Discovery 2016 PrimaryCare. To make people healthier and enhance and protect their lives.

Slides:



Advertisements
Similar presentations
Choose a Healthcare Plan Taylor Bohl, Mia Feldmann, Jaclyn Saltzman, Cara Venegoni.
Advertisements

Health Insurance Options and Benefits.
Midland Memorial Hospital 2014 Employee Health Benefits.
Insurance.  Many people in the US are uninsured – assume all responsibility for health care costs.  Insurance decreases out of pocket expenses for health.
CapitationCapitation. Determination of Premium Rates Benefit Payments –Paid to providers Risk Premiums –Profit earned by payer as a function of accepting.
What is Health Insurance? Health insurance is a contract between a consumer and an insurance company. Health coverage helps people pay for medical costs.
NIADA Health Insurance Exchange and Defined Contribution Plans Webinar brought to you by the NIADA Health Insurance Exchange and administered by JLBG Health.
The BT Retirement Saving Scheme (BTRSS)
Patient Protection and Affordable Care Act Notification of Exchange / Marketplace (Thirty (30) Hour Rule) Presented by Dr. Michael B. Brinkos Michael Garofalo.
What is the marketplace? Preventive care Hospitals Physicians Prescription drugs Mental health Rehabilitation Habilitation services Substance abuse Dental.
Employee Health Benefits Indiana State Personnel Department Benefits Division.
The Health Care Industry Part 2 - Medical Insurance Karen F. Nichols, MSA School of Allied Health Professions University of Nebraska Medical Center.
Health Savings Accounts How our plan works and its benefits for employees Presentation Subtitle/Description Presenter’s Name Date.
Copyright ©2004 Pearson Education, Inc. All rights reserved. Chapter 11 Health and Disability Insurance.
Health Savings Accounts (HSAs) Everything You Need to Know.
Benefits Overview for Employees Planning to Retire Employee Health & Benefits 114 State House Station Augusta ME (207) or
Health Insurance Law and You Mr. Blais. Managed Care Plans These involve arrangements between the insurance companies and a certain network of health-care.
Hospital Deductible Insurance (HDI) Supplementary “Gap” Coverage Complementing High Deductible Health Plans (“HDHPs”)
Flexible Spending Accounts Information for the Plan Year of: January 1 – December 31, 2014.
1 Health Benefits Under COBRA Consolidated Omnibus Budget Reconciliation Act of 1985 U.S. Department of Labor Employee Benefits Security Administration.
Healthcare Reform A look into the Affordable Care Act (ACA) and what it means to you. Presented by Bill Scuorzo President & CEO.
1 Health Insurance Briefing 22 July 2010 CHANGES IN THE HEALTH INSURANCE PROGRAMMES
Health Care Delivery Systems. Health Insurance Coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance.
Standard 7.01 Classify types of health insurance and features of types of coverage.
September 2013 HEALTH SAVINGS ACCOUNTS OUR PLAN AND ITS BENEFITS FOR EMPLOYEES.
Good health can change the world DISCOVERY 2015 PrimaryCare.
THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. Affordable Care Act Basics Signed into law by President Obama on March 23, The Supreme Court rendered.
Health Insurance.
Medical Insurance. Overview  Many people in the US are uninsured – they assume all responsibility for health care costs.  The number of uninsured is.
20 - 1Copyright 2008, The National Underwriter Company Types of Individual Health Insurance Coverage  What is it?  Provides reimbursement for certain.
The content of this Power Point is designed only for communication purposes and is not to be considered a contract, nor does it guarantee or imply coverage.
