DISCOVERER THE This brochure is intended for financial advisers only, and is presented by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider, which is the administrator of the Discovery Health Medical Scheme, in terms of its contractual arrangements. This brochure is only a summary of the key benefits and features of the Discovery Health Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. For detailed information on all Discovery Health Medical Scheme plan options, please visit www.discovery.co.za for access to plan brochures as well as a full copy of the proposed 2017 Scheme Rules. Vitality is not part of the Discovery Health Medical Scheme. Discovery PrimaryCare is administered by Prime Med Administrators (Pty) Ltd, registration number 2011/001667/07, wholly owned by Discovery Health (Pty) Ltd, an authorised financial services provider. Discovery Gap Cover and Discovery Supplementary Gap Cover are insurance products. This is not a medical scheme and the cover is not the same as that of a medical scheme. These policies are not a substitute for medical scheme membership. Discovery Gap Cover is a short-term insurance policy, underwritten by Discovery Insure Ltd, registration number 2009/011882/06, an authorised financial services provider. Discovery Supplementary Gap Cover is a long-term insurance policy, underwritten by Discovery Life Ltd, a registered long-term insurer and an authorised financial services provider, registration number 1966/003901/06. This is a separate long-term insurance product and is not conditional on the purchase of the short-term insurance Discovery Gap Cover product. Product rules, terms and conditions apply. Discovery Limited. Subsidiaries of Discovery Limited are authorised financial services providers. Vitality is a separate product sold and administered by Discovery Vitality (Pty) Ltd. Registration number 1999/007736/07, an authorised financial services provider. Enhancing benefits, without compromising affordability Discovery Health continues to invest extensively in building a better healthcare system, centred on the needs of members. This has resulted in a sophisticated platform for the administration and management of medical schemes and healthcare products. This platform offers a comprehensive suite of healthcare professional networks, patient-management programmes, proprietary digital healthcare technology and state-of-the-art service capabilities, all focused on the Discovery core purpose of making people healthier and enhancing and protecting their lives. Discovery Health Medical Scheme leverages this platform to provide members with quality healthcare and peace of mind: • Industry-leading financial stability, with more than R14 billion in member reserves • The most comprehensive plan range available in the market, with 23 plans to match members’ unique healthcare needs • Contributions that are on average 15.1% below the market average • Cover ratios in excess of 96% throughout the plan range • Member service channels that are consistently rated 8.9 / 10 by members, with 81% of queries resolved on the first interaction, far above industry benchmarks The strength of this platform also allows members to benefit from a series of enhancements in 2018, without compromising affordability. LAUNCH S E P T • Enhanced emergency healthcare services for a broad range of traumatic events • Access to the PrimaryCare Wellness Experience • Access to Vitality Move PrimaryCare 10 • Introduction of HealthyCompany Care, a proactive, relevant employee assistance programme with a fully-integrated mobile app Discovery for Corporates 08 • Comprehensive, risk-funded maternity and post-birth benefits • Dedicated support on the Discovery app Young Families 06 • Enhancements to the Discovery app that enable seamless access to high quality medical information from doctors, as well as chat and virtual consultations Digital Health Technology 05 • Enhanced Global Treatment Platform to access medical treatment outside South Africa • Access to Vitality Purple Executive Plan 04 • Weighted average contribution increase of 7.9% for 2018 • Plan-specific increases range between 7.3% and 8.3% Contributions 02 • Introduction of Discovery Gap Core providing cover for in-hospital shortfalls and cancer-related claims, from as little as R90 per month 11 Discovery Gap Cover Enhancements for 2018 KeyCare Core Smart Saver Priority Comprehensive Executive Healthcare delivery networks Digital healthcare technology Tracking and engagement Clinical care and coordination Service Clinical and actuarial data analytics
Transcript
DISCOVERERTH
E
This brochure is intended for financial advisers only, and is presented by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider, which is the administrator of the Discovery Health Medical Scheme, in terms of its contractual arrangements. This brochure is only a summary of the key benefits and features of the Discovery Health Medical Scheme plans, awaiting formal approval from the Council for Medical Schemes. For detailed information on all Discovery Health Medical Scheme plan options, please visit www.discovery.co.za for access to plan brochures as well as a full copy of the proposed 2017 Scheme Rules. Vitality is not part of the Discovery Health Medical Scheme. Discovery PrimaryCare is administered by Prime Med Administrators (Pty) Ltd, registration number 2011/001667/07, wholly owned by Discovery Health (Pty) Ltd, an authorised financial services provider. Discovery Gap Cover and Discovery Supplementary Gap Cover are insurance products. This is not a medical scheme and the cover is not the same as that of a medical scheme. These policies are not a substitute for medical scheme membership. Discovery Gap Cover is a short-term insurance policy, underwritten by Discovery Insure Ltd, registration number 2009/011882/06, an authorised financial services provider. Discovery Supplementary Gap Cover is a long-term insurance policy, underwritten by Discovery Life Ltd, a registered long-term insurer and an authorised financial services provider, registration number 1966/003901/06. This is a separate long-term insurance product and is not conditional on the purchase of the short-term insurance Discovery Gap Cover product. Product rules, terms and conditions apply. Discovery Limited. Subsidiaries of Discovery Limited are authorised financial services providers. Vitality is a separate product sold and administered by Discovery Vitality (Pty) Ltd. Registration number 1999/007736/07, an authorised financial services provider.
