NMG Benefits 1 of 24 October 2010 Discovery Health 2011 Discovery Health changes for 2011: Please note that a full benefit comparison of all the Discovery Health plans for 2011 is included at the end of this letter (including contributions). Most likely plan choice for members who were on the KeyCare plans in 2010 KeyCare Plans 2011 KeyCare Core KeyCare Plus Plans structure in 2011 KeyCare Core Critical hospital care Planned hospital care Chronic medication Screening Benefit KeyFit or Vitality KeyCare Plus Critical hospital care Planned hospital care Chronic medication Screening Benefit Day-to-day benefits Trauma Benefit KeyFit or Vitality
Transcript
NMG Benefits 1 of 24 October 2010
Discovery Health 2011
Discovery Health changes for 2011:
Please note that a full benefit comparison of all the Discovery Health plans for 2011 is included
at the end of this letter (including contributions).
Most likely plan choice for members who were on the KeyCare plans in 2010
KeyCare Plans 2011
KeyCare Core
KeyCare Plus
Plans structure in 2011
KeyCare Core
Critical hospital care
Planned hospital care
Chronic medication
Screening Benefit
KeyFit or Vitality
KeyCare Plus
Critical hospital care
Planned hospital care
Chronic medication
Screening Benefit
Day-to-day benefits
Trauma Benefit
KeyFit or Vitality
NMG Benefits 2 of 24 October 2010
Plan details
Benefits KeyCare Plans
COVER The KeyCare Core and KeyCare Plus plans offer affordable
private health care through a selected national network of
private health care providers. The hospital benefit on both
plans offer 100% cover at the Discovery Health tariff (DH-
tariff) in a network of private hospitals.
DAY-TO-DAY BENEFITS
KeyCare Core
No benefit
KeyCare Plus
Members have access to Discovery Health’s comprehensive
network of private practitioners
No Medical Savings Account (MSA)
No Above Threshold Benefit (ATB)
Cover For specialist visits with a referral from a network GP
and an authorisation number.
Specialist limit of R2,100 per person per year
OVERALL ANNUAL LIMIT No limit
IN-HOSPITAL COVER KeyCare Core and KeyCare Plus:
100% of the DH-tariff
NMG Benefits 3 of 24 October 2010
Benefits KeyCare Plans
HOSPITALISATION
Pre-authorisation required
[at least 48 hours prior to
admission]
Paid from Hospital Benefit
LIMITS
Limits on Mental Health benefit and HIV/AIDS
Mental health benefit
Annual limit of 21 days per person on both plans
Sub-limit per person for alcohol and drug rehabilitation on
both plans
HIV/AIDS and AIDS related:
Unlimited if registered with the HIV/AIDS Management
programme
R12,000 per family if not registered with the HIV/AIDS
Management programme
EMERGENCY HOSPITALISATION
Any private hospital until stabilised, will then be transferred
to a network hospital (child birth included).
PLANNED HOSPITALISATION
Only in a network hospital Subject to approval.
Elective caesarean section not covered
TRAUMA BENEFIT Cover for day-to-day medical expenses incurred in the
same year as specified catastrophic event. Only KeyCare
Plus
INTERNAL MEDICAL
APPLIANCES
No Benefit
PRIVATE NURSING No benefit
AMBULANCE AND EMERGENCY
TRANSPORT
Limited to approval by
International SOS
Paid from Hospital Benefit
No limit
ORGAN TRANSPLANTS
Pre-authorisation required
Only covered in a State hospital
DIALYSIS
Pre-authorisation required
Only covered in a State hospital
NMG Benefits 4 of 24 October 2010
Benefits KeyCare Plans
BLOOD TRANSFUSION Only if part of an emergency operation
RADIOTHERAPY AND
CHEMOTHERAPY
Pre-authorisation required
Only covered if treated by an Oncology network
practitioner
Limited to approval of Oncology treatment plan
RADIOLOGY AND PATHOLOGY
In-hospital
Paid from Hospital Benefit
No limit
Day-to-day
Core
No benefit
Plus
Only basic x-rays and blood test on referral from network
GP.
