Discovery Health 2018 Benefit and Contribution Changes Dear
Discovery Health 2018 Benefit and Contribution Changes Dear ……………… Discovery Health Member This communication provides a summary of the most important changes to the Discovery Health Medical Scheme, effective 1 January 2018, based on the information provided by Discovery Health at their recent Corporate Launch. Contents Most important changes for 2018 Contribution increases vary from 7. 3% - 8. 3% depending on Contribution increases your plan type, with a weighted average increase of 7. 9%. Medical Savings Accounts Co-payments and deductibles increased in-line with planspecific contribution increases. Annual Threshold Levels Product updates for 2018 • Enhancement to Executive and Smart Plans • Smart Plan Network Hospitals • Maternity and Post-Birth Benefit • Dr. Connect • Day-to-day Extender Benefit Update • HIVCare Programme Update Vitality changes No increase on MRI/CT scan co-payments. Oncology thresholds, external medical items and internal prosthesis limits remain unchanged. All other benefit limits increases in-line with plan specific contribution increases. Key. Care income bands have increased by 5. 6%. Chronic Drug Amounts and Chronic Medicine formularies will remain unchanged. Increase in International Travel Benefit limit and Overseas Treatment Benefit on the Executive Plan. Discovery Health Contributions Restructuring of day-to-day and in-hospital cover on the Executive Plan. 2018 Option Change Form Introduction of the New Maternity and Post-Birth Benefits on all plans. Introduction of the over-the-counter medication benefit on the Smart Plan range. Plan Increases Premier Plus GP network as Designated Service Provider for HIVCare Programme. Weighted Average Increase 7. 9% Introducing Discovery Dr. Connect. Vitality changes Medical Savings Account Savings contributions as a percentage of total contributions have remained unchanged and are as follows: Plan Executive MSA% 25% Classic Comprehensive, Priority and Saver 25% Essential Comprehensive, Priority and Saver 15% Coastal Saver 20%
Annual Threshold Levels The annual threshold levels for the Executive, Comprehensive and Priority Options have increased in line with the plan specific contribution increase. Plan Principal member Adult dependant Child dependant 2018 Executive R 20 350 R 3 850 Comprehensive R 16 790 R 3 200 Priority R 14 240 R 10 670 R 4 660 Product updates for 2018 § Enhanced Global Treatment Platform to access medical treatment outside of SA § International Second Opinion: Second opinion for life-threatening and life-changing conditions facilitated by Cleveland Clinic, funded from risk benefits § Overseas Treatment Benefit: Advanced medical care up to R 750, 000 for treatment not available 1 Executive Plan Enhancements § § § § in SA; R 300, 000 for voluntary in-hospital treatment outside of SA. Both benefits subject to scheme guidelines and managed care protocols and a 20% co-payment International Travel Benefit: $1 million per member while traveling abroad Restructuring of day-to-day and in-hospital cover In-hospital treatment by specialists: Paid from Hospital Benefit up to 300% of DH rate In-hospital treatment by other healthcare professionals: Paid from Hospital Benefit up to 200% of DH rate (currently covered from day-to-day) In-hospital dental treatment: No overall limit, an upfront deductible is payable R 26, 200 limit for dental appliances Out-of-hospital dental treatment paid from day-to-day benefits Access to Vitality Purple § Smart Plan members will have cover for Schedule 0 – 2 medicine from a network pharmacy, 2 Smart Plan Enhancements § § 3 subject to an annual limit: ü Classic Smart Plan – R 600 per family per year ü Essential Smart Plant – R 400 per family per year Scripted Schedule 0 – 2 medicine will accumulate to the prescription limit on Classic Smart (12 scripts pbpa) Un-scripted schedule 0 – 2 medicines will accumulate to the OTC limit Smart Plan Network Hospitals Free State & Eastern Cape Gauteng Gauteng Western Cape Kwa. Zulu-Natal Mediclinic Morningside Clinix Botshelong Mediclinic Panorama Mediclinic Pietermaritzburg Netcare Greenacres Wits Donald Gordon Medical Centre Life Genesis Clinic Mediclinic Contstantiaberg Netcare St Augustine Life Beacon Bay Netcare Clinton Life Fourways Melomed Gatesville Life Roseacres Clinic Mediclinic Midstream Mediclinic Cape Town Life Westville North West & Mpumalanga Netcare Waterfall City Mediclinic Legae Mediclinic Stellenbosch Netcare Umhlanga Netcare Ferncrest Life The Glynnwood Netcare Park Lane Melomed Mitchells Plain Life Wilgeheuwel Mediclinic Medforum Mediclinic Milnerton Netcare Krugersdorp Mediclinic Vereeniging Life Kingsbury Dr SK Matseke Memorial Life Wilgers Life Groenkloof JMH Isipingo Clinic Mediclinic Nelspruit