Enhancing benefits, without compromising affordability
Discovery Health continues to invest extensively in building a better healthcare system, centred on the needs of members. This has resulted in a sophisticated platform for the administration and management of medical schemes and healthcare products. This platform offers a comprehensive suite of healthcare professional networks, patient-management programmes, proprietary digital healthcare technology and state-of-the-art service capabilities, all focused on the Discovery core purpose of making people healthier and enhancing and protecting their lives.
Discovery Health Medical Scheme leverages this platform to provide members with quality healthcare and peace of mind:
• Industry-leading financial stability, with more than R14 billion in member reserves
• The most comprehensive plan range available in the market, with 23 plans to match members’ unique healthcare needs
• Contributions that are on average 15.1% below the market average
• Cover ratios in excess of 96% throughout the plan range
• Member service channels that are consistently rated 8.9 / 10 by members, with 81% of queries resolved on the first interaction, far above industry benchmarks
The strength of this platform also allows members to benefit from a series of enhancements in 2018, without compromising affordability.
L A U N C HS E P T
• Enhanced emergency healthcare services for a broad range of traumatic events
• Access to the PrimaryCare Wellness Experience
• Access to Vitality Move
PrimaryCare 10
• Introduction of HealthyCompany Care, a proactive, relevant employee assistance programme with a fully-integrated mobile app
Discovery for Corporates 08
• Comprehensive, risk-funded maternity and post-birth benefits
• Dedicated support on the Discovery app
Young Families 06
• Enhancements to the Discovery app that enable seamless access to high quality medical information from doctors, as well as chat and virtual consultations
Digital Health Technology 05
• Enhanced Global Treatment Platform to access medical treatment outside South Africa
• Access to Vitality Purple
Executive Plan 04
• Weighted average contribution increase of 7.9% for 2018
• Plan-specific increases range between 7.3% and 8.3%
Contributions 02
• Introduction of Discovery Gap Core providing cover for in-hospital shortfalls and cancer-related claims, from as little as R90 per month
The performance of a medical scheme should consider the quality of the healthcare and service that members experience, while the sustainability of the experience is measured by the growth and financial performance of the medical scheme. In the case of the Discovery Health Medical Scheme, there is a focus on constantly improving both the healthcare and service experience, despite already exceeding industry benchmarks. The growth of the Scheme has been positive every year since inception, and the Scheme is currently in the strongest financial position in its history.
Discovery Health Medical Scheme performance
The quality of service that Discovery Health Medical Scheme provides to members and their advisers is critical to the ongoing success of the Scheme, given the volume of service interactions experienced on a daily basis.
Discovery Health continuously invests and innovates in service initiatives that are relevant and meaningful to members, resulting in world-class service levels.
0201
03 04
Discovery Health works to improve the cover for and quality of healthcare available to members of Discovery Health Medical Scheme. Increasing use of HealthID is benefiting both members and their doctors by informing consultations with relevant, clinical information. Discovery Health Medical Scheme covers R96.50 of every R100 claimed from the Scheme for hospital admissions, while hospital rating tools lead to demonstrable improvements in the members’ hospital admission experience.
Since 2006, Discovery Health Medical Scheme has added more than 800,000 beneficiaries to its membership, growing its open medical scheme market share from 36.9% to 55.3%
In 2016, the Scheme produced an operating surplus, while 7 of the next 9 largest open medical schemes produced an operating deficit. The sustained surplus of Discovery Health Medical Scheme in recent years has increased the reserve and solvency levels, ensuring long term financial stability of the Scheme for the benefit of members.
