Fourth Edition of 2014 Discovery 2018 launch highlights Weighted average contribution increase: 7.9% Enhanced Vitality Active Rewards Executive Plan enhancements & changes Smart Plan access to over-the-counter meds Day-to-day Extender Benefit changes Discovery DrConnect advice line introduced New maternity & post-birth benefits Vitality Purple exclusive rewards & personalised service Vitality Active integrated with Vitality Drive Vitality Move introduced HealthyCompany Care EAP programme Primary Care enhancements Discovery Health Medical Scheme: 2018 Discovery Health Medical Scheme (Discovery Health) announced their product changes and contribution increases for 2018 at a national launch on 13 September 2017. The launch highlighted a number of exciting new benefits. The average increase, being lower than previous years, was as a result of some drastic risk management measures implemented by the scheme. The scheme has grown to over 2.7 million lives and has strengthened its financial position, now boasting over R14bn reserves - comfortably above the regulatory requirement of 25%. The scheme maintained its AA+ Global Credit Rating. 7.9% weighted average contribution increase Absa Consultants and Actuaries (Pty) Limited Reg. No. 1961/001434/07 Authorised Financial Services Provider Information: absa.co.za
Benefit changes: Discovery Health Executive Plan overseas treatment enhancements Executive Plan day-to-day benefits restructuring Smart Plan access to over-thecounter medicine Day-to-day Extender Benefit changes Chronic Illness Benefit Limits, co-payments, deductibles and income bands Premier Plus GP network as Designated Service Provider (DSP) for HIVCare Programme Discovery DrConnect advice line Comprehensive Maternity and Post-birth benefits introduced Treatment outside South Africa (SA) has been enhanced through the Global Treatment Platform which will include: International Second Opinion through clinical experts at the Cleveland Clinic funded in full Access to advanced medical care via the Overseas Treatment Benefit of up to R750 000 for treatment not available in SA and R300 000 for voluntary in-hospital treatment outside SA (both with a 20% co-payment) International Travel Benefit increased to US$ 1 million per member for medical emergencies Specialists in-hospital now paid from Risk (previously from Medical Savings Account) at 300% (other healthcare professionals at 200%) Self-payment Gap (SPG) has been introduced (Day-to-day Extender Benefit applies during SPG) Smart Plan members will have cover for Schedule 0 2 medicine from a network pharmacy, subject to an annual limit: Classic Smart Plan: R600 per family per year Essential Smart Plan: R400 per family per year Members will have access to casualty visits for children under the age of 10 at a network facility GP consultations will be available through HealthID enabled GP s that meet the digital criteria in the Discovery GP network Cover for pathology, acute medicine and external medical items (on Priority & Comprehensive Plans) will be discontinued Chronic drug amounts and chronic medicine formularies will remain unchanged All benefit limits will be increased in line with the plan-specific contribution increase, with the exception of oncology threshold, External Medical Items (EMI) and internal prosthesis limits As a result of the successful implementation of full cover through a preferred supplier, the hip and knee prosthesis limit will be reduced All co-payments and deductibles will increase in line with the plan-specific contribution increase with the exception of 0% increases for co-payments on MRI and CT scans KeyCare income bands will increase by 5.6% This is applicable to KeyCare, Core, Smart, Saver & Priority members registered on the HIV Programme. This change will be effective immediately for new members from 1 January 2018, but only effective from 1 July 2018 if already registered. All Discovery Health members will have free access to this extensive library of doctor-created and peer-reviewed healthcare content. This can be accessed via the Discovery Health app as well as www.discovery.co.za. The functionality also includes virtual consultations available through selected GP s which can be funded from day-to-day benefits. These benefits do not affect a member s medical savings account, are funded at the DH rate and depend upon the selected plan of the member. The benefits have to be activated via the Discovery app, via www.discovery.co.za, when preauthorising the delivery or when the baby is registered. The benefits can include the following, depending on your option: 2
