STELLENBOSCH UNIVERSITY Most important changes to health-care products for 2016

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1 STELLENBOSCH UNIVERSITY Most important changes to health-care products for 2016 Option renewal is the one time of the year where you are given the choice to change your medical aid option. It is a change that will directly influence your and your family s health, so make sure you choose the level of cover that best suits your needs with effect from 1 January Take some time to understand the changes in your scheme for 2016 so that you have all the information you need to make good choices and enjoy good health. The different benefits are discussed as follows: 1. Medical scheme Discovery Health Page 1 2. Vitality Discovery Health Page 5 3. Gap cover Admed option 4 Page 5 4. OcsaCare Page 6 5. Funeral cover Page 6 1. MEDICAL SCHEME DISCOVERY HEALTH Are you satisfied with your existing medical aid option? Changing your medical aid option is not compulsory. Therefore, if you are satisfied with your current option and believe it will continue to meet your and your family s health needs in the year ahead, you are welcome to continue with your chosen option. You will not need to complete any forms, but kindly note any changes for 2016 that may apply to your plan. Do you want to change your option? Members who wish to make an option change for 2016 will be given the opportunity to make these changes online via the Human Resources link on the University s website. This online function will be available from 12 November 2015 until 14:30 on 4 December No: 3064

2 HOW TO CHANGE YOUR OPTION FOR 2016 ON THE WEBSITE Visit the SU webpage at Click For Staff. Choose My.Sun. Choose SUN-e-HR. Enter your username and password. Click on SUN Employee Self Service. Click on Remuneration and Banking. At External Links, choose Medical Aid Choice Click on Medical Aid Choice You will only be allowed to structure your medical scheme option. CHOOSE YOUR OPTION FOR 2016 NOW The function to select your option will be under Struktureringsvoordele / Structuring Benefits. When clicking on the down arrow v, all the options will appear. Click on your chosen option for Once you have made your choice, your medical savings account (MSA) and threshold (if applicable) will automatically appear. CONFIRM YOUR CHOICE BY CLICKING ON Save Package. Once you have clicked on Save Package, you will receive an confirming your option choice for If you do not receive an , it means that your choice has not been stored in your package structuring. If so, kindly send an urgent to afhealth@sun.ac.za confirming your option choice for The closing date for option choices is 4 December 2015 at 14:30, and not any other date that you may see in any of Discovery Health s communications. Should you wish to join Vitality in 2016, please contact your Alexander Forbes Health consultant on What are the key questions I need to ask? Were my savings sufficient for this year? How much will I need for next year? Have I reached my above-threshold benefit as a priority, comprehensive or executive plan member? Do I need comprehensive cover, or is a savings plan more suitable? Which option will provide the best cover for my chronic medicine needs? By obtaining a claims transaction history (CTH) from Discovery Health ( ), you can review your annual medical aid usage. This will help you make an informed choice regarding your benefit needs for No: 3064

3 Do you need help making the choice? Your Alexander Forbes Health consultant, Marie-Louise du Toit, will be available to help you make the right choice so that your plan will meet your and your family s health needs. For an appointment with an Alexander Forbes Health consultant to discuss option choices for 2016, members may call the Human Resources Client Service Centre on All information regarding medical aid plans for 2016 will also be available on the SU website from 12 November 2015 ( Days and times Contact details Address Monday, Tuesday and Thursday 08:00 to 16:00 Wednesday 08:00 to 13:00 Friday 08:00 to 16:00 Tel: or afhealth@sun.ac.za Tel: or afhealth@sun.ac.za Tel: or afhealth@sun.ac.za Stellenbosch Campus Admin building Block C Room C1308 Tygerberg Campus Admin building Room 1061 Alexander Forbes Health Dorp Street office Stellenbosch Your Alexander Forbes Health consultant will also host information sessions on the 2016 health-care options. The dates and times of the member information sessions are as follows: Date Time Place 16 Nov 2015 JSG Library (General AFR) JSG Library (General AFR) 09:00 10:30 12:30 14:00 Auditorium JSG Library (General ENG) 14:30 16:00 17 Nov 2015 JSG Library (General ENG) JSG Library (General AFR) JSG Library (General AFR) 09:00 10:30 12:30 14:00 14:30 16:00 Auditorium 18 Nov 2015 JSG Library (Pensioners AFR) JSG Library (Pensioners ENG) 09:00 10:30 11:00 12:30 Auditorium 19 Nov 2015 USB (General AFR) USB (General ENG) 10:00 11:30 13:00 14:30 Main building, Room Nov 2015 Tygerberg (General AFR) Tygerberg (General ENG) 10:00 11:30 13:00 14:30 Lecture hall 4, Education Building 24 Nov 2015 JSG Library (Pensioners AFR) JSG Library (Pensioners ENG) 12:30 14:00 14:30 16:00 Auditorium We strongly advise members to attend one of the information sessions, as important aspects of the health plans of the Discovery Health Medical Fund will be discussed. How much will you pay in 2016? Discovery Health s overall weighted average contribution increase across all the options is 8,6% with effect from 1 January Most plans will however experience an increase of 8,9%. Exceptions are the Classic Saver, Essential Saver, Classic Core and Essential Core plans, which will experience an increase of 7,9%. For members on the KeyCare plans, the income bands have increased by CPI + 2% (5,5% + 2%). Please refer to the contribution table (Annexure A) for details. 3 No: 3064