Overview of CISI Benefits & Procedures For the Participants of Rotary International 2012.
Ivy Tech Community College Limited Medical Insurance Plans.
Health Insurance Mr. Peterson.  st=PLAEF1F13C29ACCC01&index=1&feature=plpp_vide o
Health Insurance Health Care Systems. Intro:  You are climbing with friends down in the canyon, suddenly you slip and fall. You cannot stand on your.
Copyright ©2004 Pearson Education, Inc. All rights reserved. Chapter 11 Health and Disability Insurance.
1 Chase Smith Health Insurance. 2 Health Insurance Facts 85 of 100 Americans are currently covered by a government based health insurance or private health.
Agribusiness Library LESSON: HEALTH INSURANCE. Objectives 1. Determine the function of health insurance, and define common health insurance terms. 2.
Insurance. Health Insurance  Many people in the US are uninsured – assume all responsibility for health care costs.  Insurance decreases out of pocket.
2 Understanding Managed Care: Insurance Plans.
Overview of CISI Benefits & Procedures For the Participants of Rotary International 2011.
1 Annual Enrollment Presented by Stephanie Bell School of Medicine.
Health Insurance Chapter 45 Employee Benefit & Retirement Planning Copyright 2011, The National Underwriter Company1 What is it? The most widespread employee.
Ivy Tech Community College Limited Medical Insurance Plans.
© 2013 Sapers & Wallack, Inc. All rights reserved. sapers-wallack.com Tel: ACA: "Cliffs Notes" for the Busy Employer How do you meet the compliance.
 Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared.
New COBRA subsidy as a result of the American Recovery and Reinvestment Act of 2009 (ARRA) Effective 2/17/09.
Health Care in Australia Medicare and Private Health Insurance.
DI Retirement Security Helping you continue saving for retirement in the event of a disability.
DWP New State Pension Delivery Programme Van Demosthenous Date:Tuesday 23 September 2014 State Pension Changes and the Ending of Contracting-Out.
Participation in all aspects of the Agent Benefits Program that are offered through AXA Advisors and AXA Network is entirely voluntary, and each participant.
CAMPBELL COUNTY EMPLOYEES BENEFIT PLAN Status Update September 2014.
Medicare Open Enrollment For Coverage in 2016 Starts October 15, 2015 Ends December 7, MEDICARE Medicare.gov.
Proposal to Medical Scheme/Administrator Index of the presentation  Brief resume of SP Net  Service offering by SP Net to Medical Scheme/Administrator.
Implications for School Systems.  Employer Mandate ◦ Schools systems with 50 or more employees will be required to provide insurance to all full-time.
Participation in all aspects of the Agent Benefits Program that are offered through AXA Advisors and AXA Network is entirely voluntary, and each participant.
HSA Educational Meeting July 13, Agenda  Why consider a HDHP/HSA plan offering?  What is an QHDHP?  What is an HSA?  HSA Contributions  How.
Ivy Tech Community College Limited Medical Insurance Plans
Boston University Student Health Insurance Plan
Effective Delivery of Small Group Level Funded Plans
Open Enrollment 2017 Please Note: The information contained in this presentation is summary information only. Please refer to your benefit plan documents.
Who pays for today’s healthcare?
Post-Employment VEBA.
Health Plan Overview & Updates
Open Enrollment 2018 Please Note: The information contained in this presentation is summary information only. Please refer to your benefit plan documents.
Open Enrollment 2018.
Ivy Tech Community College Limited Medical Insurance Plans
ADMINISTRATION.
Ivy Tech Community College Limited Medical Insurance Plans
Towards cost-effective delivery Within an insurance system
Presentation transcript:

