NMG Healthcare Newsflash Discovery Health 2017 Benefit September Changes 2013

Transcription

1 NMG Healthcare Newsflash Discovery Health 2017 Benefit September Changes 2013 Dear Discovery Health Member This communication provides a summary of the most important changes to the Discovery Health Medical Scheme, effective 1 January 2017, based on the information provided by Discovery Health at their recent Corporate Launch. Contents Most important changes for 2017 Contribution increases Medical Savings Account Annual Threshold Levels Product updates for 2017 Smart Plan renamed to Classic Smart Smart Plan Hospital Network Introducing Essential Smart Plan KeyCare Changes General Benefit Changes Introducing DiabetesCare Plan Increases Vitality and DiscoveryCard changes Discovery Health Contributions 2017 Option Change Contribution increases vary from 7.8% % depending on your plan type, with a weighted average increase of 10.2%. The Smart Plan has been renamed Classic Smart and offers more enhanced benefits. A New Essential Smart Plan has been introduced providing affordable hospital cover with unlimited GP visits. Allocated medical savings on Coastal Saver reduced to 20% KeyCare income bands have increased by 7.4%. 6 KeyCare Network hospitals will form part of the Partial Cover Network. Coordinated care for members on KeyCare with multiple chronic conditions. Benefit limits and co-payment increases range between 4%and10%. Centres of excellence for major joint replacement and specialised in-hospital psychiatry. Insured Network Benefit has been renamed to Day-to- Day Extender Benefit Enhanced individualised approach to the Screening and Preventions Benefit. Vitality and DiscoveryCard changes Medical Savings Account Savings contributions as a percentage of total contributions have remained unchanged, except for Coastal Saver and are as follows: *Savings reduced to 20% Plan MSA% Executive 25% Classic Comprehensive, Priority and Saver 25% Essential Comprehensive, Priority and Saver 15% Coastal Saver 20%

2 Annual Threshold Levels The annual threshold levels for the Executive, Comprehensive and Priority Options have increased in line with the contribution increase of 9.9%. 1 Plan Principal member Adult dependant Child dependant Executive R R R3 150 Comprehensive R R R2 950 Priority R R9 850 R4 300 Product updates for 2017 Discovery Smart Series Classic Smart Plan From 2017, the Smart plan will be renamed to the Classic Smart plan. This option will offer more advanced benefits to the members. The plan combines comprehensive cover for in-hospital costs with unique cover for essential day-to-day medical expenses. Comprehensive hospital cover at 200% of DH rate within the Smart Plan hospital network R8 200 up-front payment for admissions outside the Smart Plan Hospital Network Unlimited GP consultations within the GP network using HealthID, R50 co-payment applies for each visit Video call GP consultations within the GP network, no co-payments applicable Acute medicine cover for a defined list with a R10 co-payment for each medicine item. This is limited to 12 prescriptions a person a year. You need to collect your medicine from your network pharmacy Full cover for 27 PMB chronic conditions subject to designated pharmacy network (MedXpress, MedXpress partner pharmacies, Clicks or Dischem). Medicine formulary applies, but the Chronic Drug Amount is not applicable One dental check-up per year with a R100 payment One eye test per year at any Mellins optometrist with a R50 payment Out of hospital MRI/CT scans, co-payment of R2 900 applicable Sports injury benefit - When referred by a Smart network GP the benefit will offer basic X-rays, 2 specialist visits, a total of 4 visits to either a physiotherapist, biokineticist or chiropractor. R100 payment per visit NEW PLAN Essential Plan The Essential `Smart Plan provide affordable hospital cover with unlimited GP visits for the individual. Unlimited hospital cover at 100% of DH rate within the Smart Plan hospital network R8 200 up-front payment for admissions outside the Smart Plan Hospital Network Unlimited GP consultations within the GP network with a R100 payment for each consultation Video call GP consultations within the GP network Full cover for 27 PMB chronic conditions subject to designated pharmacy network (MedXpress, MedXpress partner pharmacies, Clicks or Dischem). Medicine formulary applies, but the Chronic Drug Amount is not applicable One dental check-up per year with a R150 payment One eye test per year at any Mellins optometrist with a R100 payment Benefit exclusions are applicable 2 Smart Plan Network Hospitals Gauteng Gauteng Western Cape KwaZulu-Natal FreeState & Eastern Cape Mediclinic Morningside Clinix Botshelong Mediclinic Panorama Mediclinic Pietermaritzburg Mediclinic Bloemfontein Wits Donald Gordon Medical Centre Life Genesis Clinic Mediclinic Contstantiaberg Netcare St Augustine Netcare Greenacres Netcare Clinton Life Fourways Melomed Gatesville JMH Isipingo Clinic Life Beacon Bay Life Roseacres Clinic Life Little Company of Mary Mediclinic Cape Town Life Westville North West & Mpumalanga Netcare Waterfall City Mediclinic Midstream Mediclinic Stellenbosch Netcare Umhlanga Netcare Ferncrest Life The Glynnwood Mediclinic Legae Melomed Mitchells Plain Mediclinic Nelspruit Life Wilgeheuwel Netcare Park Lane Mediclinic Milnerton Netcare Krugersdorp Clinix Lesedi Private Mediclinic Medforum Mediclinic Vereeniging

