South Africa’s largest medical scheme, Discovery Health Medical Scheme (‘Discovery’), launched their benefit and contribution changes for 2020 on Wednesday, 11 September 2019. An average contribution of 9.5% was announced.
Discovery has noted some of the factors contributing to their increase as medical inflation, supply-side inflation, disease and ageing (demand-side) and risk management initiatives. Discovery’s solvency of 27.3% (2018) is above the current regulated solvency of 25% which is an indication that the scheme is in a healthy condition.
ASI Financial Services’ (ASI) consulting team has analysed the changes introduced for 2020 and we have compiled the key highlights of the benefit changes and enhancements for 2020. Please look out for the member information sessions which will unpack all the changes per plan option and most importantly help members to choose appropriate plan options for 2020.
2020 WEIGHTED AVERAGE CONTRIBUTION INCREASE 9.5%
KEY BENEFIT HIGHLIGHTS
- Enhanced Specialised Medicine Technology
- Introduction of co-payments on Executive plan for MRI/CT scans
- Change to Chronic Illness Benefit formulary (1 Jan)
- Classic Comprehensive Zero MSA renamed
- Enhancements on the Smart series
- Amendments to the day-to-day Extender Benefit
- Expansion of the Delta and Smart hospital networks
- Accumulation of medication to threshold plans
- Limit applied to KeyCare Plus casualty benefit
- Funding for scopes amended
KEY VITALITY HIGHLIGHTS
- Vitality Active Rewards – additional partners
- Vitality Active Rewards for kids introduced
- Mental wellbeing becomes a personalised goal
- Vitality point brackets amended to reach Gold and Diamond status with ease
- Enhancement to Vitality Active
- Vitality Health Tracker available for all Discovery members
- Specialised Medicine Technology benefit available on Executive and Comprehensive options enhanced to provide full cover for Rheumatoid Arthritis, Ulcerative Colitis and Crohn’s disease
- Executive members will now experience a co-payment for MRI and CT scans (in-and out-of-hospital) as well as endoscopic procedures (in-hospital) of R3,040 and R4,100 respectively
- Classic Comprehensive Zero MSA has been renamed to Classic Smart Comprehensive. The benefit design has been amended to include the following:
- Oncology benefit for non-Prescribed Minimum Benefit (‘PMB’) conditions reduced to R300,000 with a 20% co-payment after the limit is reached
- Hospital admission to a non-Smart hospital will be subject to an upfront deductible of R9,650
- Chronic illness benefit only available for the PMB conditions
- The Smart day-to-day benefits will accumulate to the annual threshold however this is excluding over-the-counter medication. Additional benefits will be available once the member reaches the annual threshold
- Accumulation of non-preferred medication (generic and original) will change from 75% to 50% on all threshold options
- The Delta network options will now have access to the Life Wilgers Hospital
- The Smart hospital network list will include eight (8) additional regions including Tzaneen, Klerksdorp, Welkom, Umtata, Newcastle, Ballito, Pretoria, Cape Town
- The Classic Smart plan will have an annual limit of R1,500 per member and R2,500 per family for schedule 3 and above medication. The R10 co-payment has been removed
- Deductible and co-payment amount have increased by 9.5% across all plans
- A limit of one (1) casualty visit has been introduced on the KeyCare Plus option for all elective casualty visits
- Day-to-day benefit limits have increased by 9.5% on the Threshold plans
- The Day-to-day Extender benefit will now include unlimited video consultations with a network GP and consultations at a pharmacy clinic in the wellness network. Face-to-face network GP consultations will be available once the member is referred by the pharmacy clinic.
- The medication formulary, including the Chronic Drug Amount, on the Chronic Illness Benefit will be amended. Discovery will be in contact with the affected members during October and November 2019
- Vitality Health Tracker introduced for all Discovery non-Vitality members, where members will have access to personalised health goals at no cost. Members will be able to earn Discovery miles which will accumulate and only be allocated once the member joins a Vitality product
- Members will now earn Discovery miles instead of points for reaching their weekly goal on Vitality Active Rewards
- Vitality Active Rewards will provide members with an instant 100 Discovery miles over and above the game board for reaching their weekly goal
- Vitality Active Rewards Discovery miles can now be spent on DSTV Box Office, Netflix, Uber, Makro, Typo, Exclusive Books, Takealot and Cotton on
- Vitality Active Rewards for kids introduced where children will be rewarded by following healthy habits. Children aged between 2 and 13 will have access to earn their own Discovery miles by completing certain weekly challenges e.g. trying three (3) new vegetables. A maximum of 1,000 Discovery miles will be earned per child for challenges and 200 Discovery miles for physical activities. This will be accessed via the parent’s Discovery App.
- Children aged between 14 and 18 will now have access to Vitality Active Rewards
- Mental wellbeing added to the personalised health goals available whereby members can earn up to 1,000 Discovery miles for completing the mental wellbeing assessment. Members can earn up to 1,000 Discovery miles for completing their weekly mental wellbeing goals
- Vitality Active has been enhanced to included discounts of up to 25% for Clicks and Dischem as well as 50% on 2D and 3D movies at Ster-Kinekor. Members can also save up to 50% when purchasing a Huawei Band 3-Pro from Sportsmans Warehouse. Rewards boosted for completing a health check.
- Vitality Active gym discount has increased from 25% to 50% at Virgin Active Red and Planet Fitness Just Gym
- Vitality point brackets reduced to assist members in reaching Gold and Diamond with ease. Diamond can now be reached within one (1) year.