What is the WELLTH Fund
Discovery Health Medical Scheme is making the biggest single investment in the long-term health of its members by introducing the WELLTH Fund in 2023. COVID-19 has had an extraordinary impact on the healthcare choices we make, with many people deferring their routine, preventative care during the past few years. At the same time, people have become more conscious of their health and wellness.
Your patients will have access to a once-off, additional risk benefit called the WELLTH Fund, offering up to R10 000 per family to empower them to understand and address their personal healthcare needs.
What does the WELLTH Fund cover?
The WELLTH Fund covers a comprehensive list of healthcare services to ensure that your patients are empowered to take specific action according to their individual health needs. This benefit is separate from and additional to the Screening and Prevention Benefit and will be available to all existing and new members of the Scheme.
This benefit can be used for appropriate healthcare services up to each policy's WELLTH Fund limit. Cover is subject to the Scheme's clinical entry criteria; treatment guidelines and protocols and qualifying healthcare services are covered up to a maximum of the Discovery Health Rate (DHR).
How we calculate the WELLTH Fund amount per policy
The WELLTH Fund is a once-per-lifetime benefit available to every beneficiary on Discovery Health Medical Scheme. The value of the benefit is allocated according to size and make-up of each family on a membership.
R2 500 per adult
(>18 years old)
R1 250 per child
(> 2 years old )
Up to a maximum of R10 000 per membership
The WELLTH FUND is allocated per membership, and therefore once it is activated any person on the membership can make use of any portion of the benefit.
Listen to Podcasts
Episode 1
Episode 1 features Dr. Lerato Khatle interviewing Dr. Ron Whelan about this unique benefit, covering screenings and preventive healthcare for all scheme members. Exciting insights into the science behind the product, monetary allocation, doctors' roles, and benefits.
Episode 2
Episode 2 Discover Discovery Health's groundbreaking WELLTH Fund. A unique lifetime benefit, offering comprehensive preventive healthcare services to all members. Tune in to the podcast series as Dr. Lerato Khatle and Dr. Noluthando Nematswerani delve into activating the benefit. Your well-being, our priority.
Episode 3
Episode 3 of our podcast is a must-listen for healthcare professionals. In this episode, we delve into crucial topics that directly impact your practice: Essential for healthcare pros! Learn ICT-10 codes for claims, WELLTH Fund access, and Plan network rules. Tune in now
A Health Check is all it takes to unlock your patients' WELLTH Fund
The WELLTH Fund is automatically activated once all members (2 years and older) have completed a Health Check. All Health Checks completed from 1 January 2022 onwards count towards unlocking the WELLTH Fund.
Remember, an annual Health Check is covered in full for all members by the existing Screening and Prevention Benefit.
What is a Health Check?
A Health Check is a simple but helpful set of basic health screenings and preventive tests which you are covered for annually. These include:
Blood pressure
Blood sugar
Cholesterol or lipogram tests
Weight or body mass index (BMI) assessments
Non-smokers declaration (NSD)
Why should your patients do a Health Check?
- To understand their health status and that of their family
- For early detection of any possible health risks, which allows for better treatment and management in the case of more serious conditions
- It is likely to lower your healthcare costs over time
- It helps to inform you, the doctor and other healthcare providers for more personalized and appropriate care
- It unlocks their WELLTH Fund!
Encourage your patients to unlock their Health Check by booking a Health Check today
A Health Check can be completed at a provider on the Discovery Wellness Network near them:
Discovery Store
Visit your nearest Discovery Store.
Wellness network
Choose from hundreds of GPs and pharmacies in the Discovery Health Wellness Network.
Offering the Health Check in your rooms
You can offer a Health Check in your rooms by registering to participate in the Wellness Network. You may then submit claims electronically for the Health Checks and submit your patient's results online in real time on the HP Zone on www.discovery.co.za.
These are the Health Check assessments:
|
Health Check |
Enhanced Vitality Health Check (EVHC) |
|
Blood pressure |
Blood pressure |
|
Blood glucose |
Blood glucose |
|
Cholesterol |
Cholesterol |
|
Weight status incl. BMI and waist circumference |
Weight status incl. BMI and waist circumference |
|
Non Smokers declaration sign off |
Non Smokers declaration sign off |
|
|
Lipogram |
These are the codes and rates to use when submitting a claim:
|
Assessment |
Abbreviation |
Code |
Rate |
Payment |
|
Enhanced Vitality Health Check (Includes lipogram) |
EVHC |
EVHC + ICD10: Z13.9 |
R273.30 |
One per member, per year, paid from Risk benefit of most schemes administered by Discovery Health (Pty) Ltd |
|
HIV Voluntary Counselling and Testing |
VCT |
7000 (pre- counselling) 7010 (post- counselling) |
R177.50 R355.50 |
|
|
Kids Vitality Health Check |
KVHC |
VKIDS - 001055 |
R92.30 |
Under your guidance, your patients can take ownership of their personal health journey once their health check assessments are completed. We look forward to partnering with you in making these additional services and benefits available to your qualifying patients. Please send an email to healthpartnerinfo@discovery.co.za if you would like to establish a Health Check service in your practice.
WELLTH Fund toolkit for your practice
Downloadable material
Have a question? Check our FAQs!
Yes, the WELLTH Fund covers the following specific medical devices if they have a registered NAPPI code and are bought from a registered healthcare provider with a valid practice number (such as a pharmacy or doctor):
- Blood pressure monitors
- Glucometers
- Cholesterol monitors
- Peak flow meters
- Spirometers
It depends on which health plan you have.
