Discovery Health Changes for 2015

The average increase for 2015 is 9.9%.

Various things affect the annual increase, such as healthcare costs increasing above inflation, technology and the increase in noncommunicable diseases such as heart disease. Discovery’s member claims data has shown that those who engage in Vitality are healthier, or fall into their lower claiming group. They are thus concentrating on Vitality again this year, and particularly on exercising and engaging in the various lifestyle programs.

The year-end review timing:

06 October: Employer briefing and training sessions start
07 October: Discovery will start employer and member communications
15 December: Last date to submit changes for 2015

Major changes in 2015

MedXPress - Designated Service Provider for Chronic medication:
From 1st July 2015 for existing members and 1st January 2015 for new members, MedXPress will be the designated service provider (DSP) for Chronic and PMB medication on the Classic Core, Essential Core and Coastal Core plans. It is already the DSP for all Delta plans. If you are on one of these plans and choose another provider, there will be a 20% co-payment. From 2015 if you don’t want a delivery to your home or work, you can also select an in-store delivery to Clicks or Dis-Chem.

Annual Contribution Increases:
The Executive plan increased at 10.9% and all other plans at 9.9%. The effective increase for some members on KeyCare plans will be less than 9.9% due to the income band changes.

Threshold and Limit Increases:
Annual Thresholds for Comprehensive plans increased at 10.9% and all other plans increased at the same rate as the contribution increases. The oncology threshold remains unchanged. The internal prosthesis limit increased in line with surgical inflation. Co-Payments and Deductibles increased at the same rate as the contribution increases.

KeyCare Income Bands:
KeyCare Plus had three income bands in 2014 and a lower one has been introduced in 2015, being R0 to R360. The income band of R6651 -R8800 in 2014 has been widened to R7051-R10,000 in 2015 resulting in some members now moving from the highest band into the second highest.

Changed Benefits:
Chronicare and MedSaver combined within the new HealthyCare benefits available to all members.

New Benefits:
  • Certain fitness devices funded from day-to-day benefits
  • Virtual doctor consultations via the Discovery App
  • Discovery HomeCare: nursing and care in your own home
  • International second opinions available through Cleveland Clinic
  • Discovery PrimaryCare add on for large employer groups, enhancing day-to-day benefits for employees

Personal Health Programs 2015

Members registered on the Chronic Illness Benefit for diabetes, hypertension, hyperlipidaemia and ischaemic heart conditions will be able to enrol in personal health programs, giving their GP access to what they are doing. This includes not only managing medication, but also eating habits and exercise. This is available from the third week of January 2015.

The member can be enrolled by their GP (if on Discovery’s Premier Practice network) or they can enrol themselves. Information is shared with their treating doctor via HealthID. The member gets a complete program to manage and monitor their condition, including alerts for medication or consultations. Discovery will also offer access to wellness networks, paid from risk benefits, not Savings. They will also earn Vitality points if on Vitality.

Premier Practice doctors can recommend interventions, view health details such as fitness, weight, activity, nutrition, and will receive a monthly capitated benefit for monitoring the progress of the member.

Discovery On Call 2015

When you need to chat to your doctor, but don’t need a physical examination, you can use Discovery Health On Call through the Discovery mobile app. The Discovery app will have an On Call option to select, you choose your doctor, view his/her availability and book a virtual consultation just like you would book an appointment. If your doctor is not available, you will also have access to Discovery Health doctors 24/7. You will get a reminder on your phone before your consultation, to make sure you are in a Wifi zone. The doctor calls (video and audio through the app) and you have your consultation. Discovery is automatically billed so you do not need to submit the claim manually.

The booking service can also be used to book a consultation at your doctor’s rooms, if their calendar system is linked to Discovery’s.

Discovery On Call 2015

When you need to chat to your doctor, but don’t need a physical examination, you can use Discovery Health On Call through the Discovery mobile app. The Discovery app will have an On Call option to select, you choose your doctor, view his/her availability and book a virtual consultation just like you would book an appointment. If your doctor is not available, you will also have access to Discovery Health doctors 24/7. You will get a reminder on your phone before your consultation, to make sure you are in a Wifi zone. The doctor calls (video and audio through the app) and you have your consultation. Discovery is automatically billed so you do not need to submit the claim manually.

The booking service can also be used to book a consultation at your doctor’s rooms, if their calendar system is linked to Discovery’s.

HealthyCare for all members 2015

The Chronicare and MedSaver benefits have been combined under HealthyCare in 2015, and will be available at Clicks and Dis-Chem pharmacies. All members will receive up to 10% cash back on the relevant items. If you are a Vitality member, you can increase this to 15% with a Vitality Age assessment and 25% with a Vitality Health Check. You need to activate this benefit to start using it.

The HealthyCare products include baby care, products to stop smoking, self care, clinical services, dental care, emergency care, sun care, fitness and wellbeing, and foot care. The full catalogue is available on the Discovery website and products are also marked in the stores.

Discovery HomeCare 2015

Discovery HomeCare is designed to make members’ lives a little easier. Nursing and other care will be provided at home. The benefit will be available in Gauteng first in 2015, with other areas to be added later. The type of care offered, includes:

  • post-natal care
  • Palliative care in partnership with Hospice
  • Home IV infusions of antimicrobials, biologics, IV iron and immunoglobulins
  • Wound care of venous ulcers, diabetic foot ulcers, pressure sores, and other moderate to severe wounds
  • Respite care - short term care services that offer temporary relief for caregivers

The benefits are for stable patients only, and post-natal care is for mothers and babies who are discharged from hospital early. Payment for respite care is for the member’s own pocket, as this is not covered by Discovery.

