What is the Personal Health Fund?
The Personal Health Fund is a new benefit introduced to add value to you and your family. This fund offers the next level of precise and personalised healthcare and is available to all Discovery Health Medical Scheme members. You can accumulate funds every time you complete a next best action in your Personal Health Pathway, which you can use for eligible day-to-day medical expenses on an annual basis. You have a maximum amount of R500 cover for over-the-counter medical expenses.
Download the Discovery Health app and activate your Personal Health Pathway
Download the Discovery Health app to participate in your Personal Health Pathway, accept the terms and conditions and understand your next best actions. You can view your next best actions on the Personal Health Pathways programme, which is available on the Discovery Health app.
Complete your recommended actions
For every completed next best action on Personal Health Pathways, you accumulate up to R500 into your Personal Health Fund. You can continue to accumulate funds up to a maximum benefit limit each year, based on your plan choice and the family structure of the membership.
If there are no next best health actions available and the full benefit entitlement has not been accumulated yet, you earn up to R100 per exercise action per week, added to the Personal Health Fund, until another health action becomes available in your Personal Health Pathway.
All adults on the membership must complete at least two actions on their Personal Health Pathway to unlock the value for the children on the policy. The maximum amount that can be accumulated in the Personal Health Fund depends on your chosen plan type and the family structure of your membership.
Use the available funds for day-to-day medical expenses
You can use the available funds for day-to-day medical expenses, such as GP visits, specialist consultations, physiotherapy and medicine. Any unused funds in the Personal Health Fund expire at the end of a benefit year, and do not carry over to the next benefit year.
If there are no funds available in your Personal Health Fund, relevant day-to-day claims will be paid from your available day-to-day benefits, if applicable
Your maximum benefit limit per year
| Per adult | Per child | Per family | |
| Executive Plan, Classic Comprehensive Plan, Classic Priority Plan, Classic Saver Plan | R2,500 | R1,250 | R10,000 |
| Classic Core Plan, Classic Smart Plan | R2,000 | R1,000 | R8,000 |
| Essential Priority Plan, Essential Saver Plan, Costal Saver Plan | R1,500 | R750 | R6,000 |
| Essential Core Plan, Essential Smart Plan, Active Smart Plan, Coastal Core Plan | R1,000 | R500 | R4,000 |
| All KeyCare plans | R500 | R250 | R1,000 |
New members can access an additional once-per-lifetime benefit
Following the success of the WELLTH Fund in 2023 and 2024, all new members will continue to get a once-per-lifetime benefit, built into the Personal Health Fund in 2025. New Discovery Health Medical Scheme members who activate Personal Health Pathways and complete their once-off high-value recommended action will get up to R10,000 in additional funds in their Personal Health Fund, available immediately. The value depends on your plan and the family size and structure of your membership. This is a once-per-lifetime benefit in addition to the yearly Personal Health Fund allocation received by all Discovery Health Medical Scheme members. The once-per-lifetime benefit is the same value as the maximum Personal Health Fund allocation by plan series and family size, as shown in the table above.
Have a question? Check our FAQs!
The Personal Health Fund is a new category of healthcare funding. You accumulate value by engaging with Personal Health Pathways and completing your recommended next best actions. Accumulated funds can be used for eligible day-to-day medical expenses.
The maximum benefit amount is determined by your chosen plan type and family structure on your membership.
New members of Discovery Health Medical Scheme in 2025 will have access to an additional once-off benefit. In order to unlock the additional once-off benefit, the member must complete their high-value action, which will be appropriately highlighted. For most new members, this high-value action will likely be a health check, however it may also be a mental wellbeing assessment or some other eligible action. In order to unlock the once-off benefit available for children, all adult members on the plan must have completed their high-value actions. The high-value action must be completed within 90 days of joining the scheme.
The Personal Health Fund is available as follows:
- For all Discovery Health Medical Scheme plan types
- To every person on the membership, regardless of their age
The Personal Health Fund (PHF) is automatically activated for you and your dependants once an adult on the membership has activated their Personal Health Pathway (PHP).
Here's how to activate your Personal Health Pathway:
- Download the Discovery Health app if you have not yet done so.
- Access the Personal Health Pathways section of the Discovery Health app.
- Click through the onboarding screens and read about the key features of Personal Health Pathways, including content related to linking a device.
- Click Continue to access Personal Health Pathways and automatically accept the terms and conditions.
If you are younger than 18 or older than 85 years and not eligible to participate in Personal Health Pathways, you will be able to unlock the full value of your Personal Health Fund by completing a Health Check or Kids Health Check. If you are unable to participate in Personal Health Pathways, for example due to severe illness or because you are on palliative care, then the full value of the Personal Health Fund will be made available to you, subject to eligibility criteria
You accumulate funds by completing the recommended next best actions presented to you. A Personal Health Fund amount will be displayed on the card showing your next best action, and you can earn up to that amount in your Personal Health Fund, subject to your benefit limits, by completing that action.
There will be annual benefit limits which apply based on your plan type and the family structure on your membership.