Discovery 2016 PrimaryCare

To make people healthier and enhance and protect their lives

RankEmployees’ needs 1Transport 2Housing 3Food 4Health 5Insurance 6Clothing Access to private healthcare benefits the employer and the employee EmployeesEmployers Private healthcare meets employees’ needs Source: Stats SA IES survey, 2010/2011 Increased productivity of healthier employees Source: Discovery research For employers, the productivity gains derived from improvements in employee health justify the investment in basic occupational and primary care

Private healthcare remains unaffordable for employees earning less than R6 450 per month Medical scheme membership, % Private healthcare is unaffordable Medical scheme membership becomes affordable Monthly income

Employers and employees prioritise primary care when faced with affordability constraints Priority of healthcare servicesPriority of baskets of services Employees’ prioritisation 1 st 2 nd 3 rd 4 th 5 th 6 th Emergency hospital care GP care Optometry In-patient hospital care Dentistry Specialist care 1 st 2 nd Primary Care services Full hospital cover

DISCOVERY PRIMARYCARE No exclusions or waiting periods No individual application forms No chronic application Seamless billing integration Seamless claims experience Employer training

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry Additional services for employees Access to discounted maternity global fee Discovery Wellness Day Onsite occupational health services (quotation on request) Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT Discovery PrimaryCare is not a medical scheme

Extending affordable access to private healthcare through Discovery PrimaryCare Discovery PrimaryCare is not a medical scheme PrimaryCare Contributions with a 50% employer subsidy Contributions Proportion of income

Discovery PrimaryCare | Legal framework #1 …not a medical scheme …not an insurance product #2 #3 …not a financial product Discovery PrimaryCare is not a medical scheme as it does not fall within the ambit of the definition of “business of a medical scheme” in section 1 of the Medical Schemes Act. The term “business of a medical scheme” is defined in section 1 of the Medical Schemes Act to mean: “the business of undertaking liability in return for a premium or contribution – a)To make provision for the obtaining of any relevant health service; b)To grant assistance in defraying expenditure incurred in connection with the rendering of any relevant health service; and c)Where applicable, to render a relevant health service either by the medical scheme itself, or by any supplier or group of suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical scheme.” There needs to be an undertaking of liability to trigger an inquiry into whether a person is conducting “the business of a medical scheme”. Discovery does not undertake liability in the implementation of Discovery PrimaryCare as Discovery enters into agreements with healthcare professionals as agents for and on behalf of employers and it does not undertake any liability towards healthcare professionals. This position will not be affected when the amended definition of a “business of a medical scheme” in the Financial Services Laws General Amendments Act comes into operation. Discovery PrimaryCare is not an insurance product as it does not fall within the ambit of either the definition of a “health policy” under the Long-Term Insurance Act or the definition of an “accident and health policy” under the Short-Term Insurance Act. Discovery in its capacity as agent of the employer, is not undertaking to provide benefits upon the occurrence of health events in return for a premium. One of the key elements of insurance is the taking on of liability or risk by the insurer. In the Discovery PrimaryCare model, Discovery does not take on liability or risk. Discovery PrimaryCare does not fall within the ambit of the definition of a financial product as contemplated in the Financial Advisory and Intermediary Services Act. Discovery PrimaryCare is… #4 … an employer-funded primary healthcare service provision model Discovery PrimaryCare is an employer-funded primary healthcare service provision model, developed, administered, and managed by Discovery, that allows employers to provide employees falling below the stated income threshold with access to quality and affordable primary healthcare.

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry R209 per employee per month excl. VAT Unlimited access to chosen * PrimaryCare GP National network of PrimaryCare GPs *Employees must choose a GP from the network to be their allocated GP

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry R209 per employee per month excl. VAT Dispensed by employee’s PrimaryCare GP Dispensed from defined list of medication

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry R209 per employee per month excl. VAT Medicine for: ‒ Hypertension ‒ Hyperlipidaemia ‒ Asthma ‒ Diabetes ‒ HIV Dispensed from formulary through Clicks

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry R209 per employee per month excl. VAT Access to a network of providers Available through referral by employee’s PrimaryCare GP

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry R209 per employee per month excl. VAT Access to ambulance services in case of an emergency Employees will be transported to the nearest state facility

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry R209 per employee per month excl. VAT Included in the standard contract fee Consultations, fillings and tooth removals at a dentist in our national network

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry R209 per employee per month excl. VAT Included in the standard contract fee One eye test every year in our designated optometry network One pair of glasses or the contact lens equivalent every 24 months

Discovery PrimaryCare Additional services for employees Access to discounted maternity global fee Discovery Wellness Day Onsite occupational health services (quotation on request)

Discovery PrimaryCare Additional services for employees Access to discounted maternity global fee Discovery Wellness Day Onsite occupational health services (quotation on request) R once-off cost Package of private care for maternity, including consultations and delivery, in a network of private hospitals Funded by employer or employee

