DISCOVERY HEALTH 2015.

Name: DISCOVERY HEALTH 2015.
Uploaded: 2017-07-18T09:38:20+00:00
Duration: PTM44S33
Channel: Edward Emil Stewart
Description: DISCOVERY HEALTH 2015.

DISCOVERY HEALTH 2015

Agenda AF Health’s Commitment to You FAIS Requirements
Medical Scheme Increases for 2015 Afrox Subsidy for 2015 Benefit Changes and Product Enhancements for 2015 Discovery Health Product Range Vitality Changes for 2015 Admed Gap Cover

AF Health’s Commitment to You

AF Health’s Commitment to You
To you we provide: Assistance in choosing the correct medical scheme option, based on your needs. Clarification of benefits and the escalation of any unresolved medical scheme queries. Liaison with your medical scheme on your behalf to ensure you are treated fairly and correctly, based on your benefit entitlements. To your employer we provide: Industry updates that could affect your business and members. Strategic consulting

FAIS Requirements Alexander Forbes Health is an approved Financial Services Provider – FSP Alexander Forbes Health is accredited by the Council for Medical Schemes – ORG 3064. All information provided in this presentation is factual and NO advice is provided. General Disclosure and Product Supplier Disclosures are available upon request. Alexander Forbes Health are appointed brokers to administrators and open medical schemes (actuarial and consulting services). Alexander Forbes Health complaints procedure is included in the attendance register pack.

Prescribed Minimum Benefits (PMB)
Medical Schemes Act requires that all medical schemes provide cover for a defined list of prescribed minimum benefit (PMB) conditions. Cover for 26 chronic and 270 other conditions needs to be provided in full with no co-payments. Specific criteria and protocols define entry as a PMB condition. All Emergencies / Life threatening conditions are PMB’s – any providers Non emergency PMB’s – schemes may use designated service providers Keycare Hospitals on all plans except Delta Delta Hospitals for Delta plans Selected service providers Where non DSP’s are utilised co-payments may apply

Afrox Subsidy for 2015

Afrox Company Subsidy for 2015
The monthly company subsidy amount has been increased by 6% for 2015 as follows: Family Composition Monthly Company Subsidy Amount 2014 Monthly Company Subsidy Amount 2015 Principal (main) Member R988 R1047 Spouse/Partner (Adult) R778 R825 Child (up to age 21 years) R395 R419 Only one spouse/partner subsidised Child dependants subsidised up to a max. of 3 Adult children aged 21 to 25 in full time study and who are financially dependent on the principal member will be subsidised at the adult rate

Medical Scheme Increases for 2015

Medical Scheme Increases for 2015
Average Increase Range of Increases 8.59% 6.14% % 7.2%* 5.4% - 9.8%* Compcare Wellness 8.9% 9.7% 9.9% % 10.6% 10.6% % 11.5% 0% - 15% 9.5% 12.8% 7.9% 3.5% % *risk increase

Benefit Changes and Product Enhancements for 2015

Benefit Changes for 2015 Benefit limits, co-payments and deductibles increase by 9.9%. MRI/CT scan co-payments increase by 6.1%. Annual thresholds increase by between 6.7% and 10.9%. Oncology thresholds remain constant. KeyCare income band thresholds have been restructured. Limits, thresholds & deductibles Chronic medicine changes CIB medicine list and CDAs for 2015 updated to reflect price changes. To be implemented for existing members in July 2015 and for new members 1 January 2015. MedXpress MedXpress becomes the DSP for chronic medicine on Core plans. To be implemented for existing members in July 2015 and for new members 1 January 2015. 20% co-payment will apply otherwise. Members will be able to select in-store pick up for their chronic and acute medicines from Dischem, Clicks and MediRite pharmacies.