Plan network rules apply for members on Smart and KeyCare plans:
- Members on Smart plans must use a Smart network GP for GP services covered by the WELLTH Fund.
- Members on KeyCare plans must use their allocated GP for GP services covered by the WELLTH Fund.
Members on KeyCare and Smart plans do not need a GP-to-specialist referral and authorisation to access specialist screening and prevention check-ups covered by the WELLTH Fund.
Members on all other plans may use a provider of their choice and do not have to use a network provider to be covered by the WELLTH Fund.
No, it will not. Claims paid from the WELLTH Fund will accumulate to the WELLTH Fund limit.
No, claims paid from the WELLTH Fund do not impact your Medical Savings Account or Above Threshold Benefit, where applicable. Consultations and/or therapy that are not covered by the WELLTH Fund will be paid from your available day-to-day Allied, Therapeutic, Psychology Benefit.
No, you cannot claim any medication from the WELLTH Fund.
Your WELLTH Fund is not yet active due to one or more of these reasons:
- You or some of the dependents (aged two and older) on your policy have not completed a Health Check in the last 12 months.
- Your healthcare provider has not yet submitted the Health Check to us.
- To book an appointment for a Health Check so you can unlock your WELLTH Fund, use the booking option on your WELLTH Fund dashboard.
- To book an appointment for any of the screening and preventative check-ups covered by the WELLTH Fund, use the "Find a Provider" functionality on the Discovery website or app.
- You can also use the WELLTH Fund Tool to guide you on which check-ups are recommended for you, based on your age and gender. From the recommended check-ups, you can then book an appointment with a healthcare provider near you.
Yes, children registered on the Discovery Health Medical Scheme policy who are younger than two can go for screening and preventative check-ups covered by the Fund, as soon as it has been unlocked.
Yes, if your child turns two before the expiry date of the WELLTH Fund, they will get the child allocation of R1 250 as soon as your WELLTH Fund is unlocked. The child will not be required to complete a Health Check in this case. Children who will still be younger than two at the time when the benefit expires will not get a rand amount allocated. However, you can still use your family's WELLTH Fund on health check-ups for them, if you wish.
Yes, new dependents added to a policy can use the WELLTH Fund, but your policy can only be allocated extra funds once your new dependent completes their Health Check.
If a dependent withdraws from the Scheme during the year, your WELLTH Fund will not decrease, but any member who leaves will lose access to the Fund and any remaining benefits.
Children who turn 18 before the expiry date of your WELLTH Fund will get the adult benefit allocation of R2 500 as soon as your WELLTH Fund is unlocked.
Please allow up to 24 hours for your WELLTH Fund information to update after you have completed your Health Check.
Also make sure that:
- All dependents aged two years and older on your policy have completed their Health Checks.
- All Health Checks for dependents on your policy were completed within the last 12 months.
- If you have children that are two years old or older on your policy, the main member can complete an online Kids Health Review instead of the Kids Health Check.
We can help you with notifying members on your policy that you cannot contact. Click here to log a request for us to help.
If you cannot go for an in-person Health Check and you are in South Africa, you can book a Health Check at Home. This service is available if you live in Johannesburg, Pretoria, Cape Town, and Durban. Book a Health Check with one of our nurses at home by clicking here.
It depends on which health plan you have.
Plan network rules apply for members on Smart and KeyCare plans:
- Members on Smart plans must use a Smart network GP for GP services covered by the WELLTH Fund.
- Members on KeyCare plans must use their allocated GP for GP services covered by the WELLTH Fund.
- Members on Smart plans must use an optometrist in the Smart plan network. Members on KeyCare plans must use optometrists and dentists in the KeyCare plan network.
Members on KeyCare and Smart plans do not need a GP-to-specialist referral and authorisation to access specialist screening and prevention check-ups covered by the WELLTH Fund.
Members on all other plans may use a provider of their choice and do not have to use a network provider to be covered by the WELLTH Fund.
If you are outside the borders of South Africa, you can go to a registered healthcare practitioner in that country, who can manually send us your Health Check results. These results will unlock your WELLTH Fund. Download the Health Check form here for your healthcare practitioner to complete.
The Health Check form must include your full name and date of birth, with the following Health Check results:
- Your blood pressure
- Your blood glucose
- Your cholesterol or lipogram
- Your weight assessment or body mass index (BMI)
Your healthcare professional must validate your Health Check by either signing or stamping the form, and confirming their or the clinic's details, where relevant. Please then send your completed form to healthchecks@discovery.co.za.
If you cannot complete your Health Check at one of our accredited healthcare providers, you can go to a registered healthcare practitioner who can manually send us your Health Check results, These results will unlock your WELLTH Fund. Download the Health Check form here for your healthcare practitioner to complete.
The Health Check form must include your full name and date of birth, with the following Health Check results:
- Your blood pressure
- Your blood glucose
- Your cholesterol or lipogram
- Your weight assessment or body mass index (BMI)
Your healthcare professional must validate your Health Check by either signing or stamping the form, and confirming their or the clinic's details, where relevant. Please then send your completed form to healthchecks@discovery.co.za.
- To maintain privacy rules and protect confidentiality, only the main member can complete the online Kids Health Review.
- Other adults on the policy can also complete the Kids Health Review if they have been given consent by the main member.
To give consent, the main member must log in to their profile on the website or app. Under the "Portfolio" tab, click on "Give user access"