Discovery Health 2022 Contributions And Increases – September Newsletter

Discovery Health 2022 Contributions And Increases

Discovery Health 2022 Contributions

Discovery Health 2022 Contributions will increase by 7.9% across all plans from 1st May 2022.

Delaying the increase until May, while benefits are updated in January, means that the effective increase is 5.3% for members.

The factors influencing the increase are as follows:

• Tariff increases: cost of healthcare services,
• Demographic risk: age of members,
• Utilisation changes: The impact of Covid-19 and other factors,
• Risk Management and Vitality: this reduces the increase,
• Medical Inflation.

To keep up with the above factors, there must be an increase each year. Delaying this to later in the year can provide some relief for members, while still protecting the sustainability of the medical scheme.

2022 Benefit Updates – Enhancements from January 2022

Assisted Reproduction Therapy (Executive and Comprehensive plans)

• Cover provided for freezing of embryos as part of an IVF cycle.
• Cover provided for egg donated cycles, incl donor match fees, and extended for members age 43 to 50 years.
• Qualifying members registered on the Oncology program will have cover for cryopreservation and egg storage for up to 5 years.
• All enhancements subject to the overall annual limit of R115 000. Members are responsible for up to 25% of the costs and any excess above the medical scheme rate.

Palliative Care Enhancements

The Compassionate Care Benefit for non-oncology patients will merge with the Advanced Illness Benefit for oncology patients in 2022, to provide a single unlimited benefit for end-of-life and palliative care. Cover is subject to authorisation, treatment guidelines and clinical criteria.

Oncology Benefit Enhancements

The Oncology Innovation Benefit, currently available on Executive and Comprehensive plans only, will be extended in 2022 to include the Classic Smart Comprehensive, Priority, Saver, Smart and Core plans for a sub-set of the cancers and precision oncology medicines currently covered. Cover will be at 50% of the medical scheme rate, with a 50% co-payment paid by the member. Cover is subject to authorisation, treatment guidelines and clinical criteria.

Allied Therapeutic and Psychology Extender Benefit

• Cover will be extended to include treatment for moderate to severe strokes and head injuries.
• The two-year cover period limit will be removed for certain conditions, effectively negating the need to reinstate the benefit every two years. The conditions include: hemiplegia; paraplegia; speech and swallowing disorders; and strokes and head injuries.

Trauma Recovery Extender Benefit

This benefit provides cover for specified conditions suffered as a result of a traumatic event. The cover is for the remainder of the year in which the event occurred as well as the following calendar year. Cover has been enhanced in 2022:

• The benefit has been extended to all Discovery Health plans.
• Entry criteria have been amended to include a high acuity admission in high care or unlimited days in ICU for crime-related injury; near drowning related injury; poisoning; severe anaphylactic reaction; and external and internal head injuries.
• Addition of up to 6 counselling sessions by a psychologist, social worker or registered counsellor, available to all registered beneficiaries on the policy to ensure that family members of the patient receive the appropriate trauma counselling if required.

Basic Dental Trauma Benefit

• New benefit to cover urgent dental care for the partial or complete loss of one or more teeth as a result of sudden and unanticipated impact injury.
• Cover for approved dental appliances and/or dental prosthesis and the placement thereof within 30 days of the injury or accident.
• Subject to approval and an annual benefit limit of R58 000 per person. Subject to clinical entry criteria, treatment guidelines and protocols.
• Cover excluded on Essential Smart and KeyCare plans.

Discovery Health 2022 Contributions And Increases – New in 2022

Dyspepsia Management Programme

Scopes are currently covered with co-payments or limitations. In 2022, to promote the identification and appropriate treatment of dyspepsia (severe heart burn), and provide appropriate full cover options, this conservative care programme for out-of-hospital management of dyspepsia will include:

• Cover for additional tests and medicine for treatment of dyspepsia
• Referred and approved gastroscopies covered up to 100% of medical scheme rate, with no co-payment or deductible when completed within the Day Surgery Network.

Tonsillitis Management Programme

This is a new programme, starting in 2022, for the conservative out-of-hospital management of tonsillitis for dependants under the age of 16. It will include:

• An episode fee for treatment by an Ear Nose & Throat specialist (ENT).
• Telephone, virtual or face-to-face consultations with the treating ENT.
• Medication.
• Access to the TytoHome monitoring device, from the Home Monitoring Device Benefit, with funding of up to 75% of the cost of the device.
• If a tonsillectomy is referred and approved after conservative treatment, the deductible applicable to Priority plans will not be applied.

Anaesthetic Pre-Operative Management Programme

In 2022, this benefit will apply to major surgery such as arthroplasty, colorectal surgery, coronary artery bypass graft, radical prostatectomy and mastectomy. Cover is provided for out-of-hospital care to support the necessary pre-operative checks, including:

• A nurse led pre-operative assessment,
• Telephone, virtual or face-to-face consultations with the treating doctor,
• Specified pathology, radiology and lab tests, where required and directly related to the surgery and co-morbidities of the member,
• Individual clinical needs as determined by the treating professional.

For all three of the above programmes, clinical entry criteria, treatment guidelines and protocols apply.

2022 Limits, Co-Payments, Deductibles & Thresholds

Co-Payments and deductibles will be increased by 4.5% in line with the expected consumer price inflation.

Thresholds for the Above Threshold Benefit on the Executive, Comprehensive and Priority plans will be increased by 7.9% in line with medical inflation.

