Discovery gets warning

REGULATOR: ‘STOP CONDUCTING BUSINESS OF A MEDICAL AID SCHEME’

Discovery Health, Netcare Plus accused of selling ‘healthcare service vouchers’.

The Council for Medical Schemes (CMS) has told Discovery Health and Netcare Plus to stop conducting the business of a medical scheme. This after Discovery launched a new digital health innovation enabling people to buy vouchers for primary healthcare services in the private healthcare sector

The announcement of enforcement action by the CMS against Discovery Health and Netcare Plus, in terms of section 20(1) of the Medical Schemes Act, for “conducting the business of a medical scheme” comes after The Citizen asked the council if this product is not the same as the Discovery Comprehensive PrimaryCare and Discovery Essential PrimaryCare products that landed Discovery in hot water before.

According to the CMS, the two companies “are selling healthcare service vouchers” under the names “Discovery Prepaid Health” and “NetcarePlus vouchers” for access to mostly general practitioner services (in-person or virtually) with options to include medication.

These vouchers are sold online, on banking platforms and by retailers.

The Medical Schemes Act describes the “business of a medical scheme” as that of undertaking, in return for a premium or contribution, the liability associated with: Providing for the obtaining of any relevant health services;

Granting assistance in defraying expenditure incurred in connection with the rendering of any relevant health service; or Rendering a relevant health service, either by the scheme itself, or by any supplier or group of suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical scheme.

Discovery Health and Netcare Plus have contracted with healthcare providers who are compensated through the voucher model.

The CMS says it understands that doctors are paid less than they would ordinarily be paid by cash-paying members.

Discovery Health and Netcare

Plus receive a fee for the facilitation of this service which allows consumers to access healthcare services and in return, they assume liability or risk to ensure that the customer receives the service.

The CMS says it has instructed Discovery Health and Netcare Plus to cease conducting the business of a medical scheme without the requisite approval from the CMS and make arrangements to refund consumers.

Dr Ryan Noach, chief executive of Discovery Health, said in a statement they have received a directive from the CMS and would respond in due course.

“Discovery’s intention in launching Discovery Prepaid Health is to offer innovative access to affordable, high-quality care,” he said.

“To the best of our understanding, there is no insurance component to this product. We took steps to ensure the structure is fully compliant with relevant legislation. We will be engaging with the regulator accordingly.”

According to Discovery, the first offering will be a R300 voucher for a general practitioner, including the medicines dispensed by the doctor.

Noach said Discovery Prepaid Health would broaden access to high-quality treatment and medicine. He said Discovery wanted the vouchers to become as universal as buying prepaid airtime. –

Intention is to offer access to affordable care