Product Enhancements for 2015
Personal Health Programmes International second opinion Discovery Homecare Virtual consultations HealthyCare (enhanced through Vitality) Wearable health and fitness devices

Personal Health Programmes
Eligibility Enrolment Member of DHMS Registered for CIB Diabetes Type 1 and Type 2 Hypertension Hyperlipidaemia Ischaemic Heart Disease Vitality membership not required Heart Health Diabetes From 1 January 2015 Accept invitation for Personal Health Programme from Premier Practice GP Self-enrolment with Premier Practice GP Member eligibility and enrolment for Personal Health Programmes

Personal Health Programmes

Discovery Homecare

International Second Opinion

Funding for Wearable Health and Fitness Devices

Discovery Health on Call: Virtual Consultations

Doctor Appointments: Access GP Diary

Hospital Network Update
Delta Plans KeyCare Plans Removed: Life Claremont (WC) Life Kingsbury (WC) Added: Vincent Palotti (WC) Genesis Clinic (Gauteng) Horizon Eye Centre (Free state) Bloemfontein Eye Centre (Free state) Barberton Medi-Clinic (MP) Cape Eye Hospital (WC) Barberton Private Hospital (MP) Life Piet Retief (MP) Mediclinic Brits (NW)

Discovery Health Product Range for 2015

Discovery Health Product Range
Comprehensive Classic/ Essential Delta 200%/ 100% Chronic: 61 MSA: 0%/15%/ 25% Threshold Priority Classic/ Essential 200%/ 100% Chronic: 26 MSA: 15%/25% Limited Threshold Saver Classic/ Essential/ Coastal Delta 200%/100% Chronic: 26 MSA: 15%/25% Core Classic/ Essential/ Coastal Delta 200%/100% Chronic: 26 No MSA Keycare Plus/ Core/ Access 100% Chronic: 26 Networks Primary care

Comprehensive Saver Core
Delta Plan Range Comprehensive Saver Core 10% premium reduction 20% premium reduction

Delta Hospital Network
Gauteng - Pretoria Bougainville Legae Little Company of Mary Louis Pasteur Femina Kwa-Zulu Natal Chatsmed Entabeni Ethekwini Midlands Medical Centre Westville Plus 10 day clinics Western Cape Cape Town Medi-Clinic Mitchells Plain Panorama Vergelegen Vincent Pallotti Plus 19 day clinics Gauteng Arwyp Bedford Gardens Brenthurst Carstenhof Clinix – Lesedi Clinix - Sebokeng Clinton Genesis Fourways Lenmed Morningside Robinson Roseacres The Donald Gordon Wilgeheuwel + 49 day clinics Free State Rosepark Universitas Horizon Eye Centre Plus 3 day clinics Gauteng - Vaal Midvaal Emfuleni Suikerbosrand Eastern Cape Life New Mercantile Deductible of R5 950 if non-Delta hospital used Med X-Press must be used for chronic medication, or 20% co-payment

Core Plan Series No Day to Day Cover Hospital Benefit
Covers approved hospitalization with no overall limit Full cover when using specialists on a payment arrangement Classic: 200% of Discovery Health Rate Essential/Coastal: 100% of Discovery Health Rate MRI on back and neck treatment or not related to the hospital admission is not covered Home Care - new Chronic Illness Benefit Cover for 26 conditions Subject to formulary or lower chronic drug amount Oncology Limit R , thereafter 20% co-payment MedXpress designated service provider for chronic medication - new No Day to Day Cover Screening and Prevention Screening tests – blood glucose, blood pressure, cholesterol, BMI Mammogram, pap smear, PSA, HIV

Core Plan Contributions
Member Classic Core Classic Delta Core Essential Core Essential Delta Core Coastal Core Main Member R1 617 R1 294 R1 389 R1 110 R1 195 Spouse/ Adult Dependant R1 272 R1 018 R1 040 R833 R896 Child Dependant R646 R517 R557 R445 R477

Saver Plan Series Hospital Benefit No Above Threshold Benefit
Covers approved hospitalization with no overall limit Full cover when using specialists on a payment arrangement Classic: 200% of Discovery Health Rate Essential/Coastal: 100% of Discovery Health Rate Home Care - new No Above Threshold Benefit Insured Network Benefit GP’s Single Family Classic & Coastal 3 visits 6 visits Essential 2 visits 4 visits Maternity Benefit Classic plans 8 antenatal consults two 2D scans Chronic Illness Benefit Cover for 26 conditions Subject to formulary or lower chronic drug amount MedXpress is DSP on Delta Plan Oncology Limit R , thereafter 20% co-payment Medical Savings Account Pays day-to-day medical costs Full annual deposit available up front Classic: 25% Essential: 15% Coastal: 25% Screening and Prevention Screening tests – blood glucose, blood pressure, cholesterol, BMI Mammogram, pap smear, PSA, HIV Trauma Recovery Extender Benefit