Comprehensive levels of coverIn-hospital claims cover ratio*
Improving patient experience through hospital rating tools
Patient Satisfaction Score (PaSS)**
** Discovery Health Medical Scheme members rating of their hospital admission experience
2010 2013 2014 2016
58%
56.40% 56%
59.30%
Started sharing results with
hospitals
Started sharing results publically
* Cover ratio = Claims paid / Claims received
201696.5%
51%GP visits
4,300Doctor users
+1.3 million Member consents
6 906 000 General Practitioner visits in 2016
703 000 Hospital admissions in 2016
Leading service metrics
Independent benchmarking: McKinsey service comparison 2016 Dimension Data’s Global Contact centre benchmarking
Discovery Health Medical Scheme 2016
First Call Resolution Member Based
Research Survey
73%
81%80%
89%
Discovery Health Medical Scheme membership growth 2006 - 2016
Open medical scheme market share
2016
2006
55.3%
36.9%
Beneficiaries covered (millions)
2006 2016
1.88
+800 0002.71
R1.3bn Net surplus 2016 Operating surplus (including investment returns)
R14.2bn Member reserves Reserves available to cover unexpected claims costs, as at 31 December 2016
AA+ Credit rating
Highest credit rating that can be afforded to a medical scheme in South Africa
26.3% Solvency ratio
Member reserves as a proportion of gross contributions exceed 25% statutory minimum
A day in the life of the Scheme
Calls handled
36 600
Claims processed
250 900
Discovery app logins
87 000
LOG IN
Social media conversations
115
Healthcare cover and experience
Healthy, sustained growth Financial stability
Member service
PG 2
HEALTH DISCOVERER
Lower than average contribution increases maintained in 2018
2018 Contribution increases
The 2018 contributions reinforce the competitive advantage that the Discovery Health Medical Scheme has built over time through contribution increases that have been consistently lower than competitors. This advantage is illustrated through the Discovery Health Medical Scheme inflation differential, shown below
The significant financial strength of the Discovery Health Medical Scheme provides a foundation to maintain and enhance benefits for 2018, whilst offering contribution increases that are expected to be well below the industry average.
The contribution increases for 2018 are linked to medical inflation.
Over the 12-month period of August 2016 to July 2017, average CPI was 5.9%. This suggests that the average medical inflation over this period was 8.9%, if CPI + 3% is used as an indication of medical inflation.
In comparison, the weighted average contribution increase for Discovery Health Medical Scheme is 7.9% for 2018.
For each plan, explicit allowance has been made for the differences in demand-side and supply-side driven inflation factors, as well as the expected impact of plan- specific benefit changes. This results in the following plan-specific contribution increases for 2018:
Medical inflation is driven by CPI and three other factors unique to healthcareTariff inflation, which is correlated with CPI, and reflects increases in the price of healthcare services01
Demand-side factors that reflect an ageing demographic, adverse selection and increased burden of disease02
Supply-side factors due to advances in medical technology and procedures, opening of new facilities and fragmentation of care03
Drivers of claims inflation for Discovery Health Medical Scheme 2006-2017
6.1%
11.3%
2.8%
1.8%
0.5%
TariffsCPI Demand-side utilisation
Supply-side utilisation
Medical inflation
2018 contribution increases are linked to medical inflation
Contribution increases by plan
8.9% average CPI+3%
Aug 2016 – Jul 2017
% of total membership
7.9%weighted average
increase in gross
contributions
Jul 2
016
4.6%
Jun
2016
5.1%5.4%
May
201
6
5.3%
Apr
2016
6.1%
Mar
201
6
6.3%
Feb
2016
6.6%
Jan
2016
6.8%
Dec
201
6
6.6%
Nov
201
6
6.4%
Oct
201
6
Sep
2016
6.1%
Aug
2016
5.5%
19%13%2%8%1% 12% 45%
Exec
utiv
e
7.3%
Com
preh
ensi
ve
8.3%
Prio
rity
8.3%
KeyC
are
8.3%
Save
r
7.6%Co
re7.6%
Smar
t
7.3%
5.9% average CPI Aug 2016 - Jul 2017
(CPI+3% medical inflation range)
0%
10%
Discovery Health Medical Scheme actual
Next 7 largest open schemes actual
3 PG
2017
Executive Plan EnhancementsThe Executive Plan currently offers more than 23 000 members the most comprehensive benefits in the Discovery Health Medical Scheme, at a contribution that is 28% lower than that of comparable plans in the market. The extensive benefits of the Executive Plan provide members with absolute peace of mind that the healthcare needs of their families, regardless of their current state of health, are comprehensively catered for. In 2018, the Executive Plan will offer enhanced benefits for treatment overseas and restructured day-to-day and in-hospital benefits.
03
01
02
Executive Plan A Global Treatment PlatformThe Global Treatment Platform offers members access to medical treatment outside South Africa.
International Second Opinion ServicesMembers and their treating specialist can access a second opinion for life-threatening and life-changing conditions from world-leading clinical experts at the Cleveland Clinic, funded in full by the Executive Plan.
