Discovery Health Medical Scheme defers 2026 contribution increases to April and unveils new plans for young families, plus richer day-to-day benefits

Disclaimer

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.

Note: The Discovery Health Medical Scheme contribution increases and benefit updates for 2026 have been submitted to the Council for Medical Schemes for approval. Contribution increases will be effective from 1 April 2026, while benefit updates and new benefit options will be effective from 1 January 2026, subject to approval by the Council for Medical Schemes.

Highlights

• Discovery Health Medical Scheme announces a 7.2% weighted average contribution increase for 2026 with 65% of members experiencing a 6.9% increase in contributions
• All contribution increases are deferred from 1 January 2026 to 1 April 2026 saving members R1.5 billion - around R1,100 per membership
• Contributions for the Active Smart plan will remain unchanged for 2026
• Introduction of a new plan series called Smart Saver designed around the needs of young families
• Significant enhancements to the Personal Health Fund in 2026

Johannesburg, 30 September 2025 – Discovery Health Medical Scheme (“the Scheme”) has announced a 7.2% weighted average contribution increase for 2026. Notably, 65% of members will experience only a 6.9% increase, while contributions for members on Active Smartplans will remain unchanged from 2025 (0% increase). In a continued effort to support affordability, the Scheme will defer all contribution increases to 1 April 2026, leveraging its strong solvency position to deliver R1.5 billion in direct savings to members.

In addition to this affordability focus, the Scheme is introducing two major enhancements for 2026:

1. Smart Saver Series – A new range of plans tailored to meet the health and financial needs of young families. Within the new Smart Saver series, there are two plan options available - Classic Smart Saver and Essential Smart Saver.
2. Enhanced Personal Health Fund Benefits (adult members accumulate funds into their Personal Health Fund by completing ‘next best actions’ in their Personal Health Pathways, which can be used to finance their day-to-day benefits).

– Members will benefit from:

• More than double the earning limits available in 2025,
• R1,000 opening balances for engaged members,
• New personalised health challenges to support members in improving their long-term health and wellness

Discovery Health Medical Scheme uses strong solvency to defer contribution increases

Deferring the contribution increases for 2026 from 1 January to 1 April delivers significant value to members who will continue paying 2025-level contributions for the first three months 2026. For example, a family of four on Classic Comprehensive will save over R5,100, while a family of three on Classic Saver will save more than R2,000 during this period.

This strategic deferral is made possible by the Scheme’s robust solvency position, which is projected to remain well-above 30% , (minimum required solvency level is 25% as set out in Regulation 29 of the Medical Schemes Act). This strength is driven by better-than-expected claims experience and returns on Scheme investments.

“This strategic use of excess solvency enables the Scheme to offer members meaningful financial relief without compromising its long-term sustainability,” explains Dr Ron Whelan, CEO of Discovery Health – the administrator of Discovery Health Medical Scheme. “Contribution increases remain accurately priced, in line with medical inflation, ensuring affordability and long-term stability. This approach reflects Discovery Health Medical Scheme’s commitment to using every lever available to enhance member value.”

“The Scheme remains acutely aware of the affordability pressures facing South African households. By deferring the 2026 contribution increase to 01 April 2026, the Scheme provides significant financial relief while continuing to deliver industry-leading healthcare benefits.”

DHMS has leveraged its robust solvency position previously, by deferring the contribution increase during the COVID pandemic three times - in 2021, 2022 and 2023 - for members when it mattered most.

• Buffering the impact of medical inflation through cost containment

Globally, medical inflation continues to outpace consumer price inflation (CPI), driven by rising healthcare utilisation due to ageing populations and the increasing availability and cost of advanced medical treatments and technologies.

Discovery Health Medical Scheme’s weighted average contribution increase of 7.2% for 2026 reflects the expected rise in both the cost of healthcare products and services as well as their utilisation. While the cost of healthcare services is expected to rise in line with CPI, utilisation of healthcare services is expected to drive an additional 3% to 4% increase in claims paid by the Scheme.