2015 Medical Scheme Contribution Rates

2015 Annual Savings Account

2015 Thresholds

Executive and Comprehensive Plans:

Priority Plans:

2015 Vitality and KeyFit Contribution Rates

Members on any plan may join Vitality. Members on KeyCare plans may join KeyFit.

Members on any plan wanting Vitality and also wanting the funeral benefits included in KeyFit, can join both Vitality and KeyFit at the combined rate. The funeral cover is available to members where the principal member is age 64 or younger at inception.

2015 KeyFit

The KeyFit benefits are unchanged for 2015, and include:

  • Up to 10% cash back on HealthyFood items at Pick n Pay, HealthyCare products at Clicks and HealthyGear products at Total Sports. This is increased to 15% with a Vitality Health Check.
  • Access to certain Virgin Active gyms at a discount of 65%, with a once-off joining fee. Adult and Child dependants are discounted at 50%.
  • R10,000 funeral cover for member and three spouses, R5,000 cover for up to 5 children. This is increased to R15,000 and R7,500 after completing a Vitality Health Check.
  • 5% discount on prepaid airtime with Cell C, Vodacom, MTN and Telkom
  • Vitality baby for all expectant mothers, including information, baby products and discount vouchers
  • Access to fitness, nutrition and health support online.

Vitality 2015

The points required for status levels are the same as previous years, and again there is no carry over of points.

  Blue Bronze Silver Gold
Single member start on this level 15,000 points 30,000 points 45,000 points
Member + 1 start on this level 30,000 points 60,000 points 0,000 points
Member + 2 or more start on this level 40,000 points 80,000 points 120,000 points

For each additional member aged 18 years or older, add 10,000 for Bronze, 20,000 for Silver and 30,000 for Gold. To reach Diamond status you need to qualify on Gold Status for three consecutive years.

 

Vitality LiveWell programmes

The LiveWell programs are up and running, from September 2014. Go to Vitality and select LiveWell Programs. The programs offered to you are based on your Vitality Age assessment, and your Vitality Check if you have completed one. These would help Vitality determine which programs are best suited to you, and what points to give you for completing the programs. The points will differ depending on the need for change. For example if you have 10kgs to lose, you may earn less points for completing the Lose Weight program than someone who has 40kgs to lose.

You will earn points for actions completed prior to joining the program. For example if one of the actions required on the program is to have a Vitality Check and you have done this already, the system will pick this up and award your points immediately.

The program is designed to suite you. If one of the actions required is exercise, you will be asked how you prefer to exercise - in a gym, outdoors or at times events. The system will then make suggestions of who to contact to arrange your preference.

You don’t have to complete everything to earn points. You are awarded points as you complete the suggested actions, so the number of points you earn over the designated period depends on the number of actions you complete.

2015 HealthyLiving Benefits

The HealthyLiving benefit partners for 2015 are Pick n Pay and Woolworths for HealthyFood, Clicks and Dis- Chem for HealthyCare and Totalsports and Sportsmans Warehouse for HealthyGear.

All members earn an immediate 10% cash back at these partners when you activate your membership.

Vitality members can increase their cash back by taking the following action:
  • HealthyFood: Increase to 15% at your preferred partner when completing an online nutrition assessment and to 25% when completing a body composition assessment.
  • HealthyCare: Increase to 15% when you complete your online Vitality Age assessment and 25% when you complete a Vitality Check at Clicks or Dis-Chem.
  • HealthyGear: Increase to 15% when you complete an online Fitness Assessment and 25% when you complete a Vitality Fitness Assessment with a participating biokineticist.

If you have a DiscoveryCard credit card, and you have activated Discovery Miles, then your Discovery Miles will be increased when you shop at these partners, depending on your Vitality Status. You earn one Discovery Mile per R15 spent on your card. Those on Bronze will earn double Miles, Silver 3x, Gold 5x and Diamond 10x.

2015 Vitality Fitness

There are more fitness benefits in 2015, with Vitality focusing on increasing activity. You earn 150 points per day for fitness sessions. Team Vitality and Vitality Fit are new benefits and you can now earn cash back for devices.

Team Vitality: Activate and get up to 50% off a selection of running and cycling race events. Activation costs R300 per year for running and R600 for cycling, which includes annual licence fees. You will get vouchers for kit and devices, and can earn up to 5000 points per event.

Vitality Fit: In 2015 you will be able to get up to 25% cash back on your Adventure Boot Camp, CrossFit and Sweat 1000 costs. You need to activate this benefit for R300.

Vitality Gym: Discounts of up to 80% of fees for Virgin Active, Planet Fitness and Run/Walk for Life.

Health and Fitness Devices: Earn up to 25% cash back on selected devices at Clicks and Dis-Chem through HealthyCare, and claim R750 from your day-to-day benefits. Earn points by linking the devices to Vitality. These include Adidas, micoach, Magellan, Polar, Timex, tomtom, Jawbone, Suuntu, Nike+, fitbug, fitbit, Garmin.

Other facilities: Earn points at Curves (with reduced rates), Handicaps Network Africa, Outdoor Sporting Events (timed events), parkrun, and log your workout on an iPad station at other facilities.

2015 DiscoveryCard

The SmartShopper multiplier will fall away in 2015 and be replaced by the Miles Multiplier at HealthyLiving partners.

You will still earn up to 20% cash back at partner stores. Builders Warehouse will not be a partner store in 2015. You can increase your savings up to 50% on holiday accommodation, depending on your Vitality Status.


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