Overseas Treatment BenefitExecutive Plan members can access advanced medical care outside South Africa. Members have R750 000 to cover the cost of medical treatment not available in South Africa. Members also have R300 000 to cover the cost of voluntary in-hospital medical treatment outside South Africa.
Both these benefits are subject to Scheme guidelines and managed care protocols, and a 20% co-payment.
International Travel BenefitIn 2018, Executive Plan members will have US$ 1 million per member to cover the cost of medical emergencies while traveling outside SA.
In 2018, the Executive Plan will offer members cover for day-to-day healthcare expenses through the following benefit structure:
• A Medical Savings Account, equal to 25% of annual contributions
• Once the MSA has been exhausted, members can self–fund through the Self–payment Gap. The Day–to–day Extender Benefit will cover a defined list of healthcare services during this Self–payment Gap
• An unlimited Above Threshold Benefit
Currently, day-to-day benefits cover the cost of in-hospital treatment by healthcare professionals. In 2018, these costs will be covered by the Hospital Benefit, and the Medical Savings Account will be exclusively for out-of-hospital medical expenses.
In-hospital treatment by specialists
In-hospital treatment by other healthcare professionals
In-hospital dental treatment
Out-of-hospital dental treatment
Paid from the Hospital Benefit, up to 300% of the Discovery Health Rate.
Paid from the Hospital Benefit, up to 200% of the Discovery Health Rate.
No overall annual limit. Paid from the Hospital Benefit, with an upfront deductible and a limit of R26 200 per person per year for dental appliances.
Paid from Day-to-day Benefits. A limit of R26 200 per person per year for dental appliances.
Over-the-counter medicine benefit on the Smart Plan
In 2018, 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
Day-to-day Extender Benefit
In 2018, once a member has spent their annual MSA allocation, the Day-to-day Extender Benefit will cover casualty visits for children under the age of 10 at a network facility, and GP consultations through HealthID-enabled GPs that meet the digital criteria in the Discovery GP network. Cover depends on selected plan. Cover for pathology, acute medicine and external medical items through the Day-to-day Extender Benefit will be discontinued.
Chronic Illness Benefit
Chronic Drug Amounts and Chronic Medicine formularies will remain unchanged for 2018.
Limits, co-payments, deductibles and income bands
• For 2018, 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 reduce for 2018
• 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 band thresholds are increased by 5.6%.
Premier Plus GP network as Designated Service Provider for HIVCare Programme
In 2018, the Premier Plus GP network will become the Designated Service Provider (DSP) for Priority, Saver, Smart, Core and KeyCare members registered on the HIVCare programme.
This change will be effective immediately for new members registering on the HIVCare programme from 1 January 2018, while the change will only be effective from 1 July 2018 for members already registered on the HIVCare programme.
2018 changes
Restructuring cover for day-to-day and in-hospital healthcare expenses
2018 Discovery Health Medical Scheme benefit updates
PG 4
HEALTH DISCOVERER
Introducing Discovery DrConnect
• When members have asked a question, the library of curated content will provide answers to commonly asked questions that have been answered by doctors
• If the answer is not immediately available, the question will be answered by available doctors
• Other doctors will be able to agree with the answers given or will provide additional information
• The highest rated answers to questions will be shown first, so members always have access to high quality peer-reviewed medical advice anywhere, anytime.
• If the member’s doctor is available for follow-up virtual consultations, these can be booked and conducted using the app
• Virtual follow-up consultations can only be conducted with a doctor that the member has visited in the past 12 months
• These consultations will be paid from the member’s available day-to- day benefits
• Members need to download the Discovery DrConnect app once and then the DrConnect funtionality will be available, and accessed directly from the Discovery app.
Get personalised doctor-created checklists
Subscribe to health goals to manage chronic
conditions, pregnancy and other wellness goals
Conduct virtual follow-up consultations with doctors using video,
voice or text
Access the DrConnect functionality through the Discovery app and www.discovery.co.za
Your clients will automatically be prompted to download the DrConnect app on their phone.
Ask a doctor a medical question anywhere, anytime.
5 billion doctor-created
medical answers
105 000doctors available worldwide to answer medical questions
174countries
Every year over a billion people turn to the internet to get information about their health and wellness. It is estimated that 1 in 20 of these searches are about health-related concerns but unfortunately, these searches yield the correct answer less than 34% of the time.
Discovery Health has partnered with HealthTap Inc. in Palo Alto, to provide DrConnect – a tailored offering for members of the Discovery Health Medical Scheme. The DrConnect functionality provides seamless access to high quality medical information from a worldwide network of doctors and facilitates personalised interactions between patients and their doctors.
Discovery DrConnect. Doctor Advice. On your device.
