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Microsoft word - 2013 discovery health - medical scheme update


2013 MEDICAL SCHEME UPDATE: DISCOVERY HEALTH
The summary below is as per the information provided by the scheme at their launch for 2013. Should you require any detailed information, please contact HealthGroup directly on 031 764 7298 or [email protected]
ANNUAL CONTRIBUTION INCREASE

This increase is higher than expected – the market had anticipated an 8.5% Jonny Broomberg (CEO) explained that an average increase of 8.9% was possible but the scheme has elected to increase premiums by a further 2% in Discovery’s solvency has been affected by two years of above average

2013 STRUCTURAL CHANGES:

 The structure of the various benefit options remains largely unchanged from 2012 to  New plan introduced at upper end: Classic Comprehensive Zero MSA  New plan introduced at lower end: KeyCare Access 2013 BENEFIT CHANGES:
Update to the Chronic Disease Management:
Introduction of the ChroniCare benefit whereby members can save up to 25% on chronic care products for hypertension, hyperlipidemia, diabetes or Executive plan members have full cover for certain branded chronic medicines (previously had a copayment). These are Crestor, Aspavor, Prexum, Glucophage, Symbicort, Lantus, Venlor XR, Tareg, Co-tareg and Lilly-fluoxetine Introduction of LivingVitality, empowering members to understand and manage their chronic conditions using experts, tools and social media. See www.LivingVitality.com for additional information. Chronic Illness Benefit medicine list and Chronic Drug Amounts for 2013 have been updated to reflect the price reductions on a list of medicines  This is as a result of negotiations carried out during the benefit year  Members impacted by the changes will be contacted by the Chronic Department and will have the option to migrate to the new  Discovery will implement the changes from July 2013.  Extending the Insured Network Benefit:
Day-to-day generic medicine cover: unlimited day-to-day generic medicine for schedule 3 and above medicines within our network of pharmacies on Executive, Classic Comprehensive and Classic Delta Comprehensive plans Pathology: it is no longer a requirement for the member’s GP or specialist to use the Discovery Health pathology form. Within our networks, all members on Executive, Classic Comprehensive, Classic Delta Comprehensive and Classic Priority plans have unlimited cover for pathology. Tests must be  NEW: Classic Comprehensive Zero MSA:
Classic Comprehensive Zero MSA offers the same security of extensive private healthcare cover in-hospital and for chronic medicine as Classic Comprehensive, but with the flexibility to fund for day-to-day healthcare needs without a Medical Savings Account. The plan does not have a Medical Savings Account and so there is no benefit for day-to-day medical expenses until the member reaches the Annual Threshold. After this, Discovery pay claims from the Above Threshold Benefit. All benefits and limits are the same as on Classic Comprehensive, however, the plan does not have a Medical Savings Account, the Insured Network Benefit and the Trauma Recovery Extender Benefit. MRI and CT scans are covered only when the member reaches the Above Changes to KeyCare:
NEW: Introduction of KeyCare Access, offering the same out-of-hospital cover as KeyCare Plus. Cover includes:  Private GP visits, optometry and dental benefits  Private hospitalisation, from the KeyCare Access Network of hospitals, for childbirth, care for your baby up to 12 months after birth, and sudden, accidental traumatic events and emergencies.  Approved elective procedures are covered in a contracted network of Introduction of the KeyCare Cataract Network:  KeyCare members will be covered in full for cataract surgery within this comprehensive network of over 120 facilities across the country. Removal of the lowest income band on KeyCare Plus (R0 – R3900):  Due to utilisation, this option is no longer viable  Members on this plan will have to choose from the following options: an increase in premium from R485pm to R638pm  Move to the KeyCare Core (R0 – R6250) an increase in premium from R485pm to R511pm private in hospital cover only, lose all day to day  Move to KeyCare Access (R0 – R3900) A decrease in premium from R485pm to R450pm Lose cover for elective procedures in a private facility,  KeyCare members will only be required to submit average monthly earnings over the last 12 months from guaranteed sources such as regular salary, guaranteed allowances and employer benefit contributions. Variable income sources will no longer be considered.  Introduction of an Optometry network:
Discovery has created an extensive network of optometrists, where all members will receive a 20% discount on frames and lenses through the The discount is immediate and the lower costs to the members will help preserve their Medical Savings Accounts. The details of the network are yet to be published  HIV Cover:
OptiPharm have been contracted as the preferred provider for HIV treatment to members on ALL Discovery Health Medical Scheme plans  Allied, Therapeutic and Psychology Extender Benefit:
Chiropractors have been added to the list of providers  Basic dental treatments (such as simple fillings and root canal treatment for
members 13 and older) will be covered from the available day-to-day benefits Limit Changes:
Benefit limits, co-payments and deductibles: Oncology, hip and knee joint prostheses: Specialised Medicine and Technology Benefit limits:
PLAN CHANGES:

