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Discovery Health Benefit Update 2018

Benefit Update Discovery Health 2019 Benefit Update Discovery Health 2019

Discovery launched their product updates for 2018 to market yesterday
For your convenience, we have compiled some key highlights from the event.
Additional information will be presented to you at our Healthcare Solutions launches in the various regions.

Please find below some key highlights from the 2018 Discovery product update.

High level summary of key updates:

  • Weighted average contribution increase of 7.9%
  • Enhancements to the Executive Plan and Smart Plans
  • Introduction of the Young Families Offering, with significant risk benefits for pregnant moms and their babies for the first 2 years of life
  • Day-to-day Extender Benefit Updates
  • Updates to the HIV Care Programme
  • Introduction of an Industry leading digital health technology platform –  Dr Connect
  • Significant enhancements to Healthy Company and Discovery Primary Care
  • Introduction of Discovery Gap Core

Additional detail regarding key updates:
2018 Increase

  • Weighted average contribution increase of 7.9% for 2018
  • Plan specific increases range between 7.3% and 8.3%
  • Industry leading financial stability with more than R14 billion in reserves
  • 23 plans to match members’ unique healthcare needs
  • Contributions which are on average 15.1% below the market average
  • Cover ratios in excess of 96% throughout the plan range

Executive Plan Enhancements

  • 7.3% increase
  • 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 R750,000 for treatment not available in SA; R300,000 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
  • Access to Vitality Purple

New Maternity Benefit on all plans

  • In 2018, 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 risk
  • Benefits are covered at the Discovery Health Rate
  • Benefit applies from January 2018 and must be activated by the member

Healthy Company
A comprehensive corporate wellness solution offering health screening, employee support tools and integrated reporting:

Healthy Company Screening
Employers have access to four screening solutions:

  • Discovery Traditional Wellness Day
  • Discovery Premier Mobile Wellness Experience
  • Discovery Premier Wellness Experience
  • Discovery Executive wellness

The results are communicated to each Employee and aggregated results to the Employer

Healthy Company Care
Utilises data from Vitality, Healthy Company Care and the medical scheme
Stratifies employees according to their risk profiles in 3 areas:

  • Physical wellbeing
  • Emotional wellbeing
  • Financial wellbeing
    This triggers relevant interventions:
  • Episode management
  • Ongoing management
  • Prevention
    Employers have access to a multi-skilled coach, a fully integrated mobile app, educational content (library of doctor generated advice,) financial planning and legal consultation

Healthy Company Insights
Integrates data from Screening and Care programs and creates a dashboard

  • Clear and Actionable insights for each employee and the employer
  • Updates employer risk stratification
  • Assists employer in defining their health and wellness strategy

Key Care 2018

  • Income band thresholds increased by 5.6%
  • Specialist Benefit increased from R3,570 to R3,860
  • Casualty: Upfront payment of R325
  • Medical Equipment: Increased overall limit of R5,200 p/family

Primary Care
Enhanced benefits for employees:

  • Ability to extend cover to dependents
  • Cover for 27 chronic conditions on Primary Care Comprehensive

Enhanced benefits for employers:

  • Inclusion of Primary Care employees in Discovery Wellness Experience

Primary Care Essential

  • Through Primary Care Essential, members and dependents can access primary healthcare services at Primary Care network GPs, including consultationsmedical procedures and day-to-day prescription medicine which is to be collected from a Clicks pharmacy
  • In addition, members have access to R5,000 funeral cover including their dependents under the age of 70 years.
  • Members will have access to Vitality Move as well as the Primary Care Wellness Experience

Primary Care Comprehensive

  • Members and their dependents will have access to a rich set of services, in addition to those offered by Primary Care Essential

Members are supported throughout their maternity journey, with the following benefits included:

  • Unlimited GP consultations
  • Unlimited day-to-day prescription medicine based on the defined medicine list
  • Range of essential blood tests
  • Two ultrasound scans

Emergency health services
Enhanced emergency healthcare services for a broad range of traumatic events

Trauma Benefit

  • Employers can extend cover through the Trauma Benefit, to provide access to emergency private healthcare services for a broad range of traumatic events
  • Members are covered in full for these events up to a limit of R100,000 per admission and will not have to pay upfront for these medical services at a hospital or casualty facility in the network
  • The following traumas are covered in a network of private hospitals: burns, head injuries, loss of an arm, hand, leg or foot, near drowning, poisoning or a serious reaction that may cause death, injuries resulting from a crime, sexual assault, a fall, a car accident or an injury at work

Medical evacuation
If the member experiences a traumatic event, Primary Care provides cover for medical evacuation services to the nearest private hospital facility in our network, or a state facility

Casualty Treatment
At the hospital, the member will have access to medical treatment in the casualty facility

Additional Services

  • Primary Care Wellness Experience
  • Onsite occupational health services (additional cost)
  • Vitality Move: Vitality Move members can win shopping rewards at Pick n Pay, and can get up to R300 back monthly on shopping, gym and movies

Discovery Gap Cover: What’s new in 2018
Introducing Discovery Gap Core

  • In-hospital Specialist gap cover provides an additional 200% of DH rate cover
  • Hospital Admission Benefit Extender provides up to R10 000 additional cover for in-hospital shortfalls
  • Oncology Benefit Extender provides up to R75 000 for co-payments related to your oncology treatment plan
  • Priced from as little as R90 p/month

Vitality 2018
The Vitality Product range has been extended to include:

  • Vitality Move: Rewarding people for taking steps towards a healthier lifestyle
  • Vitality Active: Rewarding young adults under 30 for getting active and driving well
  • Vitality Purple: Rewarding our most discerning clients

E&EO – this is a summary and does not supersede the rules of the scheme