Discovery Health Medical Scheme has been found guilty of misleading advertising and has been instructed to amend all its promotions containing the words “comprehensive chronic cover” to be properly accurate.
The instruction, issued by the Advertising Regulatory Board, comes after businessman Grant Pattison made a formal complaint against Discovery’s online advertising for comprehensive chronic medical aid cover.
Pattison complained to the ARB that, while Discovery claimed to offer medical aid cover for all chronic diseases, in reality this excluded cover for the most chronic conditions — including depression, dementia, asthma, anaemia and hypertension, to name a few.
In the advert, Discovery offered “comprehensive chronic cover for Discovery Health Medical Scheme members”.
Pattison replied to the advert by asking Discovery for a list of conditions they do not cover, so that he could understand what they meant by “comprehensive” cover. The list he received was lengthy, leading Pattison to complain that Discovery appeared to have tried to make out that they cover “most” chronic ailments when — by their own admission — they don’t.
Discovery responded to the claim by pointing out that they adhere to the Medical Schemes Act and the regulations that require all medical aids to cover “costs related to the diagnosis, treatment and care of a defined list of 27 chronic conditions (including HIV) according to Prescribed Minimum Benefits (PMBs)”.
Discovery said they also follow the rules set down by the Council for Medical Schemes (CMS) as the benefit entry criteria, that patients must meet to qualify for cover. Once approved, Discovery claimed that they do provide comprehensive chronic cover under the Chronic Illness Benefit (CIB) for the 27 chronic conditions listed in the Medical Schemes Act and would cover the costs of approved medicines on the CIB list on the scheme rate at a network pharmacy.
By making the claim, we believe the advertising implies that they offer something over and above the legal minimum PMB benefits. From its submission, this does not appear to be the case.
— Advertising Regulatory Board
Discovery also gave details of additional cover it offers under its specialised chronic care programmes for diabetes, cardio care, mental health and HIV, adding that members on the top tier Executive and Comprehensive plans qualified for further cover for conditions on the Additional Disease List (ADL), with approved medicines for those conditions funded up to a limit.
Discovery claimed to offer comprehensive cover through its specialised care programmes for members managing chronic conditions, providing cover and ongoing management of asthma, haemophilia, hypertension, hypothyroidism and major depression.
Alzheimer’s and dementia did not make the chronic disease list or the additional disease list because they were not conditions classified as PMBs. However, members with these conditions could fund their treatment through their medical savings or the Above Threshold Benefit (ATB) if they had funds available.
The Advertising Board then went on to view the advert along with Discovery’s full response to decide whether the advert was misleading.
“The advertising code 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 board noted in deciding whether the use of the words “comprehensive chronic cover” in an advert was likely to mislead the public to believe that Discovery offers chronic cover for all or most chronic conditions.
The definition of “comprehensive” used by the ARB, as obtained from the online Cambridge Dictionary, is “including everything that is necessary; complete”.
Discovery, however, argued that the word “comprehensive” was meant to describe the benefits offered once patients qualify for chronic cover, and was not intended to indicate that most chronic conditions are covered. According to their own explanation, members that need to receive cover for more than these 27 illnesses defined as PMBs, their members must be on a specialised or “higher” package as they cover only the medicines that every medical aid is obliged to cover by law.
“By making the claim, we believe the advertising implies that they offer 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 our understanding, it is legally obliged to offer)”, the ARB stated in its ruling, finding that Discovery’s advertising does create an expectation that they offer more chronic cover to all members than they are legally obliged to and that the advertising was therefore definitely misleading.
Discovery was ordered to amend its advertising as quickly as possible to more accurately explain the meaning of their “comprehensive chronic cover” claim, so that it is not misleading.
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