Dis-Chem's medical insurance is aimed at SA's 'under-served population' – Here's what it can get you

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Dis-Chem's Core plan allows members one general dental check-up per insured party, per annum.
Dis-Chem's Core plan allows members one general dental check-up per insured party, per annum.
Getty Images/Nataliia Nesterenko
  • This year, Dis-Chem launched its affordable medical cover for medical needs, including day-to-day GP visits, dentistry, and optometry benefits.
  • The Core plan is the standard primary healthcare insurance option that provides coverage for a broad spectrum of health needs.
  • The Plus plan is more comprehensive and includes unlimited access. However, these medical insurance plans are not medical schemes. 

This year, Dis-Chem Health, a division of Dis-Chem Pharmacies, announced that it had entered the health insurance market by offering day-to-day cover. Their aim was to provide "affordable primary healthcare to South Africans who don't yet have access." 

Said Rui Morais, CFO at Dis-Chem:

"The health and well-being of our community has always been at the heart of our philosophy of caring for our customers… This new offering, under the Dis-Chem Health brand, is entrenched in our belief that affordable private healthcare should be within everyone’s reach." 

Dis-Chem partnered with Kaelo, a leading company in the health insurance sphere, and Centriq Insurance, a licensed non-life insurer, to deliver primary health medical insurance products that provide universal access to affordable and quality private primary healthcare, said Morais.

READ MORE | Low-cost medical schemes set to boom as cost of living spirals, says Momentum Health

Premiums start at R450 per month for adults and R315 per month for children for the Core plan and increase to R620 per month for the Plus plan. Additional cover options are available for accident and medical emergency illness cover.

What the R450 plan gets you

The Core plan is Dis-Chem Health’s standard primary healthcare insurance option. It provides coverage for a broad spectrum of health problems. 

According to its website, Core includes:

1. Private doctors (GPs)

  • Four doctor visits per insured party per year: You’ll get access to visit a Prime Cure network contracted doctor (GP), which will be covered at the agreed rate.
  • My Telehealth Virtual Doctor consultations: four over-the-phone or virtual consults per insured party per year.
  • Nurse and wellness clinic visits: The treatment of minor illnesses such as coughs and colds at a network provider wellness clinic/pharmacy.
  • Clinic-based care: Your benefit will cover over-the-counter medication if recommended by a nurse.

2. Dentistry

Through Network Dentists, you can access:

  • One general dental check-up per insured party per annum.
  • One preventative treatment, such as cleaning, scaling and polishing. Topical Application of fluoride and polishing only (excluding scaling) is limited to children under 12.
  • Unlimited additional cover for restorative treatment such as fillings, extractions, X-rays, and emergency treatment for pain and sepsis.
  • Pre-authorisation is required for procedures exceeding certain limits.

READ MORE | Why medical schemes are increasingly unaffordable

3. Optometry: eye exams, specs and frames

You can take your family for annual eye examinations, but examinations are limited to one per insured party per year. Spectacles and frames are limited to one pair in a 24-month period.

4. Medication: access to acute, chronic and over-the-counter medication

  • Acute medication: Prescribed by your network contracted (GP). Eight Scripts at 100% of the agreed rate. Acute medication is available without a co-payment, limited to the 4 private doctor visits.
  • Chronic medication: 100% of the agreed rate for chronic medication on the formulary at a network provider contracted pharmacy seven listed chronic conditions, including HIV, asthma, diabetes, cholesterol and hypertension (high blood pressure).
  • Over-the-counter medication: Obtained on the advice of a network contracted pharmacist. Limited to R105 per quarter, up to a maximum of R420 per insured party per year.
  • Flu Vaccine: one per year.

5. HIV programme

The HIV Programme is designed to optimise the health and well-being of HIV-positive patients, including:

  • Voluntary counselling and testing, and therapy
  • Antiretroviral (ARVs) medicines and supplements

6. X-rays and blood tests

  • Black & white X-rays and soft tissue ultrasounds paid at 100% of the agreed rate, subject to referral by your network Doctor (GP).
  • Blood tests that must be requested by a contracted service provider (GP) and performed by a network contracted pathology laboratory paid at 100% of the agreed rate.

7. Maternity scans

Receive two 2D sonar scans per pregnancy per insured party, performed by a network provider or contracted service provider (GP).

8. Health screenings

Take your family to a contracted wellness pharmacy to measure height, weight, and body mass index. You can also get glucose, blood pressure, cholesterol or HIV tests done. This includes a personal consultation along with suggestions on how to improve your health. Limited to two visits per insured party per year.

9. Accident cover

Accident cover can be bought separately or combined with day-to-day benefits. Accident Cover is R123 a month for principal policyholders and R110 a month for children.

You can save by combining when you buy Accident Cover with the Core Plan & Value Added Services for R509 a month for adults and R331 a month for children, according to Dis-Chem Health.

*Refer to the policy limits here.

Plus

For R620 per month, Dis-Chem Health’s Plus plan is a more comprehensive option. Plus has all the same benefits as Core, but it has unlimited access to doctors and virtual consultations; specialist visits, dentistry, pathology and optometry benefits and chronic medication for 27 conditions.

You can compare the Core and Plus plans on the Dis-Chem Health website.

However, these plans are not a Medical Scheme, and the cover is not the same as that of a Medical Scheme. Its website states: "This Policy is not a substitute for a Medical Scheme." 

READ MORE | Supplement the pay gap when medical aid schemes become unaffordable

South Africa’s inequitable healthcare system has made private healthcare too expensive for most people, as the public healthcare system is increasingly overburdened and under-resourced, resulting in delayed and/or inadequate treatment, Dis-Chem said earlier this year. Ever-increasing medical aid premiums coupled with a lack of access to quality public healthcare has led to a strong demand for affordable medical insurance.

"People are prepared to pay for healthcare, and this product is in line with our intention and commitment to play a leading role to extend universal access to a wider and under-served segment of the population," said Morais.

Full details can be found at www.dischemhealth.co.za   


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