Presented by : Marlon Allamby Role: Business Consultant and Registered Financial Representative of the Discovery Health Medical Scheme

Transcription

1 Presented by : Marlon Allamby Role: Business Consultant and Registered Financial Representative of the Discovery Health Medical Scheme

2 Declaration: Factual product information will be provided during this session. Should you require financial advice, please contact your dedicated financial advisor. If you need more product information, you can meet with a Discovery consultant for a one on one consultation. At the individual consultations, you will be provided with a copy of the signed employer BC declaration and Statutory notice that confirms my role and the fact that no financial advise can be provided during these sessions

3 Core purpose To make people healthier and enhance and protect their lives

4 A choice of plans to suit all levels of medical and financial need Executive 1 Comprehensive 1 Classic Comprehensive 2 Classic Delta Comprehensive 3 Essential Comprehensive 4 Essential Delta Comprehensive 5 Classic Comprehensive Zero MSA Classic Priority Essential Priority 1 2 Priority Saver Core Classic Core Classic Delta Core Essential Core Essential Delta Core Coastal Core Classic Saver Classic Delta Saver Essential Saver Essential Delta Saver Coastal Saver KeyCare Plus KeyCare Core KeyCare Access KeyCare 4

5 We have a plan option for each individual Extensive cover when you need it most No overall limit on hospital cover Trauma Recovery Extender Benefit Comprehensive Above Threshold Benefit No gaps in cover for GP and pathology Comprehensive chronic cover Cover for everyday medical expenses Preventative cover for all members Access to Vitality a science based programme with a personalised approach to wellness

6 We cover you for planned and life threatening emergency events You may use any private hospital Your benefits 1. Unlimited hospital cover on ALL our plans 2. Full cover at any hospital for life threatening medical emergencies 3. The highest in-hospital benefits in the industry 4. The most extensive payment arrangements in place with specialists: 89% coverage KeyCare and Delta members need to use a network hospital

7 We cover you when you have a chronic condition You may use any private hospital Your benefits 1. Choice of plans which offer cover for PMB and non-pmb conditions 2. Full cover for medicines on the Discovery medicine list 3. Medicine list consists of a wide range of generic and non-generic medicines 4. Choice of a high monthly rand amount for medicines not on the list 5. Full cover through network pharmacies KeyCare and Delta members need to use a network provider

8 You have cover for chronic conditions Prescribed Minimum Benefit conditions Addison s Disease Asthma Bipolar Mood Disorder Bronchiectasis Cardiac Failure Cardiomyopathy COPD Chronic Renal Disease Coronary Artery Disease Crohn s Disease Diabetes Insipidus Diabetes Mellitus Type 1 Diabetes Mellitus Type 2 Dysrhythmias Epilepsy Glaucoma Haemophilia Hyperlipidaemia Hypertension Hypothyroidism Multiple Sclerosis Parkinson s Disease Rheumatoid Arthritis Schizophrenia SLE Ulcerative Colitis HIV & AIDS Non Prescribed Minimum Benefit conditions Ankylosing sponylitis Behcet s disease Connective Tissue disorder (mixed) Cushing s disease Cystic fibrosis Delusional disorder Dermatopolymyostis General anxiety disorder Huntington s disease Hypoparathyroidism Major depression Motor neurone disease Muscular dystrophy and other inherited myopathies Myasthenia gravis Obsessive compulsive disorder Organ transplantation Osteoporosis Paget s disease Panic disorder Paraplegia Pemphigus Peripheral artheriosclerotic disease Pituitary microadenomas Polyarteritis Nodosa Post traumatic stress disorder Psoriatic arthritis Pulmonary interstitial fibrosis Quadriplegia Sjogren s syndrome Stroke Systemic sclerosis Thrombocytopaenia purpura Valvular heart disease Wegener s granulomatosis

9 We offer the widest choice of chronic cover- Formularies and CDAs

10 Cover for everyday medical expenses Choose a Medical Savings Account (MSA) plan Your MSA gives you control of how you use your benefits Unused funds are carried over providing members greater cover Dentistry Spectacles MSA for 2015 Medicines GP Carried over 2014 MSA 2014 Claims 2015 MSA

