Update for Discovery Health for 2017
(as per information from the Discovery Health launch)
New Smart Plan (the Essential Smart Plan)
Introduction of DiabetesCare.
Contribution increases, from 7.8% to 14.9% (dependant on plan type)… Overall weighted increase in gross contributions of 10.2%
Background on Discovery Health for 2017
Healthy, sustained growth:
Discovery Health continues to increase it’s share of the open medical scheme membership year on year. Now, at 54% market share (of all open schemes); covering 2.7 million lives, with an average age of 33.9 years.
Exceptional Financial Security:
Meets the regulatory requirements for medical schemes. Highest possible credit rating by Global Credit Rating. 25.98% solvency; R12.9 bn in reserves and AA+ GCR credit rating.
Most comprehensive cover:
Discovery Health offers higher levels of cover than the next 9 largest open medical schemes. The difference in this cover ratio is equivalent to an additional R1.1 bn in claims paid in 2015.
Discovery Health offers the lowest contributions in each plan segment, and is on average 15% more affordable in comparison to the next nine largest open medical schemes.
Focus of Discovery Health Medical Scheme for 2017.
(8 out of 10 Discovery Health members, will experience a single digit contribution increase for 2017).
Increasing contributions equitably across its membership base, without compromising on benefits.
Medical Inflation increases higher than CPI year on year. Over the period 2008 to 2015, medical inflation was on average 3.1% above CPI. Medical inflation is unique to each plan type… this is as a result of usage within specific plan types. I do not want to bore you with the details (you can read more about this on Discovery’s ediscover- ask me and I will send to you). However, medical inflation is expected to be between 10% and 20% for 2017.
Discovery Health Medical Scheme 2017 contribution increases:
- Plans excluding Comprehensive, Executive and Coastal= 9.9%
- Comprehensive and Executive plans= 11.9%
- Coastal Saver and Coastal Core= 7.8% (Coastal Saver- MSA reduced to 25% of risk contributions, 2016 25% MSA), Coastal Core = 14.9% (significantly increased hospital submission rates due to availability of new hospital bed rates).
Contribution increase per plan type (2017):- DH contributions_2017 (to download 2017 contribution table)
Executive plans: 11.9%
Comprehensive plans: 11.9%
Priority plans: 9.9%
Saver plans: 9.9%
Coastal Saver: 7.8% (MSA reduction to 20% of risk premiums)
Smart plan: 9.9%
Coastal Core: 14.9%
Expanding the Smart Series plans to enable a lower price point through the effective use of networks, digital tools and health informatics:
Market response on the launch of last years Smart Plan has been extremely positive. This plan has attracted younger healthier members. Therefore, there are benefit enhancements to the Smart plan for 2017. (the original Smart plan is now known as the Classic Smart plan). Including:
- enhanced acute medicine benefit (cover has been enhanced to cover over 80% of acute medicines, of what doctors currently prescribe for Smart plan members).
- dental check up (added- one dental check up per year, with a R100 payment for the check up).
- Eye test (added-one eye test per year at any Mellins optometrist with R50 payment per test).
- Sports Injury Benefit ( basket of benefits offered for sports- related injuries, when referred by a Smart Network GP- includes basic x-rays; two specialist visits; a total of four visits to either a physiotherapist, biokineticist or chiropractor)- With a R100 payment for each visit.
- Expansion of the Smart provider and hospital network – GP network has doubled in size in 2016 and a new hospital has been added to the network for 2017 (Pretoria East).
Discovery Health have also launched the Essential Smart Plan for 2017. This plan is the most affordable plan in the open scheme market for individuals wanting affordable hospital cover, with unlimited GP visits. (download the 2017 Smart Plan member guide here): member_guide_2017-smart-plan
Providing new benefits and tools to enable members and doctors to more effectively manage chronic conditions, starting with Diabetes.
Diabetes is one of the fastest growing lifestyle diseases. Early detection and proper management is critical.
Therefore, Discovery Health have launched DiabetesCare– this is a programme designed to achieve well coordinated care, and to provide the information and motivation that members need to manage their condition.
The DiabetesCare programme has 4 key elements:
- Access to the best GP network to coordinate care. (the Premier Plus GP network).
- Additional Funding for allied healthcare services (you need to register on programme to unlock an additional visit to a biokenticist and a dietician).
- Incentives to motivate a journey to better heath (the usage of Vitality).
- Access to real-time, clinically verified data on their condition. (monthly progess dashboard).
Enhancing the quality of care that members can access by expanding the Discovery Health networks.
- Creation of Centres of Excellence–
- Major Joints network. Aimed at best care for major joint replacements.
- In- hospital Pyschiatry network– aimed at improving in- hospital psychiatric care.
- Enhanced individualised approach to the Screening Benefit– enhanced screening benefits for members that are at-risk.
- The Keycare hospital network, is going to be extended into a two tier network (full cover network and a partial cover network).- If you are a Keycare member make sure you understand this!!!!
- Keycare- members with multiple chronic conditions will be contacted to join a Care Coordination programme- if you do not register- you will be exposed to a 20% co- payment for all voluntary non- emergency admissions. If you are a Keycare member, make sure that you understand this!!!!!
If you have any questions regards the 2017 changes… make sure to contact your broker, or the scheme.