Saver Plan Contributions
Member Classic Saver Classic Delta Saver Essential Saver Essential Delta Saver Coastal Saver Main Member R2 172 R1 734 R1 725 R1 378 R1 710 Spouse/ Adult Dependant R1 368 R1 294 R1 036 R1 282 Child Dependant R869 R697 R690 R552 R688 Annual MSA (PAC) R14 244 R11 388 R6 660 R5 316 R11 028

Priority Plan Series Above Threshold Benefit (ATB) Hospital Benefit
Limited ‘safety-net’ for day-to-day expenses Paid by the scheme at the Discovery Health rate once day-to-day claims reach certain level Threshold ATB Limits PM: PM: Adult: Adult: Child: Child: Hospital Benefit Covers approved hospitalisation with no overall limit Full cover when using specialists on a payment arrangement Classic: 200% of Discovery Health Rate Essential: 100% of Discovery Health Rate Home Care - new Defined procedures attract deductibles Insured Network Benefit GP -100% cost through network during SPG Pathology at DSP & Maternity on Classic option Defined list of external medical items on Classic & Essential plans Self Payment Gap Chronic Illness Benefit Cover for 26 conditions Subject to formulary or lower chronic drug amount Oncology Limit R , thereafter % co-payment Screening and Prevention Screening tests – blood glucose, blood pressure, cholesterol, BMI Mammogram, pap smear, PSA, HIV Medical Savings Account Classic: 25% Essential: 15% Trauma Recovery Extender Benefit

Priority Plan In Hospital Deductibles
Deductibles applicable to the following procedures: Deductibles 2014 2015 Conservative back and neck treatment, myringotomy (grommets), tonsillectomy, adenoidectomy R2 150 R2 350 Colonoscopy, Proctoscopy, Sigmoidoscopy, Gastroscopy, Cystoscopy R2 850 R3 150 Arthroscopy, functional nasal procedures, hysterectomy, endometrial ablation, laparoscopy, hysteroscopy R5 150 R5 650 Reflux surgery, spinal surgery (back and neck) surgery and joint replacements R10 500 R11 550

Priority Plan Contributions
Member Classic Priority Essential Priority Main member R2 478 R2 130 Spouse/adult dependant R1 950 R1 672 Child dependant R992 R850 Annual MSA (PAC) R16 248 R8 352

Comprehensive Plan Series
Above Threshold Benefit (ATB) Unlimited ‘safety-net’ for day-to-day expenses subject to certain sub-limits Paid by the scheme at the Discovery Health rate once day-to-day claims reach certain level Threshold 2015 PM: Adult: Child: Hospital Benefit Covers approved hospitalisation with no overall limit Full cover when using specialists on a payment arrangement Classic: 200% of Discovery Health Rate Essential: 100% of Discovery Health Rate Home Care - new Chronic Illness Benefit Cover for 61 conditions (27 CDL & 34 ADL) Oncology Limit R , thereafter 20% co-payment Specialised Medicine & Technology: R Overseas Treatment Benefit: R Insured Network Benefit GP, external medical items – all options except Classic Comp Zero MSA Maternity, pathology & Preferred Medicine – on Classic & Classic Delta plans at designated service providers Self Payment Gap Screening and Prevention Screening tests – blood glucose, blood pressure, cholesterol, BMI Mammogram, pap smear, PSA, HIV Medical Savings Account Classic: 25% Essential: 15% Zero : 0% Trauma Recovery Extender Benefit

Executive Plan Hospital Benefit Above Threshold Benefit (ATB)
Covers approved hospitalisation with no overall limit Specialists in hospital paid up to 300% of the Discovery Health Rate from MSA/ATB Private ward cover R1 500 per day HomeCare - new Above Threshold Benefit (ATB) Unlimited ‘safety-net’ for day-to-day expenses subject to certain sub-limits Paid by the scheme at the Discovery Health rate once day-to-day claims reach certain level Threshold 2015 PM: Adult: Child: Chronic Illness Benefit Cover for 61 conditions (27 CDL & 34 ADL) Additional Medicines covered Oncology Limit R , thereafter 20% co-payment Specialised Medicine & Technology: R Overseas Treatment Benefit: R Insured Network Benefit GP, Pathology, Preferred Medicines, external medical items & maternity benefit 100% cost through network during SPG Medical Savings Account - 25% No gap between MSA and ATB A self payment gap can occur Specialists covered up to 300% of Discovery Health rate Screening and Prevention Screening tests – blood glucose, blood pressure, cholesterol, BMI Mammogram, pap smear, PSA, HIV Trauma Recovery Extender Benefit