Discovery Health Medical Scheme members now have access to an extensive library of doctor-created and peer-reviewed healthcare content. The library provides a credible source of online medical information to members, including doctor-created personalised tips and checklists to help members meet their health goals. Members also have access to doctors worldwide to get medical advice at no additional cost.
Discovery Health has also integrated this technology into the clinical case management systems, facilitating personalised care pathways to optimise the management of members with specific chronic conditions, as well as for mothers during and after pregnancy. Members will be able to conduct virtual follow-up consultations through voice, video or text consultation with their doctors, paid from applicable day-to-day benefits.
5 PG
2017
Tailored offering to protect Young Families right from the startIn 2018, Discovery Health Medical Scheme members will have access to comprehensive maternity and post-birth risk benefits on all plans, supported by access to 24/7 support, advice and guidance through the My Pregnancy and My Baby programmes on the Discovery app.
Comprehensive maternity and post-birth benefits
Access to 24/7 clinical support, advice and guidance
My Pregnancy and My Baby app features
Antenatal classes or consultations with a nurse
Members have covered for up to five pre- or postnatal classes or consultations with a registered nurse
Private ward
Members have cover for up to R1 880 per day in a private ward for delivery in hospital on the Executive and Comprehensive plans
Blood tests
Cover for a defined list of routine blood tests
Antenatal consultations
Members are covered for up to 12 gynaecologist, GP or midwife visits, based on plan type selected
Essential registered devices
Executive and Comprehensive plans have cover for up to R5 000 for essential registered devices e.g. breast pumps and smart thermometers, with a co-payment of 25%
Ultrasound scans and prenatal screening
Members are covered for up to two 2D ultrasound scans and one Nuchal Translucency or Non-invasive Prenatal Test (NIPT) screening
Mental Health
Members are covered for up to two mental health consultations with a counsellor or psychologist
Six week consultation
Members are covered for one six week post-birth consultation with a midwife, GP or gynaecologist
Nutrition assessment
Members are covered for one assessment with a dietician
Lactation consultation
Members are covered for one lactation consultation with a registered nurse or lactation specialist
My Pregnancy dashboard
Track pregnancy milestones and access an array of tools and features personalised for each pregnancy.
Pregnancy health record
View all pregnancy related health information, in one place.
Maternity cost estimator
Get an estimate for the typical costs associated with pregnancy, based on plan type, delivery type and choice of doctor and hospital.
Pregnancy care checklist
View a personalised step-by-step guide of what to do each week of pregnancy
Connect with doctors
Get trusted medical advice, on your device from doctors at any time
My Baby dashboard
Activate the My Baby programme on the Discovery app and create baby’s profile
Education cost estimator
Get an estimate of the total cost of education from pre-school to university
Kids digital health record
View medical record, with a view of vaccinations, screenings, milestones and development.
Digital vaccination card
Keep track of all vaccinations by setting reminders and having access to the updated immunisation card.
Caring for mother and baby
Quality healthcare is critical during pregnancy. Prenatal care and screening benefit both mother and baby. For the average healthy pregnancy and birth, the estimated medical costs can be in excess of R120 000. Expectant parents should be able to depend on comprehensive health cover for complete peace of mind.
Raising a healthy child involves optimal health, nutritional and physical wellbeing and future education needs. Average medical costs for the first two years of a child’s life, including GP and specialist visits can be as much as R80 000. In the unfortunate event that a child is admitted to neonatal ICU, ultra-high cost claims can be in excess of R4 million. Complete cover for the health of a young family should provide access to comprehensive healthcare, alongside access to vital clinical support and knowledge.
GP and specialist visits
Babies are covered for up to two visits with a GP, paediatrician or an ENT. Cover depends on the plan selected
DURING PREGNANCY
Technical details
• The benefits do not affect a member’s day-to-day Medical Savings Account benefits
• Healthcare services are covered through this benefit at the Discovery Health Rate
• The benefits depend on the selected plan of the member
– The benefits only apply from 1 January 2018
– The benefits only apply after the benefits have been activated by the member
• Technical details related to maternity benefits prior to delivery:
– The benefits can be activated either by
- creating a pregnancy profile in the Discovery app; or
- creating a pregnancy profile at www.discovery.co.za; or
- preauthorising the delivery
– Members that preauthorised their delivery during 2017 will have automatic access to the benefits from 1 January 2018
– The benefits do not cover healthcare services received prior to the activation of the benefit
• Technical details related to the post-birth benefits:
– The baby has to be registered on the Scheme to activate the benefits
– The benefits for babies born on Discovery Health Medical Scheme prior to 1 January 2018 have to be activated through www.discovery.co.za
TWO YEARS FROM BIRTH
PG 6 7 P
G
2017HEALTH DISCOVERER
Introducing HealthyCompany Care
Utilising the data from the Screening programme, medical scheme and Vitality, HealthyCompany Care seamlessly stratifies employees according to their risk profile in three areas
of wellbeing, and proactively triggers relevant interventions, which may include referral into existing healthcare and wellness programmes
offered to employees.