Maternity and Post-Birth Benefit 4 Discovery Health Medical Scheme members on all plans will have access to comprehensive maternity and post-birth risk benefits. Members will be further supported through access to 24/7 support, advice and guidance through the My Pregnancy and My Baby programs made available on the Discovery app. These benefits do not affect member’s day to day benefits and are funded from the risk benefit at the Discovery Health Rate. The benefit applies from 1 January 2018 and must be activated by the member. Benefits during Pregnancy Post-Birth Benefits Antenatal Consultations: • 12 visits to a GP, gynaecologist or midwife based on plan type Antenatal Classes or Consultation with a nurse: 5 pre- or post-natal classes or consultations with a registered nurse • GP & Specialist Consultations: Up to 2 visits with a GP, paediatrician or ENT for baby, subject to plan type Key. Care members requires GP to specialist authorisation for antenatal gynaecologist consultations Ultrasound Scans & Prenatal Screening: Up to 2 ultrasound scans, 1 nuchal translucency or Non-Invasive Prenatal Test (NIPT) covered Six Week Consultation: 1 six week post-birth consultation with a mid-wife, GP or gynaecologist Blood Tests: Defined list of tests per pregnancy Nutrition Assessment: 1 nutrition assessment with a dietician Antenatal Classes or Consultation with a nurse: Up to 5 pre- or post-natal classes or consultations with a registered nurse Mental Health: 2 mental health consultation with a counsellor or psychologist Executive & Comprehensive Options: Private Ward – up to R 1 880 p/day Essential registered devices up to R 5 000 with a 25% co-payment e. g. breast pumps and smart thermometers Lactation Consultation: 1 lactation consultation with a registered nurse or lactation specialist Maternity Digital Tools Members will have access to 24/7 clinical support, advise and guidance through the following digital tools: My Pregnancy App Features My Baby App Features My pregnancy dashboard My baby dashboard Pregnancy health record Education cost estimator Maternity cost estimator Kids digital health record Pregnancy care checklist Digital vaccination card Connect with doctors 5 Discovery Dr. Connect Preferred suppliers for spinal Discovery Health has partnered with Health. Tap Inc. in Palo Alto to provide Dr. Connect. All members will have surgery devices access to high quality medical information and doctors advice from a worldwide network of doctor’s via the 7 Dr. Connect App. Virtual follow-up consultations can only be conducted with a doctor that the member has visited in the past 12 months. These consultations will be paid from the available MSA. 6 7 Day-to-Day Extender Benefit After depletion of the annual savings account, the Day-to-Day Extender Benefit will provide the following benefits: § Casualty visits for children under the age of 10 at a network facility on Classic Plans only § GP consultations through Health. ID-enabled GP’s that meet the digital criteria in the Discovery GP network § Cover depends on selected plan type Cover for pathology, acute medicine and external medical items through the Day-to-Day Extender Benefit will be discontinued on the Executive, Comprehensive and Priority Plans in 2018. It is important for members to view the Discovery website at www. discovery. co. za or email nmg@discovery. co. za to confirm the Discovery GP network for 2018. HIVCare Programme The Premier Plus GP network will be the Designated Service Provider for members registered on the HIVCare Programme on the following plans: § § § Priority Saver Smart Core Key. Care The change will be effective for new members registered on the HIVCare programme from 1 January 2018. Existing members registered on the programme change with effect 1 July 2018. 20% co-payment will be applicable on a GP consultation outside the Premier Plus GP network.