Discovery PrimaryCare Additional services for employees Access to discounted maternity global fee Discovery Wellness Day Onsite occupational health services (quotation on request) Access to the Discovery Wellness Day which covers all essential biometric and health screenings (incl HIV VCT) Post-Wellness Day reporting is provided, giving employers valuable insight into their employees’ state of health and wellbeing

Discovery PrimaryCare Additional services for employees Access to discounted maternity global fee Discovery Wellness Day Onsite occupational health services (quotation on request) Discovery Health and its preferred sub-contracted providers can provide a comprehensive range of workplace health and wellness services

Discovery PrimaryCare Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request Discovery PrimaryCare is not a medical scheme

Discovery PrimaryCare Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT Single billing platform Billing and reconciliation integrated with Discovery Health Medical Scheme

Discovery PrimaryCare Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT Discovery will provide the employer with the required training to assist employees in accessing their benefits

Discovery PrimaryCare Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT Monthly healthcare utilisation reporting Integrated with existing Discovery Health Medical Scheme wellness reporting, if applicable

Discovery PrimaryCare Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT Discovery will provide the employer with appropriate marketing material to communicate the available services to employees

Discovery PrimaryCare Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT Discovery will pay the healthcare provider directly and therefore: there is no need for employees to submit claims to Discovery; and the employee experiences no out-of- pocket expenses on the services provided

Discovery PrimaryCare Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT Discovery can arrange for an occupational health and wellness review on request

Discovery PrimaryCare Healthcare services for employees GP visits Prescription medicine Chronic medicine Basic pathology Basic radiology Ambulance service Dentistry Optometry Additional services for employees Access to discounted maternity global fee Discovery Wellness Day Onsite occupational health services (quotation on request) Management service for employers Integrated billing Training Integrated healthcare usage reports Communication and marketing Seamless claims experience Occupational health and wellness consulting on request R209 per employee per month excl. VAT *Figures quoted inclusive of VAT Discovery PrimaryCare is not a medical scheme

Discovery PrimaryCare | Tax implications Employer Employee The extent to which the employer subsidises the monthly PrimaryCare fee represents a fringe benefit in the hands of the employee If an employee earns less than R6 138 per month, there is no tax implication for the employee The full cost of the PrimaryCare fee is tax deductible for the employer, irrespective of whether it is fully subsidised or not The employer will be able to claim back the VAT portion of the service fee

Discovery PrimaryCare | Eligibility criteria A minimum of 25 employees to be enrolled on Discovery PrimaryCare Defined in line with the employer’s recruitment criteria Employees’ spouses and dependants will not be eligible Discovery PrimaryCare can only be accessed through an employer that is contracted to Discovery Health Employers will need to provide access to these services on a compulsory basis to existing employees (with a three month open period) as well as all new qualifying employees Which employees are eligible to join Discovery PrimaryCare?

Discovery PrimaryCare | New business process Financial adviser completes Discovery PrimaryCare quote request form for eligible employers and submits it via their Discovery business consultant. Discovery will issue a Discovery PrimaryCare offer letter and the PrimaryCare Quotation to the financial adviser and employer with details on: Services to be provided Implementation date Fees Discovery will draw up the Discovery PrimaryCare employer contract once we get confirmation that the quote has been accepted. The Discovery business consultant will be assigned to engage on implementation.

Discovery PrimaryCare | Implementation process On-boarding employees Determining the list of employees that will be making use of the contracted healthcare services Employer training Training will be provided to employer representatives on healthcare services available, service rules, network of healthcare providers and servicing of the contract Employee communication Discovery will provide the employer with marketing collateral, information on participating healthcare providers and healthcare services which can be used to educate employees on the services that they have access to through Discovery PrimaryCare Ongoing administration The employer will be invoiced on a monthly basis based on up-to-date staff records in accordance with current Discovery Health billing arrangements Annual contract renewal and price reviews The contract will automatically renew at the start of the calendar year One calendar month’s notice of termination of the contract is required The employer will be notified of the calendar year increase in the last quarter of the year On contract renewal, the fee per employee per month will automatically adjust to reflect the increases in cost of providing these services

Discovery 2016 PrimaryCare