11 Full Cover Choice is available for all members Members need to look out for the Full Cover stamp, which will indicate that they will be covered in full for the services required

12 Core series Hospital Benefit Covers approved hospitalisation with no overall limit Full cover when using specialists we have an agreement with No day to day cover Chronic Illness Benefit Cover for PMB conditions Preventive Screening Benefit VitalityCheck & other screenings

13 Saver series Hospital Benefit Covers approved hospitalisation with no overall limit Full cover when using specialists we have an agreement with Chronic Illness Benefit Cover for PMB conditions Trauma Recovery Extender Benefit Insured Network Benefit Members have access to G.P visits once their annual savings are depleted Classic Maternity benefit Medical Savings Account Pays day-to-day medical costs Full annual deposit available up front Classic, Essential, Delta or Coastal Preventive Screening Benefit VitalityCheck & other screenings Key differences to Core Series

14 Priority series Hospital Benefit Covers approved hospitalisation with no overall limit Full cover when using specialists we have an agreement with Deductibles in-hospital on defined list of procedures Chronic Illness Benefit Cover for 27 PMB conditions Trauma Recovery Extender Benefit Preventive Screening Benefit VitalityCheck & other screenings Above Threshold Benefit Further day-to-day cover Paid by Discovery once day-to-day claims add up to set amount Limited Above Threshold Benefit Insured Network Benefit Members have access to unlimited network GP visits, pathology and maternity consultation and 2 2D scans while in Self Payment Gap once their annual savings are depleted Medical Savings Account Pays day-to-day medical costs Full annual deposit available up front Classic (25%) or Essential (15%) Key differences to Saver Series

15 What is a deductible? A deductible is an amount payable upfront for a specific procedure Procedure Tonsillectomy, adenoidectomy Myringotomy (grommets) Conservative back and neck treatment Gastroscopy Colonoscopy, sigmoidoscopy, proctoscopy, Cystoscopy Arthroscopy Functional nasal procedures Hysterectomy (not applicable to pre-operatively diagnosed cancer) Laporoscopy, hysteroscopy, endometrial ablation Spinal surgery (back and neck) Joint replacements Nissen fundoplication (reflux surgery) Deductible R2 150 R2 150 R2 150 R2 850 R2 850 R2 850 R5 150 R5 150 R5 150 R5 150 R R R10 500

16 Comprehensive series Hospital Benefit Covers approved hospitalisation with no overall limit Full cover when using specialists within our payment arrangements i.e. Premier Rate No deductibles Above Threshold Benefit Further day-to-day cover Paid by Discovery once day-to-day claims add up to set amount Unlimited Above Threshold Benefit for Radiology, Pathology etc Chronic Illness Benefit Cover for both PMB and non-pmb conditions Trauma Recovery Extender Benefit Overseas Treatment Benefit Specialised Medicines and New technology Insured Network Benefit Members have access to unlimited network GP visits and pathology once their annual savings are depleted Medical Savings Account Pays day-to-day medical costs Full annual deposit available up front Classic,Essential or Delta Preventive Screening Benefit VitalityCheck & other screenings Key differences to Priority Series

17 Your choices within the KeyCare Series KeyCare Plus KeyCare Access KeyCare Core KeyCare Hospital Network KeyCare Hospital Network for emergencies and trauma; KeyCare Access Hospital Network for child birth and care of newborns KeyCare Hospital Network KeyCare Hospital Network Contracted state hospitals KeyCare Hospital Network Cover for maternity services and specialist consultations

18 You will have the best access to medical cover and support both in-and-out of South Africa Africa Benefit International Travel Benefit Evacuation to SA for emergencies Emergency support Cover for medical emergencies while overseas Trauma support Emergency HealthID Medical Liaison Managers 18

19 Appropriate benefit design allows unlimited cover in areas with greatest clinical need Oncology benefit and key metrics Unlimited oncology cover on all plans DHMS members receiving treatment for cancer Access to the latest treatment protocols and technologies R930 million Annual spend on oncology benefit Ongoing care and support through Oncology Liaison Managers and Cancer Coaches 98.8% Oncology claimants covered in full Appropriate benefit design allows unlimited cover in areas with greatest clinical need 19