Vitality Changes 1 Vitality 2018 Vitality product range has been extended to include three NEW Vitality options: Vitality Move – activated at your nearest Pick’n Pay Vitality Active – activated via the Discovery app or the website Vitality Purple – qualifying individuals only Key. Fit & Vitality combo will not be available in 2018 Current Vitality continues as is, with some enhancements to Active Rewards Vitality Move NEW Vitality Move will be rewarding members for taking steps towards a healthier lifestyle and will be available to Discovery Health Medical Scheme members Free of Charge. § Swipe your Vitality Move card every time you shop at Pick n Pay § Stand a chance to win back your Healthy. Food shopping spend every time you swipe § Do a Vitality Check to learn more about your health and stand a chance to win back your FULL shopping spend, every time you swipe § Upgrade Vitality Move for R 35 per dependant over the age of 18 and enjoy the following additional rewards: § Get up to R 100 off your monthly gym membership at Virgin Active or Planet Fitness with no activation fee § Get up to R 100 in Pick n Pay shopping vouchers every month § Get up to R 100 in movie vouchers every month Vitality Active NEW Vitality Active will be rewarding young adults from 18 - 29 for getting active and driving well at a monthly fee of R 40. Over 30 will pay R 60. § Get 25% off monthly gym fees at Virgin Active or Planet Fitness with no activation fee § Earn weekly rewards for achieving your goals § Achieve a 3 -in-a-row goal streak to earn surprise rewards § Get 100% of your Discovery Life Smart premiums back Vitality Purple NEW Vitality Purple will be rewarding the most discerning clients from R 399 (includes standard Vitality premium) for a single member § Offers access to the most exclusive health, wellness and lifestyle experiences § Vitality members with a qualifying Discovery Purple § 2 Vitality Active Rewards 3 product or on an Executive plan may upgrade to Vitality Purple Members who have activated a Vitality policy through Group Risk Vitality Active Rewards members can earn cashbacks on top of the Healthy. Gear benefit (up to 25%) : Vitality has expanded Vitality Active Rewards to make it even more engaging, rewarding and exciting: Ø Up to 25% on the bicycle booster at Cyclelab limited to Ø Earn 3 consecutive goals to spin the wheel & earn a Ø Up to 75% on the fitness device booster limited to R 4 000 Ø Members can track their progress, invite and challenge an Ø Up to 100% on the shoe booster at partners limited to surprise reward unlimited amount of friends Ø Airtime and carwash rewards introduced R 20 000 per bike once every 36 months per device once every 24 months R 2 000 per pair once every 12 months
Member information sessions NMG Benefits will be presenting the 2018 changes to members during the member information session/s. We urge you to try and attend these sessions as it will help you understand your benefit option and changes, hence making an informed decision. The times and dates of the presentations are as follows: Venue Date Time Malmesbury – Member Hall 17 October 2016 11: 30 Bellville - Agriplas 19 October 2016 09: 00 Worcester - Agrimark 24 October 2016 12: 30 Paarl – Agrilog 25 October 2016 10: 00 Porterville – Training Hall 15 November 2016 14: 00 Hermanus – Agrimark 16 November 2016 09: 30 17 October 2016 11: 30 Malmesbury – Member Hall Contact details Please do not hesitate to contact your NMG administration consultants should you need assistance: Name Telephone Email Charmaine Lesch 021 943 1800 clesch@nmg. co. za Should you require further assistance, please contact your dedicated Healthcare Consultant: Lizelle Hickey Tel: 021 943 1814 Fax 0864077125 E-mail: lhickey@nmg. co. za
Discovery Health 2018 Contributions Monthly Contributions Series Plan Executive Comprehensive Priority Saver Smart Core Key. Care Principal Member Adult Dependant Child Dependant* 2018 Executive 5 950 1 134 Classic Comprehensive 4 882 4 618 974 Classic Delta Comprehensive 4 398 4 162 874 Classic Comprehensive Zero MSA 3 662 3 464 731 Essential Comprehensive 4 102 3 881 825 Essential Delta Comprehensive 3 694 3 490 742 Classic Priority 3 214 2 534 1 286 Essential Priority 2 763 2 172 1 103 Classic Saver 2 773 2 186 1 110 Classic Delta Saver 2 214 1 749 890 Essential Saver 2 203 1 652 883 Essential Delta Saver 1 758 1 325 705 Coastal Saver 2 160 1 621 870 Classic Plan 1 647 1 298 658 Essential Plan 1 180 Classic Core 2 064 1 626 826 Classic Delta Core 1 652 1 301 660 Essential Core 1 773 1 329 712 Essential Delta Core 1 417 1 065 569 Coastal Core 1 610 1 209 641 Key. Care Plus (R 12 201+) 2 064 553 Key. Care Plus (R 8 551 to R 12 200) 1 386 389 Key. Care Plus (R 0 to R 8 550) 990 359 Key. Care Access (R 12 201+) 2 018 546 Key. Care Access (R 8 551 to R 12 200) 1 344 378 Key. Care Access (R 5 331 to R 8 550) 930 337 Key. Care Access (R 0 to R 5 330) 697 306 1 525 345 Key. Care Core (R 8 551 to R 12 200) 988 243 Key. Care Core (R 0 to R 8 550) 792 205 Key. Care Core (R 12 201+)