4 Most important benefit changes in 2016 The threshold levels on the comprehensive plans have increased by 9,9%, and by 8,9% on the priority plans threshold limits Plan Principal member Adult dependant Child dependant Executive R R R2 800 Comprehensive R R R2 620 Priority R R8 990 R3 910 Priority above-threshold limit R R7 250 R3 500 Oncology limits have remained the same at R on the executive and comprehensive plans, and at R on the priority, saver and core plans. Keycare plans provide oncology cover for prescribed minimum benefits only. The priority plan deductibles have increased and will range from R2 550 to R The Delta plan deductibles for planned procedures at non-network hospitals have increased from R5 950 to R KeyCare plan changes include the following: Out-of-network GP visits have increased from one to four visits per person per year. KeyCare Access and Plus members must obtain pre-authorisation after 15 GP visits to access further benefits. No benefit for any non-prescribed minimum-benefit surgery and treatment relating to knees and shoulders. In-hospital or day-clinic dentistry deductibles have increased: Member category Hospital Day clinic % increase % increase Members younger than 13 R1 700 R ,8% R800 R850 6,2% Members 13 and older R4 400 R % R2 850 R ,7% ALL routine conservative dentistry, such as preventative treatments, simple fillings and root canal treatments, whether done in or out of hospital or a day clinic, is covered from your available medical savings on the saver plans. On the priority, comprehensive and executive plans, these services are covered from your available medical savings, or from your own pocket while you are in your self-payment gap. Once your claims have accumulated to your annual threshold level, these services are covered through the above-threshold benefit. New benefits The new Discovery Health Smart Plan, which offers a fully digital experience, making use of the latest smart technologies. Key benefits include the following: Unlimited hospital cover at 200% of the Discovery Health rate through Smart Plan network hospitals Unlimited chronic medication cover for prescribed minimum benefit conditions, subject to the formulary through MedXpress, Clicks or Dis-Chem Unlimited GP consultations through the Smart Plan network, subject to a R50 co-payment per visit Unlimited video-call GP consultations through the Smart Plan network, covered in full Unlimited acute medication prescribed by network GPs through Clicks or Dis-Chem, subject to R10 co-payment per line item Access to genetic testing through Human Longevity Inc, a world leader in genome sequencing and interpretation, which includes whole exome, prenatal and newborn screening The advanced illness benefit, which will provide cancer patients with cover for GPs specialising in palliative care, a personalised high-touch experience through the Discovery HomeCare programme, and a dedicated care coordinator Unlimited cover for spinal surgery devices through a preferred provider, otherwise subject to a defined limit 4

5 2. VITALITY New Vitality Active Rewards will reward members weekly for achieving personalised goals, tracked through the Discovery app on their smartphone or the Apple watch fitness device. Members may qualify for a free Apple watch if they achieve weekly goals. If not, the cost will be recovered through the Discovery Card. Maximum fitness points have changed to for adults and for kids. A separate assessment points category was created for fitness assessments and exercise consultations. These assessments will no longer count towards the fitness points category. Kids will earn the same number of points for physical activity as adults from age 6 onwards, and the same gym points from age 12. New Vitality Healthy Kids is an electronic health record that will allow parents to record and track their children s health and wellness information from birth until the age of 18. Families qualify for a R250 voucher to spend at any HealthyLiving partner if all kids complete the following before 30 April 2016: Kids Vitality health review Kids Vitality health check Dental health check HealthID consent 3. GAP COVER ADMED OPTION 4 Guardrisk Insurance will no longer offer Admed option 4 as from 31 December The new product, with better benefits, provides members with better value. All members on the existing Admed option 4 will automatically be moved to Admed Supreme on 1 January Gap cover products are short-term insurance policies that cover the difference between the provider s rates (e.g. anaesthetists, surgeons, other specialists and GPs) and the product tariff, for procedures done in hospital and that are subject to certain limits. Even on your scheme s more comprehensive options, you may still experience some gaps between the rate the scheme pays and the amount the service provider charges. The gap cover contribution will increase from R94 in 2015 to R164 per family per month as of 1 January The differences in the products are briefly set out below: Admed option 4 Admed Supreme Cover 5 x the scheme tariff 5 x the scheme tariff Premium R94 per family per month R164 per family per month Co-payments Yes, unlimited cover for certain copayments and deductibles in hospital. Co-payments for MRI/CT/PET scans on an out-patient basis. Yes, unlimited cover for certain co-payments and deductibles in hospital. Co-payments for MRI/CT/PET scans on an out-patient basis. Policy limit Unlimited benefits Unlimited benefits Additional benefits - Personal accident cover of R for all members - Cancer benefit of R for first diagnosis of any cancer - Oncology benefit of R per dependant if scheme tariff is reached and where 20% co-payment is required - In-hospital sublimit benefit of R for internal prosthesis - Personal accident cover of R for all members - Cancer benefit of R for first diagnosis of any cancer - Oncology benefit of R per dependant if scheme tariff is reached and where 20% copayment is required 5