“Medical inflation is a global challenge affecting all health systems - not just medical schemes in South Africa,” says Dr. Whelan. “Together with the Scheme we are deeply committed to improving the efficiency and cost-effectiveness of healthcare while delivering exceptional value and quality care.”

Discovery Health Medical Scheme continues to mitigate the impact of medical inflation through a range of cost containment initiatives. These include value-based care models, promoting appropriate levels and settings of care, and preventing fraud, waste, abuse, and errors in scheme funds. Personal Health Pathways and Vitality also play a key role in improving member health and reducing demand for healthcare services.

• 0% contribution increase reinforces the affordability of Active Smart

Discovery Health Medical Scheme will not increase contributions for the Active Smart plan in 2026. This is a powerful signal of affordability and access for young professionals entering the medical scheme market.

Since its launch in January 2025, Active Smart has grown to over 22,000 lives, making it the fastest-growing new plan in the Scheme’s history. Designed with young professionals in mind, Active Smart offers cover for hospital and emergency care, valuable day-to-day benefits, and access to Personal Health Pathways - all at a compelling contribution of R1,350 per month.

“With more than 80% of new members under the age of 40, Active Smart’s design supports the Scheme’s long-term sustainability. Given its strong growth, favourable demographic and healthcare utilisation profile, and our commitment to making medical scheme cover more accessible, we’ve made the decision to hold contributions flat for 2026. Members will continue paying R1,350 per month next year,” explains Dr Whelan.

This decision reflects the Scheme’s commitment to affordability, innovation, and meeting the evolving needs of a younger, health-conscious population.

Introducing the Smart Saver series, designed to meet the needs of young families

Launching on 1 January 2026, the new Smart Saver plans set a fresh benchmark in affordable healthcare, tailored to the evolving needs of young, growing families. With innovative benefit design and accessible monthly contributions, Smart Saver offers comprehensive protection against large, unexpected healthcare costs, guaranteed cover for predictable needs, and flexible benefits for family-specific healthcare needs – all while rewarding families for prioritising their health through Personal Health Pathways.

“Discovery Health Medical Scheme data shows that certain primary healthcare needs among young families are universal — over 92% claim for GP consultations and medicine each year,” says Dr Ron Whelan. “At the same time, broader day-to-day needs are unique in terms of specialised care. This insight shaped the Smart Saver Series: guaranteed risk-funded benefits for universal needs, and flexible, innovative benefits for the more unique ones.”

Smart Saver provides guaranteed cover for the healthcare services families use most – including GP consultations, optometry, dentistry, prescribed and over-the-counter medicine, and contraceptives.These are complemented by comprehensive hospital cover, maternity benefits, mental health support, and oncology treatment within the Smart Network. Within the new Smart Saver series, there are two plan options available - Classic Smart Saver and Essential Smart Saver. The Classic Smart Saver option offers up to 200% in-hospital specialist cover while Essential Smart Saver provides up to 100% in-hospital specialist cover.

Importantly, Smart Saver combines two powerful funding mechanisms: a Medical Savings Account and the Personal Health Fund giving families the flexibility to manage their healthcare spending in a way that suits their needs.

“Smart Saver sets a new standard in affordable healthcare for families seeking meaningful cover at an accessible price,” says Dr Whelan. “With Essential Smart Saver priced at R2,750 for a principal member, R2,350 for an adult dependant, and R895 per child, it offers one of the most compelling value propositions in the open medical scheme market.”

Together, the Active Smart plan and Smart Saver Series reflect Discovery Health Medical Scheme’s commitment to affordability, innovation, and member-first design - ensuring meaningful cover at every stage of life.

Significant enhancements to Personal Health Fund in 2026: Benefit advances, increased earning limits, and new challenge-based benefits

Launched in January 2025 by Discovery Health, Personal Health Pathways is a world-first, AI-powered platform that delivers personalised health recommendations to over 2.1 million adult members of the Discovery Health Medical Scheme. Built on one of the world’s largest clinical and behavioural datasets, the platform dynamically adapts to each member’s evolving health profile - guiding them through tailored health actions and weekly exercise goals and rewarding them for completing these actions.

The remarkable engagement in Personal Health Pathways to date has entrenched the programme as a cornerstone of the Scheme’s strategy to drive healthier living and reduce long-term healthcare costs to the benefit of all Scheme members.

From 1 January to 25 September this year, 390,000 Discovery Health Medical Scheme members activated their Personal Health Pathway, completing over 390,200 health actions and two million exercise actions.

• Personal Health Pathways drives real behaviour change and member value

Discovery Health’s Personal Health Pathways programme is proving to be a powerful catalyst for positive behaviour change – with a nearly 4-fold increase in completion rates and a 5-fold increase in total health actions completed from 2024 to 2025.

“Rewarding Scheme members for completing recommended health actions is driving meaningful habit formation,” says Dr Whelan. “Beyond the individual health benefits, it is also helping to contain medical inflation by reducing avoidable healthcare costs.”

“In 2025, members completed significantly more high-impact health actions; from GP visits and mental wellbeing assessments to cancer screenings, medication collection, and other vital checks. Over 27,000 members achieved weekly physical activity goals for the first time, marking a major milestone in preventative care.

By completing personalised health actions within their pathway, members earn funds into their Personal Health Fund which can be used to cover day-to-day medical expenses. By September 2025, members had earned over R200 million in additional healthcare benefits through this mechanism.

“The power of Personal Health Pathways lies in delivering timely, personalised actions tailored to each member’s unique needs,” says Dr Whelan. “Combined with the Scheme’s Personal Health Fund, it gives members the opportunity to unlock real financial value by engaging in their health.”

• Enhanced Personal Health Fund unlocks greater day-to-day healthcare value in 2026

From January 2026, members will benefit from significant enhancements to the Personal Health Fund that are designed to deliver even greater day-to-day healthcare value. The new features are:

1. R1000 opening fund balance: Members who activate Personal Health Pathways, enable physical activity and sleep tracking on their phone or wearable device, and complete a health check will earn an opening balance of R1,000 per adult in their Personal Health Fund.
2. Higher earning potential: Families can now accumulate up to R12,000, compared to R10,000 in 2025. (Members can earn R500 for each completed Personal Health Pathway action, up to R3,000 per adult and R1,500 per child.)
3. Personalised challenges: In 2026, Personal Health Pathways will introduce health challenges - curated sets of actions designed to reinforce healthy behaviours and build lasting habits. Completing challenges unlocks up to R3,000 per adult in additional Personal Health Fund value.

“These enhancements are designed to help members in achieve targeted breakthroughs in their health and build longer-term habits,” says Dr Whelan. “Together, Personal Health Pathways and the Personal Health Fund form a powerful behavioural change ecosystem – offering precise and personalised recommendations, motivating long-term health improvements and recognising members more meaningfully than ever for engaging in their health.”

Balancing affordability and innovation to build a healthier future

Discovery Health Medical Scheme remains deeply committed to balancing affordability with long-term sustainability, while continuously evolving to meet he needs of South African families. The 2026 contribution increase, launch of Smart Saver series, and enhancements to Personal Health Fund reflect this commitment in action.

Together, these initiatives demonstrate how the Scheme is using innovation to unlock greater value, support healthier behaviours, expand access to and ensure meaningful healthcare cover at every life stage. It’s a future-focused approach that puts members first – and builds a healthier, more resilient society.

Discovery Health Medical Scheme remains the largest in the industry, with six out of every ten open scheme members choosing the Scheme. More than 290,000 beneficiaries join the Scheme each year, attracted by the exceptional value and certainty of cover it provides.