Benefit limits will be increased by 4.5% in line with expected consumer price inflation on 1 January 2022, with the exception of the following where there is no increase required for 2022 based on the expected utilisation of the benefits:

• Oncology threshold
• Specialised Medicine and Technology Benefit
• International Travel Benefit
• Overseas Treatment Benefit
• Optometry Benefit
• Prescribed Medication Benefit
• Dentistry Benefit

Discovery Health 2022 Contributions And Increases – Digital Communities

Discovery Health has partnered with myHealthTeams, a digital platform for patient communities. In a world where you can find any information, whether true or not, digital communities where patients share actual experiences will help guide patients looking for practical information. These communities include medical professionals who can share accurate clinical information.

Almost 500 000 Discovery Health members have Diabetes or heart disease, and about 22% of members have both. From 1 January 2022, members with these conditions will have access to the myDiabetesTeam and myHeartDiseaseTeam and these two communities will include Discovery moderators and myHealthTeam community moderators. In-House local and international medical experts will create content and resources for the communities, with regular blogs and live Q&A sessions.

From 1 February 2022, a new community will be set up by Discovery and myHealthTeams, for patients who have long Covid. This is not yet fully understood so having community members share their experiences is key and all experiences will help medical teams to support these members. The trend is that one in every ten Covid positive members experiences symptoms for longer than 3 weeks.

These community platforms will be accessible by all Discovery members, including family members, friends or caregivers of those diagnosed with heart disease, diabetes or long Covid. Registration on the Chronic Illness Benefit is not a pre-requisite to joining the community, and there is no additional joining cost. The communities can be accessed via the Discovery Connected Care platform on the corporate app, or via the myHealthTeams website via the “log in with Discovery” landing page. Watch a short YouTube Video Here.

2022 PMB and Chronic Benefits

For continuity and coordination of care, members who are registered for PMB (Prescribed Minimum Benefits) conditions and/or the Chronic Illness Benefit, will be required to nominate a primary care doctor to manage their condition. This doctor would then refer the patient to other medical professionals as required for the treatment of the condition.

Members are required to nominate this primary care doctor in 2022. The process for nominating the doctor will be communicated to affected members in January 2022 but the changes will only take effect on 1 May 2022.

Members that are registered on the Chronic Illness Benefit will be covered in full for consultations with their nominated primary care doctor and healthcare services referred by their nominated primary care doctor for the management of their conditions.

Should a member registered on the Chronic Illness Benefit opt not to nominate a primary care doctor, or a member voluntarily chooses to make use of a GP other than their nominated GP, the Scheme will cover the consultation and referred healthcare services up to 80% of the Discovery Health Rate.

KeyCare members must nominate their primary GP from the KeyCare GP network and Smart members must nominate a GP from the Smart GP network.

No out-of-network co-payment will apply for emergencies or involuntary use outside of the networks.

2022 Vitality Rates

The monthly rates for Vitality memberships in 2022 are below.

Vitality Vaccination Points in 2021

If you have been vaccinated in 2021, you will earn 2500 Vitality points. If your second vaccination dose is in 2022, you will be awarded the points retrospectively for 2021. These points should be awarded automatically, but if they are not showing, it is suggested that you update your vaccination record on Discovery’s vaccination navigator.

Pay-As-You-Gym in 2022 with Discovery Pay

Pay-As-You-Gym starts in 2022 and is available to all adult Vitality members who do not have an existing gym contract in place through Vitality. Members must activate Discovery Pay through the Discovery Bank app by activating an account with Discovery Bank. Use Discovery Pay to pay for your gym visits when you need them. For the first 6 months, pay-as-you-gym visits will be R75 or R100 per entry depending on the gym. This is available at all Virgin Active and Planet Fitness gyms except Virgin Active Collection. Members activating Discovery Pay will receive 3 free pay-as-you-gym visits as an introductory offer.

Discovery Pay allows you to use Discovery Bank to link your Discovery Bank accounts to:

• Instantly settle medical bills at pharmacies, hospitals, labs, and selected GP’s,
• Get access to Pay-as-you-Gym partners,
• Pay other Discovery clients using only their cellphone number, with no bank detail info exchanged.
• Access Vitality benefits such as Vitality Money, and additional discounts with Discovery Miles and Vitality Travel.

Vitality benefits

• Virgin Active and Planet Fitness contracts: adults up to 75% and children up to 50%,
• Ster Kinekor for adults: half price on 2D and 3D movies, and 25% on IMAX, Cine Prestige or NT Live,
• Ster Kinekor for children: free movies before 7pm once the online kids health questionnaire is completed,
• Flights: 15% to 35% depending on your Vitality Status, boosted to up to 75% with Discovery Bank,
• Hotel Accommodation: 25% on hotels within the Vitality network,
• Car Hire: 25%, unlimited.

The benefits below require action to maximise your rewards. Your discount starts at 10%, increases to 15% when you complete the Vitality Age questionnaire, and to 25% with a Vitality Health Check.

• HealthyFoods: increasing up to 75% as you achieve Active Rewards goals.
• HealthyCare, HealthyBaby: increasing up to 50% as you achieve Active Rewards goals.
• ActiveGear: sports gear and equipment has a maximum discount of 25% with the Health Check. Fitness devices and Nike gear and apparel can be boosted up to 50% with Active Rewards goals and up to 75% with Discovery Bank.
• HealthyDining: maximum discount 25% with the Health Check.

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Disclaimer: The information and opinions in this document have been recorded and arrived at in good faith and from sources believed to be reliable, but no representation or warranty, expressed or implied, is made to their accuracy, completeness or correctness. The information is provided for information purposes only and should not be construed as the rendering of advice. Informed Healthcare Solutions accordingly accepts no liability whatsoever for any direct, indirect or consequential loss arising from the use of this document or its contents. IHS is a licensed financial service provider: FSP # 12239