6 - Payments for shortfalls or gaps regarding prescribed minimum benefits (PMBs) - Digital doctor - In-hospital sublimit benefit of R for internal prosthesis - Payments for shortfalls or gaps regarding prescribed minimum benefits (PMBs) - Digital doctor New Not applicable Emergency out-of-hospital dental procedure involving the repair of a tooth/teeth as a result of accidental injury to the mouth. R2 000 per tooth up to a maximum of five teeth (R10 000) per policy per year. New Not applicable Where person has been hospitalised for a period of 30 consecutive days or more. R will be paid after the insured person has been discharged from hospital. Available only once per person covered on the policy per year. 4. OCSACARE The OcsaCare premium for 2016 has increased by 4,6% to R249 per month. The product offers basic day-to-day medical provision for the employee only, with no hospital cover. This product does not cover any dependants. This product is available to personnel on all levels. Should you require more information regarding the product, please contact your Alexander Forbes Health consultant. 5. FUNERAL COVER On 1 January 2016, the SU will be moving its funeral cover from MMI to Old Mutual, and the cover will increase as follows: Benefit Existing cover in 2015 Increased cover from 1 January 2016 Main member R R Spouse/life partner(s) R R Children (14 years and older) R R Children (between six and 13 years) R R Children (From birth to five years) R R Children (still-born) R R The good news is that the monthly premium for the increased cover will increase by only R5,60 per family per month. The premium in 2015 for the existing cover was R15,50 per family per month. In 2016, the new premium for the increased cover will be R21,10 per family per month. Even though the insurance will move from MMI to Old Mutual, the terms and conditions of the policy will remain unchanged. Closing 6

7 Our SERVE model drives the way we at Alexander Forbes do business. We strive to deliver simple and expert innovative solutions that build long-lasting relationships founded on the value of trust. In this way, we provide an impactful service that enriches people s lives. As an Alexander Forbes Health client, you can be assured of our steadfast commitment to help you make good choices and enjoy good health in To keep your finger on the pulse of the medical scheme industry, follow us on Twitter at For some very useful Vitality tips, follow Alex at Yours in health Alexander Forbes Health Get more information here: Browsing the website Alexander Forbes Health generic website health View our ZMag escomms/docs/discovery2016 /1 Brochure sent by Discovery Health Stellenbosch or clientspecialist@aforbes.co.za View our CorpCam overy2016 National walk-in centres Alexander Forbes Complaints: contactus@aforbes.co.za Tel: Fax: Send a letter by post to: Complaints Office PO Box Sandton 2146 View the DVDs Please note that Alexander Forbes Health has made every effort to ensure that the information provided in this newsletter is correct. However, this is merely a summary of the benefits. In the event of a dispute, the rules of Discovery Health will prevail. Disclaimer: While all reasonable care has been taken in compiling this communication, we have relied upon the accuracy and completeness of the information made available to us by the respective schemes and product suppliers. Consequently, we cannot accept any liability for any errors or omissions that may arise as a result of the reliance on such information. Further please note that the Discovery Health changes are still subject to approval by the Council for Medical Schemes. Alexander Forbes Health will keep you informed as further information or changes are made known. 7