20 Discovery Health s network footprint results in comprehensive benefit coverage Network coverage Hospital networks Coastal: 99% coverage KeyCare: 98% coverage Delta: 80% coverage GP networks GPs DHMS: 86% coverage KeyCare: 98% coverage PMB networks Specialists IH: 93% coverage OH: 83% coverage Pharmacy networks Pharmacies Delta: 93% coverage KeyCare: 96% coverage > R1 billion member savings by reducing member copays Note: Coverage in this context refers to the percentage of events occurring within the relevant network 20

21 You will have access to a range of exclusive discounts through Discovery Health s partnerships MedSaver ChroniCare Optometry Stem cell cryogenics Optometry network Save up to 25% on the purchase of schedule 1 and 2 medicines Save up to 25% on ChroniCare products at Dis- Chem pharmacies Save up to 20% on frames and lenses through our optometry network Save up to 25% on umbilical cord blood and tissue stem cell cryogenics with Netcells Biosciences 21

22 Diabetic members have access to the latest technology in the form of telemetric glucometers DHMS funds telemetric glucometers for diabetic members Tracking data will be visible to healthcare professionals in HealthID Ability to export test results with date, time and notes to Excel Glucose tracking linked to online Health and Vitality profile providing members access to additional management tools Ability to share data with loved one s via Facebook or 22

23 The Discovery member app gives you access to your health plan on the go Carry an electronic membership card Track claims and medical spend Personal health records Request a document Take a photo of a claim and send it to us View information on hospital procedures Order door-to-door medicine delivery Translate cover into one of five languages Check medicine prices and alternatives Watch our educational videos Find a healthcare provider near you Contact us directly in international emergencies 23

24 MedXpress: Discovery Health s convenient medicine delivery service Door-to-door medicine delivery Have your monthly meds delivered to your door. Convenience Order via telephone, website, member app or at a walk-in centre Delivery to your door Simple process with no forms Regular updates on changes Savings Low dispensing fees No administration or delivery fees Advice on generic substitution to ensure lower or no copayments Access to more information about treatment or condition Acute medication 6 hours Chronic medication 72 hours Delivering wherever you are 24

25 Discovery Health Medical Scheme scale of operations Every working day New lives activated on the Scheme Calls handled 136 Babies born Claims processed 585 Hospital admissions authorised R121.5 million Paid out in claims 25

26 Vitality 2014

27 The Vitality program drives and rewards healthy behaviour 27

28 Vitality makes it easy for you to improve your health Know your Health Vitality Fitness Assessment Improve your Health Fitness partners Vitality Status 2500 points boosted to 7500 points Vitality Check Dietitian visit Up to points Up to 7500 points Vitality Age Mental Wellbeing Assessment 2500 points Lifestyle partners 150 points per workout LiveWell Programmes 2000 points Online Nutrition Assessment Online Fitness Assessment 1000 points 1000 points Up to points 28

29 Know your health: Find out about your health through a range of tests and assessments Know your Health Complete online health assessments on discovery.co.za Vitality Age 2000 points Online Nutrition Assessment Mental Wellbeing Assessment 2500 points Online Fitness Assessment Do a Vitality Fitness Assessment or consult a dietitian Dietitian visit Up to 7500 points Vitality Fitness Assessment 2500 points boosted to 7500 points 1000 points 1000 points Blood pressure Cholesterol HIV test Glaucoma screening Do a Vitality Health Check Boosted to 3000 points Weight assessment Boosted to 3000 points Blood glucose Do further health checks 5000 points Pap smear Mammogram 2500 points Prostate screening Boosted to 3000 points Boosted to 3000 points 2500 points 2500 points 2500 points 29

30 Improve your health: Enjoy great savings at fitness partners Get active and get great savings at fitness partners Make healthier lifestyle choices Lose weight Save 30% at these partners. Earn 500 points for a weight assessment and points for reaching your goal weight. Stop smoking Save 80% at these partners. Earn points for being a nonsmoker. Fitness devices Discovery app Fitness devices Earn 150 Vitality points for each daily workout Earn 150 Vitality points and 50 bonus points for every session using one of these web-enabled fitness devices or the Discovery app. 30