 All plan changes must be submitted to Discovery by 14th December 2012
VITALITY:

NEW: Woolworths added as a HealthyFood partner:
Members can save up to 25% on HealthyFoods purchased at Woolworths Members must choose their primary and secondary provider (i.e. Woolworths or Pick n Pay) Primary provider savings of 25%, secondary provider savings limited to 10% Woolworths savings only available to members on Executive or Classic health  NEW: LivingVitality interactive platform:
Gives members fitness, nutrition and health support to manage wellbeing Earn Vitality points for physical activities, through your mobile device (android or apple) or via www.discovery.co.za Engage with Vitality through fitness devices e.g. adidas micoach, Garmin,  NEW: VitalityMobile, a partnership with Cell C:
A unique wellness community of Vitality members Choose the latest phone from Cell C (all models available) Activate VitalityMobile (at R29pm) and receive  Free calls to all VitalityMobile members  50% additional data (minimum of 100MB)  International calls at 99c/m  Standard call rates to all others  NEW: Personal Health Goals:
Earn points by achieving personal goals logged online, based on your individual health risk (e.g. improving nutrition, taking part in a sports event  Change to point allocations:
Points received for a Fitness Assessment will be reduced in 2013 (to a maximum of 7500). Members can still go twice annually. Carry over points to be removed from 2014 HealthyFood vs Less desirable food points per basket changes to +20 for HealthyFoods and -5 for less desirable foods (minimum transaction is 0) DISCOVERYCARD:
NEW: Additional Card partners in 2013:
Update to Discovery mall:
iStore will be available on the portal (with 12 months interest free finance)  Change to cash back rewards:
Limited to retail partners only, direct debit orders will be excluded:  No new Autopage contracts will qualify for cash back (existing clients continue to qualify for the remainder of their contract)  Virgin Active co-payments will no longer get a cash back reward  NEW: Health Wallet – Flexible funding for healthcare expenses:
Operates alongside medical plan, enabling members to fund day to day  Earn DiscoveryMiles on ‘loading’ the wallet (1 DiscoveryMile per R12 on debit order, 1 DiscoveryMile per R6 on lump sum deposits)  Top up the wallet with cash backs from HealthyFood, HealthyCare,  If the Health Wallet is empty, it can automatically access the DiscoveryCard credit facility for 55 interest-free credit  Discovery will top up the Health Wallet if a family member develops a  Payout is based on Vitality status and severity  Blue – R20 000, Bronze – R30 000, Silver – R50 000, Gold –  Severity levels A, B, C and D get 100%, 75%, 50% and 25% Excludes pre-existing conditions and ceases at 65 Funds can be withdrawn in the following year
CONCLUSION:

Although the increase is slightly higher than expected, there are still enhancements to
benefits in several areas. The introduction of two new plans, and the Health Wallet, shows that the scheme is committed to providing alternative funding models to members. Should you require any further information or clarification of benefits, please do not hesitate to contact us:
DISCLAIMER
The information contained in this guide is as per information provided to accredited intermediaries. Certain benefits
may be subject to approval by the Council for Medical Schemes. The registered rules of the scheme supersede this
guide at all times.

Source: http://www.healthgroup.org.za/downloads/2013%20Update/2013%20Discovery%20Health%20-%20Medical%20Scheme%20Update.pdf

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