8 ANNEXURE A: 2016 DISCOVERY HEALTH TOTAL CONTRIBUTIONS Plan Principal member Adult dependant* Child dependant* Executive R R R 942 Classic Comprehensive R R R 802 Classic Delta Comprehensive R R R 721 Classic Comprehensive Zero MSA R R R 602 Essential Comprehensive R R R 681 Essential Delta Comprehensive R R R 611 Classic Priority R R R Essential Priority R R R 925 Classic Saver R R R 938 Classic Delta Saver R R R 752 Essential Saver R R R 745 Essential Delta Saver R R R 596 Coastal Saver R R R 750 Smart Plan R R R 557 Classic Core R R R 698 Classic Delta Core R R R 557 Essential Core R R R 601 Essential Delta Core R R 900 R 480 Coastal Core R R 976 R 519 KeyCare Plus (R0 - R290) R 290 R 290 R 290 KeyCare Plus (R291 - R7 550) R 832 R 832 R 301 KeyCare Plus(R R10 750) R R R 326 KeyCare Plus (R ) R R R 464 KeyCare Access (R0 - R4700) R 586 R 586 R 256 KeyCare Access (R R7 550 R 782 R 782 R 281 KeyCare Access (R R10 750) R R R 317 KeyCare Access (R ) R R R 458 KeyCare Core (R0 - R7550) R 665 R 665 R 173 KeyCare Core (R R10 750) R 830 R 830 R 204 KeyCare Core (R ) R R R 289 *Contributions are charged for up to a maximum of three children. Dependants 21 years + are considered adult dependants. VITALITY & KEYFIT CONTRIBUTIONS Family size Single member Member with one Member with two or dependant more dependants Vitality R 199 R 239 R 269 KeyFIT R 43 R 53 R 65 Vitality & KeyFIT R 215 R 259 R 299 8

9 MEDICAL SAVINGS ACCOUNT ALLOCATIONS (MSA) Principal member Adult dependant Child dependant* Plan Annual Monthly** Annual Monthly** Annual Monthly** Executive R R R R R R 235 Classic Comprehensive R R R R 952 R R 200 Classic Delta Comprehensive R R 906 R R 858 R R 180 Essential Comprehensive R R 507 R R 479 R R 102 Essential Delta Comprehensive R R 457 R R 431 R R 91 Classic Priority R R 675 R R 531 R R 270 Essential Priority R R 348 R R 273 R R 138 Classic Saver R R 586 R R 461 R R 234 Classic Delta Saver R R 468 R R 369 R R 188 Essential Saver R R 279 R R 209 R R 111 Essential Delta Saver R R 223 R R 167 R R 89 Coastal Saver R R 465 R R 349 R R 187 * A maximum of three children are counted when calculating the annual MSA allocation. ANNUAL THRESHOLD LEVELS Plan Principal member Adult Child Executive R R R Comprehensive R R R Priority R R R Priority above-threshold limit R R R * A maximum of three children are counted when calculating the annual threshold. LATE JOINER PENALTIES Please note these rates are the standard Discovery Health rates and do not take into account any late joiner penalties (LJP) that may be applied to an applicant or to the adult dependant of an applicant older than age 35. Depending on the number of years they have not belonged to a registered South African medical scheme, an additional penalty (a percentage of the contribution) may be added to the member's monthly contribution, as shown in the following table: Penalty bands Maximum penalty 1 4 years 0,05 x contributions 5 14 years 0,25 x contributions years 0,50 x contributions 25+ years 0,75 x contributions The LJP is calculated as follows: A = B minus (35 + C), where: A = the number of years in the first column; B = the age of the applicant at the time of application; C = the number of years of credible cover. 9

10 ANNEXURE B: 2016 DISCOVERY HEALTH DEDUCTIBLES PRIORITY SERIES: CO-PAYMENTS ON HOSPITALISATION Members participating in priority plans should please note that the predetermined payment by the member for in-hospital procedures will still apply in Members need to pay an amount upfront to the hospital when admitted for one of the following procedures: CO-PAYMENT ON HOSPITALISATION R2 550 R3 300 R6 150 R PROCEDURE LIST Conservative back and neck treatment; myringotomy (grommets); tonsillectomy; adenoidectomy Colonoscopy; sigmoidoscopy; proctoscopy; gastroscopy; cystoscopy Arthroscopy; functional nasal procedures; hysterectomy (except for preoperatively diagnosed cancer); laparoscopy; hysteroscopy; endometrial ablation Nissan fundoplication (reflux surgery); spinal surgery (back and neck); joint replacements If the procedure can be done out of hospital, for example in the doctor s rooms, and the member does not need to go to hospital, no payment is required. It is recommended that members contact Discovery Health directly on prior to the procedure to confirm their benefits. DELTA PLAN DEDUCTIBLES Delta plan members should please note that a R6 450 payment will apply if they do not use their Delta hospital network for planned procedures. 10