Employees will have access to a multi-skilled coach to guide them every step of the way, through a fully-integrated
mobile app. In addition, HealthyCompany Care offers a suite of educational content
for all employees, including a library of doctor-generated advice, assistance with financial
planning and access to a consultation with a legal expert.
HealthyCompany 2018
Discovery HealthyCompany is our cost-effective, integrated wellness solution that combines and augments the health and wellness management capabilities of Discovery Health and Discovery Vitality. The platform provides a focused approach to meet the needs of the employer, who is concerned with both the effectiveness of interventions, and the return on investment of such interventions.
HealthyCompany Insights
While each employee journey is unique, aggregated reporting is crucial in providing insight into the risks having the greatest impact on absenteeism and productivity at an organisational level. This view not only assists employers in defining their health and wellness strategy, but should enable measurement and continuous improvement as well.
Aggregate corporate reporting informs health and wellness strategy
HealthyCompany Screening
Employers have access to four screening solutions, tailored to the needs of the company:
• Discovery Traditional Wellness Days
• Discovery Premier Mobile Wellness Experience
• Discovery Premier Wellness Experience
• Discovery Executive Wellness
The results of these screenings are reported to each individual employee, and the aggregated screening results are reported to the employer. These seamlessly integrate with the reporting functions provided by HealthyCompany Insights.
HealthyCompany Insights
HealthyCompany Insights integrates an employer’s data collected from the Screening and Care programmes and provides employee- and employer-relevant dashboards. These are developed to provide clear and actionable insights for each individual employee, as well as for the employer. In addition, an employees’ engagement with healthcare and wellness management programmes is integrated to dynamically update an employer’s risk stratification and appropriately adjust the recommendations.
Physical Wellness
Emotional Wellness
Financial Wellness
HighRisk
Episode management
Medium Risk
Ongoing management
LowRisk
Prevention
HealthyCompany Care will be available from April 2018.
Phys
ical
Emotional
Legal Financial
Education and Planning
Prevention
Epis
ode
Man
agem
ent
Ongoing Management
Individual employee reporting
Integrated employer reporting
HealthyCompany Insights
HealthyCompany Care
Hea
lth
yCompany Screening
Discovery PrimaryCare
A unique healthcare product that provides affordable, quality primary healthcare and emergency healthcare services for your low-income employees.
John’s wellness day results show glucose levels which are elevated beyond the desirable range, and that he is under a large amount of stress. According to the financial wellness assessment, John is not at immediate financial risk, but he could use some insight into how to ensure that his protection needs are met.
Physical | Medium risk: Ongoing management
Emotional | High risk: Episode management
Financial | Low risk: Prevention
Legal
Enrolment on a care pathway with Discovery Health Medical Scheme and Vitality
Up to 6 face-to-face sessions with a counsellor or psychologist
If John requires legal assistance at any point, he is able to access a legal expert for a consultation
Through John’s Discovery Health Medical Scheme Classic Saver Plan, he is enrolled in the DiabetesCare Programme which provides him access to a GP, unlocks additional funding for allied healthcare services, and gives him access to a monthly progress dashboard. Since John is also a Vitality member, he is enrolled in a personalised physical activity and weight-loss programme through Vitality Active Rewards and Weight Loss Rewards.
John receives a personalised report, as well as access to a dynamic health and wellness dashboard, which ensures that he not only fully understands his risk profile, but can track his progress as he engages with the support tools.
John attends the Discovery Premier Wellness Experience where he is screened to determine how well he is according to three dimensions: physical, emotional and financial wellness.
Hea
lthyC
ompa
ny
Scre
enin
gH
ealth
yCom
pany
Ca
reH
ealth
yCom
pany
In
sigh
tsH
ealth
care
an
d w
elln
ess
Discovery for Corporates
Employers that invest in the health and wellness of their employees benefit from greater productivity through lower absenteeism and presenteeism, which benefit employer and employee alike. A typical employee health solution includes components such as health screening, employee support, healthcare and wellness programmes, and some reporting on each individual component. Discovery provides a comprehensive solution in each of these areas, with the unique ability to integrate and report across all the elements to augment the impact on the health and wellness of employees.
Integrated health and wellness in actionJohn is a manager in a large manufacturing firm that has partnered with Discovery HealthyCompany. He is on a Discovery Health Medical Scheme Classic Saver Plan and is a Discovery Vitality member
Hea
lthca
re
A range of healthcare cover to suit the diverse needs of employees.
