued paying 2025 contribution rates for January, February and March of this year.

While the weighted average contribution increase for the year is 7.2%, this deferral reduces the effective increase for the full year to around 5.4%—the lowest increase for 2026 among major open medical schemes.

By deferring the increase, the Scheme returned R1.5 billion to members. This decision reflects a clear recognition of the financial pressures households face and provides direct support during what is typically the most financially demanding time of the year.

This approach reflects the Scheme’s disciplined contribution strategy. The deferral is not a reduction in benefits, nor a short term discount; it is simply a pause on the annual increase that gives members real, measurable relief without compromising the quality of their cover. While many schemes have increased contributions by between 6.8 percent and 9.9 percent this year, with one significant outlier close to 19 percent, the Scheme has prioritised affordability through careful stewardship rather than through benefit erosion.

2. Stewardship and sustainability that protects members

A medical scheme’s long-term stability is one of the strongest indicators of its ability to keep healthcare affordable. The Scheme maintains solvency of around 32.6%, well above the statutory minimum of 25%. These reserves are not idle funds; they are a protection mechanism designed to ensure claims can be paid reliably, even in times of economic or medical volatility.

Over the past five years, the Scheme has returned more than R11 billion in surplus reserves to members. This includes 21 months of total contribution deferrals and more than R2 billion in additional day-to-day benefits. This pattern demonstrates a clear philosophy: reserves should serve members, not accumulate unnecessarily.

Reserves are not stockpiles. They are commitments honoured and value returned.

3. Innovation that improves health and bends the cost curve

The most effective way to keep healthcare affordable over time is to keep members healthier. Preventing illness, detecting conditions early and supporting the ongoing management of chronic disease all reduce the need for costly interventions later on.

The Scheme’s Personal Health Pathways programme is designed with this precision in mind. Rather than a one size fits all approach, each member receives a personalised, data driven health pathway that reflects their age, gender, health risks and clinical history - prompting the right screening tests, healthier behaviours and condition specific support at the right time. This targeted approach helps members take earlier, more informed action, improving outcomes while reducing avoidable healthcare costs.

More than 570,000 members are already engaging with personalised pathways, with close to one million expected to be using the programme by the end of 2026.

The results are compelling:

• More than 870,000 health actions were completed in just six months.
• Members living with chronic disease, who account for a large share of health costs, made up two thirds of these completed actions.
• Cancer screening rates increased by 20 percent, supporting earlier diagnosis and treatment.
• More than 30,000 members completed structured exercise goals for the first time.
• Earlier detection and better management delivered an estimated R200 million in savings in six months.

These outcomes show why innovation is at the heart of long-term affordability. When people stay healthier, the entire system becomes more sustainable.

4. Immediate value for households

While long term benefits matter, families also need immediate support. The Personal Health Fund provides this by helping members pay for everyday healthcare such as GP visits, medicine, pathology and optometry. Members who engage with their Personal Health Pathway can unlock up to R7,000 in total Personal Health Fund value in 2026, with additional support available for child dependants.

This year also includes a once off Personal Health Fund Boost of R1,000 per beneficiary, up to R6,000 per family. These rewards are unlocked through three simple steps - completing a Health Check, activating a pathway and enabling basic activity tracking. These steps support both better health and lower out-of-pocket costs.

A healthcare model built for the future

Affordability and quality are not opposing forces. When a medical scheme strengthens its risk pool, deploys reserves responsibly and invests in innovation that materially improves health outcomes, the result is a model built for long term resilience.

For members, this means access to high quality healthcare at a cost that remains within reach. For South Africa, it demonstrates that progress in healthcare does not have to come at the expense of affordability. DM

1. This press statement is issued by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider and accredited administrator of medical schemes, on behalf of Discovery Health Medical Scheme, registration number 1125, which it administers.
2. Personal Health Pathways is brought to Discovery Health Medical Scheme members by Discovery Health (Pty) Ltd. Personal Health Pathways is enabled by the combination of Discovery Health’s healthcare capabilities and Vitality’s behaviour change expertise. Vitality is a separate wellness product, sold and administered by Discovery Vitality (Pty) Ltd.
3. The Personal Health Fund boost is subject to approval by the Council for Medical Schemes
4. The Personal Health Fund is a benefit offered by Discovery Health Medical Scheme.