3 3 KeyCare Changes The following changes were introduced : Coordinated care for members with multiple chronic conditions Members suffering from complex medical conditions can be enrolled in the Care Coordination Programme. The programme will provide members with additional out of hospital benefits. Qualifying members will be contacted by the scheme, if they do not register, a 20% co payment for all voluntary admission related to the chronic conditions will apply. Keycare Hospital Network The Keycare hospital network will be divided into full cover network and partial cover network hospitals. Partial cover network hospitals will only be covered up to 70% of the Discovery Health rate. Please refer to the list below. Gauteng Kempton Park Arwyp Medical Centre 4 Lenasia Lenmed Ahmed Kathrada Private Hospital KwaZulu-Natal Pietermartizburg Midlands Medical Centre Sydenham Lenmed Health Shifa Hospital Pretoria Louis Pasteur Hospital Zuid-Afrikaans Hospital 4 7 General Benefit Changes Enhanced screening benefit available for at risk members Health check benefits, As from 1 April 2017, members with results that are out of range for the glucose and cholesterol test will have cover for Lipogram and HbA1c as part of the screening process Breast Cancer and cervical cancer screening: All members will be covered for: One mammogram every 2 years One papsmear every 3 years At risk* members will be covered for: One mammogram or breast MRI test per year Annual papsmear BRCA testing (once-off) *Member are considered at risk-based on scheme clinical entry criteria Preferred suppliers for spinal Changes surgery to the devices chronic illness medicine list and chronic drug amounts will apply as from January For existing members changes will be effective July 2017 Discovery PrimaryCare Day-to-Day Extender Benefit replaces the Insured Network benefit. GP consultations will be covered in the new Premier GP network 5 Limit Changes All co-payments and deductibles are increased by 9.9% Thresholds increased in line with specific contribution increase All benefit limits increased by 9.9 % with the exception of: Oncology Threshold External Medical Items limit Spinal devices limit Internal prosthesis limit increase by surgical inflation KeyCare income band thresholds increased by 7.4% 6 DiabetesCare This is a programme designed to achieve well-coordinated care for members with diabetes. The programme has 4 key elements: Access to the Premier Plus GP network for members registered with diabetes on the Priority, Saver, Smart, Core and KeyCare plans to manage your condition and avoid a 20% co-payment Additional funding for allied healthcare services with a biokineticist and dietitian Incentives to motivate a journey to better health where member can join Vitality and maintain a healthy lifestyle by enrolling in a personalised physical activity and weight-loss programme Access to real-time, clinically verified data on their condition that will provide a monthly progress dashboard to empower the member to engage and manage their condition