31 Improve your health: Get rewarded for healthy living The Vitality HealthyLiving benefits HealthyFood HealthyCare Up to 25% cash back rewards on a range of self-care items at Clicks HealthyGear Up to 25% cash back rewards on HealthyFood items at Pick n Pay and Woolworths Up to 25% cash back rewards on adidas products at Totalsports and adidas stores 31

32 Enjoy the rewards: Rewards on local and international travel Vitality flights Domestic flights 31 International destinations 114 International destinations 8 International destinations Domestic flights Vitality car rental Vitality members have more than 100 international destinations to choose from 32

33 Enjoy the rewards: Stay for less in the Vitality Hotel Collection The Melrose Arch Hotel Johannesburg Simbambili Game Lodge Kruger National Park Pumba Private Game Reserve Port Elizabeth The Beverly Hills Umhlanga and more 15 on Orange Cape Town L ermitage Franschhoek Over 500 top hotels, lodges and resorts. *New Partners will be available in the 3 rd quarter of 2015 Blue Bronze Silver Gold Diamond 15% 20% 25% 30% 35% 30% 35% 40% 45% 50% 33

34 Enjoy the rewards: Additional lifestyle rewards VitalityMobile Clicks ClubCard Cash-back Movies Baby Bag Magazine subscriptions Get free calls to other VitalityMobile members and a 50% data boost Up to 15% Clicks ClubCard Cash-back Rewards based on Vitality status Get movies for less than half price and children see movies for free Expectant parents can receive a baby bag packed filled with useful items Get up to 60% off newspaper and magazine subscriptions 34

35 Example of Blue Vitality members monthly savings Potential savings through Vitality R1 490 Gym HealthyLiving VitalityMobile Travel Movies Discovery Card Purchases R400 Vitality Premium R130 R206 R825 R48 R50 R169 Total Savings for the month The monthly saving is after the VitalityMobile monthly fee. Flight costs are before taxes and the member has not exhausted the maximum number of flights and hotel bookings for the year. The member booked a hotel at least 21 days before checking in and has a DiscoveryCard. Total DiscoveryCard spend is in excess of R1 500 for the month. Member has been on Vitality for three years. Member has calculated his/her Vitality Age, went for a Vitality Health Check and did the online Vitality Fitness Assessment 35

36 Example of Gold Vitality members monthly savings Potential savings through Vitality R2 225 Gym HealthyLiving VitalityMobile Travel Movies Discovery Card Purchases R400 Vitality Premium R325 R206 R1 350 R48 R65 R169 Total Savings for the month The monthly saving is after the VitalityMobile monthly fee. Flight costs are before taxes and the member has not exhausted the maximum number of flights and hotel bookings for the year. The member booked a hotel at least 21 days before checking in and has a DiscoveryCard. Total DiscoveryCard spend is in excess of R1 500 for the month. Member has been on Vitality for three years. Member has calculated his/her Vitality Age, went for a Vitality Health Check and did the online Vitality Fitness Assessment 36

37 Welcome Pack voucher will be included in your membership card pack Additional benefit: Welcome pack for your new digital members Vouchers will be delivered in the 1 st 2 nd week of May 2014 You can redeem your welcome pack at your nearest Dis Chem outlet 37

38 Way Forward Should you wish to change your option, please complete the option change form in your pack, and it to or fax it to Please submit your option change for by no later than 14 April 2014 To take advantage of the 4 month free Vitality offering, please Call us on or complete the Vitality application form and submit it to us by at vitalitysales@discovery.co.za or by fax to (011) You will receive your membership cards within the first or second week of May 2014

39 Declaration: Factual product information will be provided during this session. Should you require financial advice, please contact your dedicated financial advisor. If you need more product information, you can meet with a Discovery consultant for a one on one consultation. At the individual consultations, you will be provided with a copy of the signed employer BC declaration and Statutory notice that confirms my role and the fact that no financial advise can be provided during these sessions