8/12 antenatal consultations with gynaecologist, GP or midwife 1 pre-natal test 2 ultra-sound scans A defined basket of blood tests 5 pre- or postnatal classes with a registered nurse Executive & Comprehensive have additional private ward cover as well as cover for essential registered devices of up to R5000 (25% co-pay) Baby cover for 2 years after birth includes 2 visits to a GP, paediatrician or ENT, one 6-week post-birth consultation at midwife, GP or dietician, two mental health consultations and one lactation consultation. On Keycare Access, the benefits are subject to the baby being born onto the scheme and extended to 12 months after birth. Vitality enhancements Vitality Move Brings Vitality to every Discovery Health member and rewards them for taking steps towards a healthy lifestyle Members can activate Vitality Move for FREE to win shopping rewards at Pick n Pay Members can choose to upgrade for R35 per month and get up to R300 back on gym, shopping and movies each month Vitality Active Designed for 18 30 year olds, Vitality Active members get rewarded for being active and driving well. Members enjoy these great benefits: 25% discount on Virgin Active or Planet Fitness gym memberships Weekly Vitality Active Rewards for achieving fitness and driving goals Earn surprise rewards for achieving 3 goals in a row All members earn Vitality points and a status to ensure a seamless transition to Vitality The premium is R40 per month for each adult under the age of 30 and R60 per month for each adult aged 30 years or older. Vitality Purple Only available on the Executive option. Offers enhanced benefits in addition to those available through the Vitality programme: Access to a Discovery Purple Private Consultant for all Discovery product and benefit needs Up to 50% off top-of-the-range fitness devices or up to 25% off premier bike brands or golf clubs 75% off any Virgin Active or Planet Fitness gym membership Up to 50% saving at the Purple Spa Collection Discounted access to the Discovery Executive Wellness Experience Access to elite athletes and coaching experts Access to a calendar of the world s most iconic international sporting events and global awards ceremonies Enhanced Active Rewards Surprise rewards for regular goal achievements: Achieve 3 consecutive goals and Spin the wheel and choose your reward e.g. dream holidays up to the value of R75 000 Leader boards for members to challenge themselves and compete with friends: Team rewards will fall away in Q4 2017. 3
New Vitality Booster Benefits Choose between: Bike Booster - Get up to 25% cash back on the first R20 000 of the retail price of the bike over 36 months Device Booster - Get up to 50% cash back on the first R4 000 of the retail price of the fitness device over 24 months Shoe Booster - Get up to 75% cash back on the first R2 000 of the retail price of running shoes over 12 months Discovery Health contribution table 2018 Series Plan Principal Member Adult Dependant Child Dependant Average increase Executive Executive R5 950 R5 950 R 1 134 7.3% Comprehensive Priority Saver Classic Comprehensive R4 882 R4 618 R 974 8.3% Classic Delta Comprehensive R4 398 R4 162 R 874 8.3% Classic Comprehensive Zero MSA R3 662 R3 464 R 731 8.3% Essential Comprehensive R4 102 R3 881 R 825 8.3% Essential Delta Comprehensive R3 694 R3 490 R 742 8.3% Classic Priority R3 214 R2 534 R1 286 8.3% Essential Priority R2 763 R2 172 R1 103 8.3% Classic Saver R2 773 R2 186 R1 110 7.6% Classic Delta Saver R2 214 R1 749 R 890 7.6% Essential Saver R2 203 R1 652 R 883 7.6% Essential Delta Saver R1 758 R1 325 R 705 7.6% Coastal Saver R2 160 R1 621 R 870 7.6% Smart Classic Smart Plan R1 647 R1 298 R 658 7.3% Core KeyCare Essential Smart Plan R1 180 R1 180 R1 180 7.3% Classic Core R2 064 R1 626 R 826 7.6% Classic Delta Core R1 652 R1 301 R 660 7.6% Essential Core R1 773 R1 329 R 712 7.6% Essential Delta Core R1 417 R1 065 R 569 7.6% Coastal Core R1 610 R1 209 R 641 7.6% KeyCare Plus (R12 201+) R2 064 R2 064 R 553 8.3% KeyCare Plus (R8 551 to R12 200) R1 386 R1 386 R 389 8.3% KeyCare Plus (R0 to R8 550) R 990 R 990 R 359 8.3% KeyCare Access (R12 201+) R2 018 R2 018 R 546 8.3% KeyCare Access (R8 551 to R12 200) R1 344 R1 344 R 378 8.3% KeyCare Access (R5 331 to R8 550) R 930 R 930 R 337 8.3% KeyCare Access (R0 to R5 330) R 697 R 697 R 306 8.3% KeyCare Core (R12 201+) R1 525 R1 525 R 345 8.3% KeyCare core (R8 551 to R12 200) R 988 R 988 R 243 8.3% KeyCare Core (R0 to R8 550) R 792 R 792 R 205 8.3% 4
Discovery Health Medical Savings Account (included in the above monthly contribution, where applicable) Series Plan Principal Member Adult Dependant Child Dependant Annual Monthly Annual Monthly Annual Monthly Executive Executive R17 844 R1 487 R17 844 R1 487 R 3 396 R 283 Comprehensive Classic R14 640 R1 220 R13 848 R1 154 R 2 916 R 243 Classic Delta R13 188 R1 099 R12 480 R1 040 R 2 616 R 218 Essential R 7 380 R 615 R 6 984 R 582 R 1 476 R 123 Essential Delta R 6 648 R 554 R 6 276 R 523 R 1 332 R 111 Priority Classic R 9 636 R 803 R 7 596 R 633 R 3 852 R 321 Essential R 4 968 R 414 R 3 900 R 325 R 1 980 R 165 Saver Classic R 8 316 R 693 R 6 552 R 546 R 3 324 R 277 Classic Delta R 6 636 R 553 R 5 244 R 437 R 2 664 R 222 Essential R 3 960 R 330 R 2 964 R 247 R 1 584 R 132 Essential Delta R 3 156 R 263 R 2 376 R 198 R 1 260 R 105 Coastal R 5 184 R 432 R 3 888 R 324 