Specialist benefit of R2,100 per person for all services
rendered by a specialist in a network hospital, subject to a
referral from a network GP and authorisation
MRI and CT SCANS
Pre-authorisation required
In-hospital
Paid from Hospital Benefit
Only if related to emergency operation.
Day-to-day
Limited to the specialist benefit limit of R2,100.
SCREENING BENEFIT Certain screening tests to be covered from Hospital Benefit
OVER THE COUNTER
MEDICATION SCHEDULE 0, 1 &
2 (even when prescribed)
No benefit
NMG Benefits 5 of 24 October 2010
Benefits KeyCare Plans
CHRONIC MEDICATION
Limited to registration with
scheme via Chronic Illness
Benefit (CIB)
Core
100% of cost from formulary or list from network provider. No
limit
Limited to registration with scheme via Chronic Illness Benefit
(CIB)
Plus
100% of cost from formulary or list from network provider. No
limit
Limited to registration with scheme via Chronic Illness Benefit
(CIB)
ACUTE MEDICATION
Preferred Provider: Medikredit
Pharmacies
Core
No benefit
Plus
100% of cost for medication on formulary or list from network
provider
OPTICAL BENEFIT Core
No benefit
Plus
One test and one pair of white mono- or bifocal glasses with
basic frame or standard contact lenses per person every
two years only at an optometrist within the KeyCare
optometry network.
SCOPES
The following procedures will be covered if done in a
KeyCare day clinic:
Colonoscopy
Gastroscopy
Sigmoidoscopy
Proctoscopy
Adenoidectomy
Myringotomy
Tonsillectomy
Cytourethroscopy
Prostate biopsy
Vasectomy
DENTAL BENEFIT Core
No benefit
Plus
Only basic dentistry covered at a network practitioner
EXTERNAL MEDICAL
APPLIANCES
Covered if part of a hospital procedure.
R3,500 per family for day-to-day appliances through a
network.
NMG Benefits 6 of 24 October 2010
Most important changes
Headline increase of 7.9%
Dentistry benefit
The single limit for dentistry no longer applies to the Comprehensive and Priority options –
Professional and facility fees for both in-and out-of-hospital are no longer subject to an overall
limit.
Related accounts (professional fees) for in-hospital dentistry will be paid from the hospital
benefit at 100% of the Discovery Health rate on Comprehensive and Priority plans – These
accounts are no longer paid from the Medical Savings Account.
The R1,975 co-payment on in-hospital dentistry will fall away and will be replaced as follows:
� R3,000 deductible for dental admissions to a normal hospital
� R2,000 deductible for dental admissions to a day-care facility.
Children under the age of 13 years will have a R1,200 deductible in hospital and a R600
deductible for day-care facilities.
There will be no deductible applicable to severe dental admissions – examples include but are
not limited to: cancer related surgery, severe trauma related surgery, cleft palate surgery.
Dental devices, appliances and orthodontics (including orthognathic surgery) will be subject
to the following limits and will be paid from the day-to-day benefits:
� R16,000 per person per year on the Comprehensive plans and R10,000 on the Priority
plans.
Benefit limits and Thresholds
Benefit limits have increased by 7.9% and Threshold levels have increased by between 7% -
10%.
Discovery Med-Xpress
This benefit allows members to contact Discovery directly to get their medication delivered to
an address of their choice. This will include monthly chronic medication orders and same-day
orders for acute medicine prescriptions.
* This benefit will be rolled out in the first quarter of 2011
NMG Benefits 7 of 24 October 2010
Oncology Care Programme
Provides additional support to members who are newly diagnosed or are living with cancer.
This benefit will include an Oncology and Medical Liaison Manager to assist the member and
their families.