Discovery Health 2018 Contributions (continued) Medical Savings Account (MSA) included in the above monthly contributions Principal Member Adult Dependant Child Dependant Plan * Series - A maximum of 3 children are taken into account. MSA % when calculating the Annual Threshold and Above Threshold Limit Annual Monthly Executive Classic Vitality & Key. FIT Classic Delta Comprehensive Essential Delta Priority Vitality Key. FIT Vitality & Key. FIT Saver 25% 17 844 1 487 1 220 17 844 13 848 1 487 1 154 3 396 14 640 2 916 283 243 25% 13 188 1 099 12 480 1 040 2 616 218 633 For further information or advice please contact 615 582 123 7 380 6 984 1 476 Cipla Consult on 021 914 0680 or email 15% 554 523 111 6 648 6 276 1 332 Member with one Member with two or more Single member info@ciplaconsult. co. za 15% Essential 15% Classic Saver 25% Classic Delta 25% Essential 15% 179 3 960 803 dependant 7 596 414 3 900 199 693 6 552 44 553 5 244 215 330 2 964 Essential Delta 15% 3 156 263 Coastal 20% 5 184 432 Classic 25% 9 636 169 36 4 968 8 316 6 636 325 dependants 3 852 321 165 247 1 980 225 3 324 55 2 664 249 1 584 2 376 198 1 260 105 3 888 324 2 088 174 546 437 277 222 132 Annual Thresholds Executive and Comprehensive Plans Annual Threshold Executive Plan 2018 Comprehensive Plans 2018 Principal member 20 350 16 790 Per adult 20 350 16 790 Per child* 3 850 3 200 * A maximum of 3 children are taken into account when calculating the Annual Threshold and Above Threshold Limit Priority Plans Annual Threshold 2018 14 240 10 670 4 660 Annual Threshold Principal member Per adult Per child* Above Threshold Limit 2018 12 080 8 610 4 170 * Contributions are charged up to a maximum of 3 children Please note The above rates are the standard Discovery Health 2018 rates and do not include any Late Joiner Penalties. Vitality Single Member + 1 Member + 2 + Vitality 239 289 329 Vitality Purple 399 459 499 Vitality Move (Upgrade) 35 person over 18 Vitality Active (18 – 29 years) 40 person over 18 Vitality Active (30+ years) 60 person Vitality Please note If you want to join Vitality, please complete the Vitality application form which is available from your HR department.
Discovery Health Medical Scheme Option Change Form 2018 Kindly complete this option change form ONLY if you are changing your option for 2018 OR if you need to do any changes to Vitality/Key. Fit. This form must please be submitted to HR before 30 November 2017. Forms submitted after the deadline, cannot be processed Member name and surname: Company name and branch: Membership number: Telephone number: Email address: Employer number ID Number: Cell number: Series Plan choice for 2018 X (DH – Discovery Health Rate) Executive Hospitalisation at 300% of DHR, 25% MSA and an ATB Classic Comprehensive Hospitalisation at 200% of DHR, 25% MSA and an ATB Essential Comprehensive Hospitalisation at 100% of DHR, 15% MSA and an ATB Classic Delta Comprehensive Hospitalisation at 200% of DHR at network hospitals, 25% MSA and an ATB Hospitalisation at 200% of DHR, 0% MSA and an ATB Comprehensive Series Classic Comprehensive Zero MSA Essential Delta Comprehensive Priority Series Saver Series Smart Series Core Series Keycare Series Classic Priority Essential Priority Classic Saver Classic Delta Saver Coastal Saver Essential Saver Essential Delta Saver Classic Smart Essential Smart (New plan) Classic Core Classic Delta Core Coastal Core Essential Delta Core Key. Care Plus Key. Care Access Key. Care Core Hospitalisation at 100% of DHR at network hospitals, 15% MSA and an ATB Hospitalisation at 200% of DHR, deductibles, 25% MSA and a limited ATB Hospitalisation at 100% of DHR, deductibles, 15% MSA and a limited ATB Hospitalisation at 200% of DHR, 25% MSA and no ATB Hospitalisation at 200% of DHR, network hospitals, 25% MSA and no ATB Hospitalisation at 100% of DHR, 20% MSA and no ATB Hospitalisation at 100% of DHR, 15% MSA and no ATB Hospitalisation at 100% of DHR, network hospitals, 15% MSA and no ATB Hospitalisation at 200% of DHR, network hospitals, network GP visits Hospitalisation at 100% of DHR, network hospitals, network GP visits Hospitalisation at 200% of DHR, network hospitals Hospitalisation at 100% of DHR, network hospitals Hospitalisation and limited day-to-day benefits at network facility Hospitalisation at network facility only – Elective procedures at a State facility Hospitalisation at 100% of DHR , network hospitals If the Key. Care Plus and Key. Care Access options are selected, please nominate your chosen Key. Care doctor below Principal member Doctor’s name Practice number Adult dependant Doctor’s name Practice number Child dependant Doctor’s name Practice number Date Member signature Consultant providing advice OFFICIAL USE ONLY Needs analysis number OFFICIAL USE ONLY By placing my signature to this document, I hereby acknowledge and confirm that the information herein contained is both true and correct and I hereby indemnify NMG Consultants and Actuaries (Pty) Ltd (“NMG”) and hold it harmless against any claim of whatever nature and for any amount whatsoever, arising out of any such incorrect disclosure or non-disclosure and/or any act or omission incidental hereto. I further absolve and indemnify NMG in respect of any financial loss or damages that I may incur where I unilaterally elect to change medical scheme plan options without obtaining expert advice from the NMG Health Care consultant
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