R 2 088 R 174 Contributions and savings are calculated and charged up to a maximum of 3 children; dependants 21 years + are considered adult dependants Discovery Health annual threshold levels Executive & Comprehensive plans Executive Plan Comprehensive Plan Principal member R20 350 R16 790 Per adult R20 350 R16 790 Per child* R 3 850 R 3 200 A maximum of three children are counted when calculating the Annual Threshold Priority plans Annual Threshold Above Threshold Limit Principal member R14 240 R12 080 Per adult R10 670 R 8 610 Per child* R 4 660 R 4 170 A maximum of three children are counted when calculating the Annual Threshold and Above Threshold Pool Limit Vitality & KeyFIT contributions Single Member Member with one dependant Member with two or more dependants Vitality Purple R 399 R 459 R 499 Vitality R 239 R 289 R 329 KeyFIT (2017) R 47 R 57 R 71 KeyFIT 2018 contributions to still be confirmed. KeyFIT will no longer be available for new applicants from 2018. 5
Discovery Gap Cover and Discovery Supplement Gap Cover 2018: Discovery Gap offering now consists of two plans, Gap Core and Gap Comprehensive. The two products are differentiated as follows: Plan Type Discovery Gap Comprehensive Discovery Gap Core In-hospital specialist cover Hospital Admission Benefit Extender Additional 200% of DH Rate Up to R20 000 additional cover for in- and outof-hospital shortfalls related to the admission Additional 200% of DH Rate Up to R10 000 additional cover for in-hospital shortfalls for specialist clams Oncology Benefit Extender Annual maximum per person Premiums (based on oldest member on scheme plan) Up to R100 000 for co-payments related to your oncology treatment plan Up to R75 000 for co-payments related to your oncology treatment plan Executive and Comprehensive: Executive and Comprehensive: R100 000 R40 000 Other plans: R40 000 Other plans: R30 000 Executive and Classic Essential and Coastal Executive and Classic Essential and Coastal Single Family Single Family Single Family Single Family 0-54 R 135 R 230 R 250 R 560 R 90 R 150 R 165 R 395 55-64 R 230 R 340 R 455 R 865 R150 R 180 R 390 R 575 65+ R 290 R 475 R 605 R1135 R180 R 265 R 575 R 920 The Discovery Gap Cover offering still differentiates itself from its competitors through the simple seamless claiming process. Discovery Gap Cover premiums are based upon selected Gap plan selected medical scheme option, family composition and age of eldest member on the medical scheme option. The Discovery Supplementary Gap Cover still provides additional cover for life-changing health-related events to provide treatment and lifestyle protection for Discovery clients and their families via Discovery Life. The premium for this product depends on the age and smoker status of the policy holder and their spouse as well as the number of dependents on the medical scheme plan. 6
HealthyCompany Care (Employee Assistance Programme) This Discovery HealthyCompany integrated wellness solution combines the health and wellness management capabilities of Discovery Health and Discovery Vitality. Using the data from health screenings, the medical scheme and Vitality, the programme will offer interventions in terms of employees physical-, emotional- and financial wellness. More detail will be provided to interested employers. Discovery Primary Care Discovery Primary Care is a separate product aimed at providing access to healthcare for lower income employees. The offering includes access to private healthcare services for primary care, emergencies medical services, chronic treatment, including cover for a spouse and children. The product also offers access to the employer s wellness day screenings and Vitality Move. Further information will be provided to interested employer groups. Year-end member sessions Apart from the communication which all members will receive from Discovery regarding the changes to their specific options, ACA Healthcare will make available our allocated healthcare consultants for year-end member sessions as agreed. Further, the ACA Healthcare Helpdesk (0860 100 380) is always available to assist your employees with detailed information about the 2018 benefits and to select a suitable option. Absa Consultants & Actuaries - Healthcare September 2018 Disclaimer Although this document has been prepared with due care and in good faith, the interpretations and opinions are those of the authors and are subject to change without notice. As such, the contents do not constitute definitive advice and should not be accepted as such. Neither Absa Consultants and Actuaries (Pty) Limited nor the authors accept liability for any damage whatsoever or however it may arise, including but not limited to, direct, indirect or consequential loss that may arise as a result of sole reliance on the information herein. Competent professional advice should be sought when dealing with any contentious issue. Absa Consultants and Actuaries is a duly authorised financial services provider. 7