Chronic Dialysis network arrangement
National Renal Care (NRC) will be the designated service provider for patients receiving
chronic dialysis on the Priority, Saver and Core plans. Newly diagnosed members who do not
utilise the NRC network will be liable for out-of-network penalties.
Integrated Care Unit
This programme will provide members who have extensive medical needs, with a holistic
treatment from a team of medical experts, care coordinators and community-based
providers. Members will receive treatment from the time they are admitted into an intensive
care unit, through discharge following rehabilitation, and into the community.
Supplementary Cancer Protector
This is a separate life policy which provides monthly expense cover, care co-ordination and a
medical savings boost in the event of any member being diagnosed with cancer, as well as a
medical scheme premium waiver benefit.
KeyFit
This benefit replaces the KeyFit offering and now offers members access to the HealthyFood™
benefit where they can receive up to 15% discount at Pick ‘n Pay stores.
45 Virgin Active gyms have been made accessible to KeyFit members for a once-off
activation fee of R295 with a 67% saving on the monthly gym fee. Adults and children over the
age of 18 years will save 50% on the monthly gym fee. Members have the option of
enhancing their KeyFit benefits by doing the Vitality Checks.
Vitality
Emirates has been introduced as a new international travel partner in addition to British
Airways.
NMG Benefits 8 of 24 October 2010
Information sessions
We would strongly advise members attend one of the information sessions.
Date Time
09h00 – 11h00 11h00 – 13h00 14h00 – 16h00
Monday
25 Oct 2010
Auditorium, JS Gericke
Library
Auditorium, JS Gericke
Library
Auditorium, JS
Gericke Library
Wednesday
27 Oct 2010
Auditorium, JS Gericke
Library
Pensioners
Auditorium, JS Gericke
Library
English
Auditorium, JS
Gericke Library
Thursday
28 Oct 2010
Auditorium, JS Gericke
Library
Auditorium, JS Gericke
Library
Auditorium, JS
Gericke Library
Friday
29 Oct 2010
Tygerberg Campus
Lecture Hall 8
Teaching Wing
Bellvillepark Campus
Room 103
Van Der Horst Building
Tuesday
2 Nov 2010
Auditorium, JS Gericke
Library
Pensioners
Auditorium, JS Gericke
Library
Auditorium, JS
Gericke Library
Plan changes for 2011
Members who wish to make a plan change for 2011, will be given the opportunity to make
these changes online via the Human Resources link on the University's website. Members will
be able to make these changes online from Monday 25 October 2010 to Tuesday 30
November 2010 at 14h30.
Members who do not have access to a computer and/or the website, have to contact the
Human Resources Customer Services Desk for assistance.
HOW TO CHANGE YOUR PLAN FOR 2011 ON THE WEBSITE
- Visit the US webpage at http://www.sun.ac.za
- Click ‘For Personnel’
- Enter your ‘Username and Password’
- Choose ‘SUN-e-HR’
- Enter your ‘Username and Password’
- Click on ‘SUN Employee Self Service’
- At ‘External Links’ choose ‘Medical Aid Choice 2011’
- Click on “Choose Medical Aid for 01 Jan 2011”
- You will only be allowed to structure your medical scheme plan
NMG Benefits 9 of 24 October 2010
CHOOSE YOUR PLAN FOR 2011 NOW
- The option to choose your plan will be under Struktureringsvoordele / Structuring Benefits
- When clicking on the down arrow v all the plan options will appear. Click on your chosen
plan for 2011
- Choose Vitality or KeyFit or Vitality & KeyFit (both)
- Once you have made your choice, your 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 and e-mail confirming the plan
choice that you have made for 2011. If you do not receive an e-mail it means that your
plan choice has not been stored and package structuring and we then request that you
send an urgent e-mail to [email protected] confirming your plan choice for 2011.
The closing date for plan choices is 30 November 2010 and not any other date that you may
see on any of Discovery Health’s communications.
Enquiries
Should you have any queries regarding your plan choice for 2011, please contact Chantel