Discovery Health Medical Scheme
SA’s leading medical aid that provides quality, affordable healthcare supported by industry-leading digital technology.
Discovery Gap Cover D
isco
very
Prim
aryC
are
Discovery Health Medical Scheme
Vitalit
y Pu
rple
VitalityWellness
Vitality Move
HealthyCompany Insights
Hea
lthyCompany Screening
Healthcare
HealthyCompany Care
Vitality Active
Hea
lthyC
ompa
ny
HealthyCompany Screening
Advanced, clinically validated onsite wellness days, and bespoke executive
wellness assessments.
HealthyCompany Insights
Dynamic reporting for employees and employer, across all elements of
Discovery HealthyCompany is our comprehensive corporate wellness solution
offering health screening, employee support tools and integrated reporting.
Discovery Gap Cover
An innovative, cost-effective insurance solution that provides additional financial protection against unforeseen medical costs.
Discovery Vitality Vitality has four distinct wellness products to provide relevant incentivised wellness for all employees in an organisation.
Vitality is Discovery’s internationally recognised science-based wellness programme, which encourages and incentivises healthy behaviours.
Wellness
Fina
ncia
l
Emotiona
l
Physical
management
managem
ent
Prev
entio
n
On-going
Episode
Individual employe
e rep
ortin
g
Integrated employer r
epor
ting
Screening
Discovery Health
Medical Scheme
and
Discovery Vitality
PG 8 9 P
G
2017HEALTH DISCOVERER
Discovery PrimaryCare 2018Providing access to quality healthcare is essential to any company that wants to ensure that the health and productivity of their workforce is sustained and optimised. However, access to private healthcare through medical scheme membership proves unaffordable for many employees with lower levels of income. From as little as R158 per employee per month, employers can now offer employees and their qualifying dependants access to quality healthcare facilities and healthcare professionals in the Discovery Health networks, for relevant primary and emergency healthcare services.
Why Discovery PrimaryCare?
2018 PrimaryCare Pricing
Discovery PrimaryCare Essential
Indicative Fee Employee Spouse Child
Monthly fee (incl. VAT) 158 158 158
Trauma Benefit 50 50 25
Total 208 208 183
Discovery PrimaryCare Comprehensive
Indicative Fee Employee Spouse Child
Monthly fee (incl. VAT) 269 269 174
Trauma Benefit 50 50 25
Total 319 319 199
PrimaryCare starts from as little as R158 per month, and pricing is dependent on the employer’s unique circumstances, including the compulsory or voluntary nature of PrimaryCare membership, and the site and demographic profile of employees.
Dependants are subject to a 6-month waiting period for access to PrimaryCare services, if they are not added on the policy when the employee joins.
There must be at least 10 members on a scheme administered by Discovery Health and a minimum of 25 employees to be enrolled on PrimaryCare Essential or PrimaryCare Comprehensive.
Employees and their families have access to quality private primary healthcare services
and healthcare professionals.
Employees can access their employer’s wellness days, and have access to Vitality Move.
Employers have the option to include access to private healthcare facilities for traumatic events.
Pricing starts from as little as R158 per employee per month, and is quoted based on the employer’s specific circumstances.
PrimaryCare Comprehensive provides cover for 27 Chronic Disease List Conditions.
No exclusions and no waiting periods for employees.
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A C C E S S T O P R I V A T E H E A L T H C A R E
A C C E S S T O W E L L N E S S
A C C E S S T O E M E R G E N C Y M E D I C A L S E R V I C E S
A F F O R D A B L E , F L E X I B L E F E E S
T R E A T M E N T F O R A W I D E R A N G E O F C H R O N I C C O N D I T I O N S
I M M E D I A T E A C C E S S F O R E M P L O Y E E S
2018 PrimaryCare Enhancements
Trauma Benefit
Employers can enhance PrimaryCare cover for their employees through the Trauma Benefit, which provides access to emergency private healthcare services for a broad range of traumatic events. Members are covered in full for medical treatment at a hospital or casualty facility in our network related to these events, up to a limit of R100 000 per admission, and they will not have to pay upfront for these medical services.
The following traumatic events are covered: burns, head injuries, loss of an arm, hand, leg or foot, near drowning, poisoning or a serious reaction that may cause death, injuries resulting from a crime, sexual assault, a fall, a car accident or an injury at work.
The following medical services are covered in the case of a traumatic event:
| Medical Evacuation Cover for medical evacuation services to the nearest private hospital facility in our network
| Casualty treatment Access to medical treatment in a casualty facility in our network
| In-patient stabilisation and treatment Up to R100 000 per admission for hospital and related accounts, at a private hospital in our network. Once the limit is reached and further medical treatment is required the member will be transferred to a public hospital. The member will be responsible for any costs over this limit if they choose to remain in the network facility.