4 Vitality and DiscoveryCard Changes 1 Vitality Active Rewards 2 Vitality Active Rewards Shoe Booster 3 new reward partners have been introduced to Vitality Active Rewards: 3 Ster-Kinekor free small or medium popcorn Mugg & Bean free selected drinks Vitality MoveToGive members can donate to a person in need during Vitality MoveToGive campaigns New Vitality Offerings Personalised wellness journeys for managing diabetes and healthy weight has been introduced for DiabetesCare Integrates Discovery Health s clinical tools and networks with Vitality s preventive screening and incentive structures The programme will provide well-coordinated care, information and motivation for members to manage their condition Vitality Weight Loss Rewards Go for a verified weigh-in and activate Vitality Weight Loss Rewards Select a personialised weight-loss goal Track a weekly progress on the Discovery App and earn Vitality points Achieve you weight-loss goal and get up to 50% cash back on HealthyFoods Members can earn up to 100% cash back on a pair of running shoes with the new Vitality Active Rewards Shoe Booster. Activate the shoe booster (R300 online activation fee) Get free Team Vitality running membership Activate the HealthyGear to get up to 25% cash back on new running shoes at Sportmans Warehouse Achieve the weekly Vitality Active Rewards goals over 12 months Get up to 100% cash back (based on the number of goals met in the previous month) Shoe Booster will be available for all running shoe brands at Sportsmans Warehouse for the first 3 months of 2017, after which it may be limited to selected brands. Vitality members must be 18 years and older to have access to 1 pair of running shoes per year. 4 Vitality Points Changes Points thresholds on Bronze and Silver status will be lowered in 2017 Gold and Diamond status thresholds remain unchanged Points for nutrition consultations have been reduced to points Up to points can be earned based on engagement and outcomes in Vitality Weight Loss Rewards Member over 60 can earn up to points for additional screening and prevention DiabetesCare member can earn up to points for Diabetes management 5 DiscoveryCard Benefit Enhancements Vitality members will get up to 50% of their points back in Discovery Miles each year and boost their travel savings through the travel partners Big Concerts is now an exclusive partner of DiscoveryCard. Cardholders get exclusive pre-booking access of 48 hours *Terms and conditions apply

5 Member information sessions NMG Benefits will be presenting the 2017 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 Johannesburg: NMG Benefits, 411 Main Avenue, Ferndale, Randburg or 22 November h00 Johannesburg: NMG Benefits, 411 Main Avenue, Ferndale, Randburg 24 November h00 Cape Town: NMG Benefits, Belvedere Office Park, Block B, Pasita Street, Bellville 22 November h00 Durban: NMG Benefits, Suite No 7, 9 Frosterley Park, Frosterley crecent, La Lucia Ridge) 22 November h30 Contact details Please do not hesitate to our NMG administration consultants should you need assistance: individuals@nmg.co.za Please call me: SMS NMG followed by your company name, your name and surname, the medical scheme name and membership number to A consultant will return your call. (SMS charged at R1.50)

6 Discovery Health 2017 Contributions Monthly Contributions Series Plan Principal Member Adult Dependant Child Dependant* Executive Executive Classic Comprehensive Classic Delta Comprehensive Comprehensive Classic Comprehensive Zero MSA Essential Comprehensive Essential Delta Comprehensive Priority Classic Priority Essential Priority Classic Saver Classic Delta Saver Saver Essential Saver Essential Delta Saver Coastal Saver Smart Classic Plan Essential Plan Classic Core Classic Delta Core Core Essential Core Essential Delta Core Coastal Core KeyCare Plus (R ) KeyCare Plus (R8 101 to R11 550) KeyCare Plus (R0 to R8 100) KeyCare Access (R ) KeyCare KeyCare Access (R8 101 to R11 550) KeyCare Access (R5 051 to R8 100) KeyCare Access (R0 to R 5050) KeyCare Core (R ) KeyCare Core (R8 101 to R11 550) KeyCare Core (R0 to R8 100)

7 Discovery Health 2017 Contributions (continued) Medical Savings Account (MSA) included in the above monthly contributions Principal Member Adult Dependant Child Dependant Series Plan * - A maximum of 3 children are taken into account MSA when % calculating Annual the Annual Monthly Threshold Annual and Above Monthly Threshold Annual Limit Monthly Executive Executive 25% Classic 25% Vitality & KeyFIT Comprehensive Classic Delta 25% For further information or advice please contact Cipla Consult on or Essential 15% Essential Delta 15% Member with one Member with two or more Classic Single 25% member info@ciplaconsult.co.za Priority dependant dependants Essential 15% Vitality Classic Saver 25% KeyFIT Classic Delta 25% Saver Vitality & KeyFIT Essential 15% Essential Delta 15% Coastal 20% Annual Thresholds Executive and Comprehensive Plans Annual Threshold Executive Plan Comprehensive Plans Principal member Per adult Per child* * A maximum of 3 children are taken into account when calculating the Annual Threshold and Above Threshold Limit Priority Plans Annual Threshold * Contributions are charged up to a maximum of 3 children Annual Threshold Above Threshold Limit Principal member Per adult Per child* Please note The above rates are the standard Discovery Health 2017 rates and do not include any Late Joiner Penalties. Vitality & KeyFIT Vitality KeyFIT Vitality & KeyFIt Member Member + 1 dependant Member + 2 or more dependants