Comprehensive and Executive Plan Contributions
Member Executive Plan Classic Comp Classic Delta Comp Essential Comp Essential Delta Comp Classic Zero MSA Main Member R4 547 R3 696 R3 329 R3 105 R2 796 R2 772 Spouse/ Adult Dependant R3 496 R3 149 R2 936 R2 642 R2 622 Child Dependant R863 R737 R662 R625 R561 R553 Annual MSA (PAC) R29 868 R23 784 R21 408 R11 976 R10 788 R0

PMB Chronic Illness Benefit
The following chronic conditions are covered on all plans: 1 Addison’s disease 14 Epilepsy 2 Asthma 15 Glaucoma 3 Bronchiectasis 16 Haemophilia 4 Bipolar Mood Disorder 17 HIV/AIDS 5 Cardiac Failure 18 Hyperlipedaemia (High Cholesterol) 6 Cardiomyopathy 19 Hypertension (High Blood Pressure) 7 Chronic Obstructive Pulmonary Disease (Emphysema) 20 Hypothyroidism (Inactive Thyroid Gland) 8 Chronic Kidney Disease 21 Multiple Sclerosis 9 Coronary Artery Disease 22 Parkinson’s Disease 10 Crohn's disease 23 Rheumatoid Arthritis 11 Diabetes Insipidus 24 Schizophrenia 12 Diabetes Mellitus (Type 1 & 2) 25 Systemic Lupus Erythomatosis 13 Dysrhythmia (Irregular Heartbeat) 26 Ulcertative Colitis

Additional Chronic Conditions
The following additional chronic conditions apply to Comprehensive and Executive plans only: 1 Ankylosing spondylitis 18 Paget’s disease 2 Behçet’s disease 19 Panic disorder 3 Connective tissue disorder (mixed)* 20 Paraplegia* 4 Cushing’s disease* 21 Pemphigus* 5 Cystic fibrosis* 22 Peripheral arteriosclerotic disease* 6 Delusional disorder* 23 Pituitary microadenomas* 7 Dermatopolymyositis 24 Polyarteritis Nodosa* 8 Generalised anxiety disorder 25 Post traumatic stress disorder* 9 Huntington’s disease 26 Psoriatic arthritis* 10 Hypoparathyroidism* 27 Pulmonary interstitial fibrosis 11 Major depression 28 Quadriplegia* 12 Motor neurone disease* 29 Sjögren’s syndrome 13 Muscular dystrophy and other inherited myopathies* 30 Stroke* 14 Myasthenia gravis* 31 Systemic sclerosis 15 Obsessive compulsive disorder 32 Thrombocytopaenia purpura* 16 Organ transplantation* 33 Valvular heart disease* 17 Osteoporosis 34 Wegener’s granulomatosis Medicine list change New formulary Must register/ formulary /CDA

KeyCare Plan Series KeyCare Plus KeyCare Access KeyCare Core KeyFIT
KeyCare Hospital Network Critical hospital care Planned hospital care Chronic Illness Benefits Day-to-day medical care Screening and prevention KeyFIT KeyCare Hospital Network for emergencies and trauma; KeyCare Access Hospital Network* for child birth and care of newborns Contracted state hospitals KeyCare Plus KeyCare Access KeyCare Core Cover for antenatal services and specialist consultations *A network of 32 private hospitals Antenatal Benefit covers you at 100% of the Discovery Health Rate for the following healthcare services: • Four visits to a GP or gynaecologist at a network hospital • One routine scan (between 10 and 20 weeks) • Selected blood tests requested by your gynaecologist or GP We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 450 for each family.

KeyCare Plan Series Vitality & KeyFIT
Critical hospital care Planned Chronic Illness Benefits Day-to-day medical care Screening and prevention Vitality & KeyFIT Unlimited emergency hospitalisation - