The Advertising Regulatory Board (ARB) has declared a Discovery Health Medical Scheme (DHMS) advert claiming “comprehensive chronic cover” misleading.
In an ARB ruling delivered on 21 November, DHMS was instructed to amend the advert to qualify the claim “within a reasonable time frame”.
The advert, which appears on DHMS’s X (formerly Twitter) account, states “Comprehensive chronic cover for Discovery Health Medical Scheme members” in its opening line.
Last month, Grant Pattison (pictured), the former chief executive of Massmart Holdings and Edcon, filed a complaint with the regulatory body. In an interview with TimesLive, Pattison explained that he took up the cause on behalf of his elderly mother, who relies on several chronic medications, none of which was covered by Discovery’s “comprehensive chronic cover” product, he claimed.
In his complaint, he submitted that DHMS did not offer cover for all chronic diseases and “excluded cover for the most common chronic conditions, including depression, dementia, asthma, chronic anaemia, and hypertension”.
Pattison maintained that the use of the word “comprehensive” in the X advertisement “seems to be deliberatly [sic] chosen to make people think they cover ‘most’ chronic conditions, which, by their own admission, they don’t”.
Chronic disease cover members qualify for
Responding to the complaint, DHMS cited the Medical Schemes Act and its Regulations, which requires all medical schemes to cover “costs related to the diagnosis, treatment and care of a defined list of 27 chronic conditions (including HIV) according to the Prescribed Minimum Benefits (PMBs)”.
In addition, to qualify for cover, the Council for Medical Schemes prescribes certain rules, known as the benefit entry criteria, that must first be met.
DHMS said that, once approved, it does provide comprehensive chronic cover, under its Chronic Illness Benefit (CIB), for the 27 chronic conditions listed in the Medical Schemes Act. The medical scheme stated that, once enrolled for the CIB, all its members received cover for approved medicines for the 27 PMB Chronic Disease List (CDL) conditions, with approved medicine on the CIB medicine list.
DHMS added that members on its Executive and Comprehensive plans (except the Classic Comprehensive Smart Plan) have further cover for Additional Disease List (ADL) conditions – an extra 22 chronic conditions.
The medical scheme argued that it provides comprehensive cover through its CIB, Chronic Drug Amount, ADL, and specialised care programmes for members managing chronic conditions.
The CDA is the monthly amount that the scheme will pay for a medicine class, subject to a member’s plan type, for chronic medicine that is not listed on the CIB medicine list.
Addressing Pattison’s claim that the medical scheme excluded cover for the most common chronic conditions, DHMS said it provided cover for the treatment and ongoing management of asthma, haemophilia, hypertension, hypothyroidism, and major depression.
It said Alzheimer’s and dementia were not classified as PMB conditions and do not form part of the CDL or the ADL.
“While cover for these conditions is not provided by the scheme’s risk benefits, a member is able to fund treatment for these conditions from the Medical Savings Account or Above Threshold Benefit, where applicable, subject to funds available,” DHMS stated.
Is the consumer being misled?
Clause 4.2.1 of Section II of the Code of Advertising Practice prohibits advertisements that contain any statement or visual presentation, which directly or by omission, ambiguity, or exaggerated claim, is likely to mislead the consumer about the advertised product.
The question the ADR Directorate needed to answer was whether using the words “comprehensive chronic cover” in the advert might make consumers think that DHMS provides coverage for all or most chronic conditions.
In its ruling, the Directorate said it noted the medical scheme’s contention that the word “comprehensive” was meant to describe the benefits offered once scheme members qualify for chronic cover and was not intended to indicate that most chronic conditions were covered.
It said DHMS appeared to rely on the fact that it covered the 27 PMB illnesses as the basis for its offer that it offers “comprehensive chronic cover”.
“To receive cover for more than these 27 illnesses, the member needs to be on a specialised or ‘higher’ package. In other words, it would seem that the advertiser claims to provide ‘comprehensive chronic cover’ because it covers those medicines that every medical aid is obliged by law to cover,” the ruling read.
The Directorate went on to say that, by making this claim, the advertising implied that the medical scheme offered something “over and above the legal minimum PMB benefits”.
“From its submission, this does not appear to be the case. It would seem that what is actually offered is ‘comprehensive PMB cover’ (which, on the Directorate’s understanding, it is legally obliged to offer),” the ruling read.
Because of these reasons, the directorate decided that the advert made it seem as if DHMS provided additional chronic cover to all members beyond what it legally has to offer.
“As this does not appear to be the case, the advertising is misleading,” the Directorate found.
Moonstone approached DHMS for comment, but it was not received by the time of publication.