The network of private hospitals and casualty facilities will be published on www.discovery.co.za
PrimaryCare Wellness Experience
Members will have access to the PrimaryCare Wellness Experience, providing a holistic set of wellness screenings (including BMI, blood pressure, cholesterol, glucose and HIV testing), as well as a one-on-one consultation with a wellness specialist and a lifestyle and wellness assessment.
The PrimaryCare Wellness Experience is for employees only.
Minimum of 30 members at an employer site required.
Access to the PrimaryCare Wellness Experience is covered in full once per year.
PrimaryCare clients have preferential access to HealthyCompany Care
Access to Vitality Move
Members have access to Vitality Move, a Discovery Vitality programme that rewards everyone for taking steps towards a healthy lifestyle. Vitality Move members can win shopping rewards at Pick n Pay, and can get up to R300 back monthly on shopping, gym and movies.
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HEALTH DISCOVERER
Discovery Gap Cover 2018Unexpected medical costs, for treatment related to approved admissions to hospital where healthcare professionals charge more than what the medical scheme pays, or where members have a life-changing severe illness, can place significant financial strain on a family.
Discovery has now combined its insurance and healthcare expertise to bring an innovative, cost-effective solution through Discovery Gap Cover and Discovery Supplementary Gap Cover to provide policyholders with significant cover for unforeseen medical expenses related to a hospital admission or severe illness diagnosis, through a unique and comprehensive benefit structure.
Why gap cover from Discovery?
2018 Discovery Gap Cover premiums
A member’s Discovery Gap Cover premium depends on the option selected, the medical scheme plan and the age that the oldest member on your medical scheme plan will turn in the year of applying for the policy.
Every person on a member’s medical scheme plan must also be on your Discovery Gap Cover policy, subject to underwriting. If the oldest person leaves or joins the Scheme, the gap policy will be rerated.
Discovery Gap Core Discovery Gap Comprehensive
Discovery Health Medical Scheme Executive
and Classic Plans
Discovery Health Medical Scheme Essential
and Coastal Plans
Discovery Health
Medical Scheme Executive and Classic Plans
Discovery Health Medical Scheme Essential
and Coastal Plans
Age at entry of the oldest member on the Scheme plan
Single Member Family Single Member Family Single Member Family Single Member Family
0 – 54 90 150 165 395 135 230 250 560
55 – 64 150 180 390 575 230 340 455 865
65+ 180 265 575 920 290 475 605 1135
2018 Discovery Gap Cover enhancements
Introducing Discovery Gap CoreYour clients can now choose from two Discovery Gap Cover options to suit their needs. Discovery Gap Core significantly enhances cover for in-hospital shortfalls and cancer-related claims, from as little as R90 per month.
Enhanced Oncology Benefit ExtenderFrom 2018, the full value of the Oncology Extender Benefit will be available immediately to policyholders, regardless of policy duration subject to underwriting and applicable waiting periods.
Benefit Discovery Gap Core Discovery Gap Comprehensive
In-hospital Specialist Gap Cover Additional 200% of DH rate Additional 200% of DH rate
Hospital Admission Benefit Extender Up to R10 000 additional cover for in-hospital shortfalls for specialist claims
Up to R20 000 additional cover for in- and out-of-hospital shortfalls related to the admission
Oncology Benefit Extender Up to R75 000 for co-payments related to your oncology treatment plan
Up to R100 000 for co-payments related to your oncology treatment plan
Annual benefit per person
Plan type Discovery Gap Comprehensive Discovery Gap Core
Discovery Health Medical Scheme Executive, Comprehensive plans
R100 000 R75 000
Other plans R40 000 R30 000
A D M I S S I O N – R E L A T E D S H O R T F A L L C O V E R
C O M P R E H E N S I V E C O V E R F O R C A N C E R
O N E S I M P L E C L A I M S S U B M I S S I O N P R O C E S S
Discovery Gap Cover provides additional funding to help cover oncology co-payments.
Discovery Supplementary Gap Cover helps fund high-cost treatments and gives access
to advanced genomic sequencing for certain cancers.
With Discovery Gap Cover clients have a simple claims submission process, where gaps in cover are identified, assessed and paid automatically once the medical scheme claim is processed, with no additional documentation required.
01 02 03Discovery Gap Cover has two options to
suit the needs of your clients, which offer rich protection against shortfalls in medical
scheme cover for specialist treatment received in-hospital. Discovery Gap Comprehensive
provides pre- and post-hospitalisation cover for specific shortfalls incurred out-of-hospital,