You'll accumulate funds up to a maximum for each member and subject to an overall family limit. For example, a Classic Saver Plan with one adult member will be allocated funds up to a maximum of R2,500 per year. If the health plan covers one adult and one child, the maximum value allocated will be R3,750. If the health plan covers 3 adults and 3 children, a maximum of R10,000 per year will apply.
|
Yearly maximum Personal Health Fund allocation for different plans |
Per adult Members aged 18 and over |
Per child Members under the age of 18 |
Per family |
|
Executive |
R2,500 |
R1,250 |
R10,000 |
|
Classic Comprehensive |
R2,500 |
R1,250 |
R10,000 |
|
Classic Smart Comprehensive |
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|
Classic Priority |
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|
Classic Saver |
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|
Classic Core |
R2,000 |
R1,000 |
R8,000 |
|
Classic Smart |
|||
|
Essential Priority |
R1,500 |
R750 |
R6,000 |
|
Essential Saver |
|||
|
Coastal Saver |
|||
|
Essential Core |
R1,000 |
R500 |
R4,000 |
|
Essential Smart |
|||
|
Active Smart |
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|
Coastal Core |
|||
|
KeyCare (all plans) |
R500 |
R250 |
R1,000 |
You can earn up to R500 towards your Personal Health Fund for completing health actions, subject to your benefit limits. If you do not have any currently surfaced, snoozed or temporarily dismissed health actions in your Personal Health Pathway and you haven't yet reached your benefit limits, you'll accumulate up to R100 in your Personal Health Fund for each qualifying exercise action you complete until a health action is recommended again. For qualifying exercise actions to earn value towards your Personal Health Fund, you must link a device and activate the Exercise Ring on your Personal Health Pathway.
If you do not have any currently surfaced, snoozed or temporarily dismissed health actions in your Personal Health Pathway and you haven't yet reached your benefit limit, you'll accumulate up to R100 in your Personal Health Fund for each qualifying exercise next best action you complete until a health action is recommended again. For qualifying exercise actions to earn value towards your Personal Health Fund, you must link a device and activate the Exercise Ring on your Personal Health Pathway.
The WELLTH Fund benefit expired on 31 December 2024 for members who joined the Scheme before 2023 and unlocked their WELLTH Fund in 2023. Any unused funds will not be carried over to 2025.
The WELLTH Fund benefit expires on 31 December 2025 for members who joined the Scheme in 2024 and unlocked the WELLTH Fund in 2024. If you have a positive balance in your WELLTH Fund at the end of 2024, it will be carried over to 2025. Any positive balance remaining at the end of 2025 will not be carried over to 2026
Once your Personal Health Fund balance shows the funds you've earned, you can start using the eligible funds to pay for your day-to-day benefits.
No, you can't choose where claims will be paid from. Eligible claims will first be paid from your Personal Health Fund (up to R500 per family per year for over-the-counter medication and up to 100% of the Scheme Rate for all eligible claims), then your day-to-day benefits where applicable.
The funds earned in your Personal Health Fund will be valid until the end of the calendar year in which you earned them. It doesn't matter at what point in the year you earned the funds.
You can track this through the Personal Health Fund dashboard on the Discovery Health app or on our website, as well as on your claims statement.
You can view your balance on the Personal Health Fund dashboard, which is available in the Discovery Health app and on the Discovery website.
Once all adult dependents (18 years and older) on your membership have completed at least 2 qualifying next best actions,you will unlock the full child value.
The funds already accumulated will not be adjusted, even if a dependant withdraws. The maximum benefit limit you can earn as an individual or family may be adjusted to reflect the new plan and/or family size. However, no adjustments will be made to funds that you have already earned or claims that have already been paid from your Personal Health Fund.
If there are funds in your Personal Health Fund, it means you've already earned those funds by participating in Personal Health Pathways and getting to understand your health better. Therefore, you won't have to pay back any funds you've already used. Any remaining funds in your Personal Health Fund will be forfeited once your membership is cancelled.
No, the Personal Health Fund is available alongside your Medical Savings Account. Claims will not accumulate towards the Annual Threshold, Above Threshold Benefit or benefit limits.
No, because this is a Scheme-funded benefit. If you cancel your membership of Discovery Health Medical Scheme, you'll lose any remaining accumulated funds in your Personal Health Fund.
It is likely that you completed multiple actions when you were close to reaching your Personal Health Fund limit. Once these actions have been marked as complete, and you've reached your Personal Health Fund limit, you will no longer accumulate funds towards your Personal Health Fund. This means that any recommended actions still to be completed will no longer carry a Personal Health Fund value.
Yes, from 2025 onwards, Health Checks will be funded from the Screening and Prevention benefit if you are in a 3-month general waiting period. This test forms part of your health assessment as part of your application to join Discovery Health Medical Scheme. This means that if a Health Check is indicated as your high-value action on your Personal Health Pathway, and you complete it, the Health Check will be funded and you will unlock your once-off benefit.
Over-the-counter medication will be funded from the available funds in your Personal Health Fund up to a maximum cover amount of R500 per family per year. Once this limit has been reached, then any additional claims for over-the-counter medication will be funded from your Medical Savings Account (where applicable) or self-funded.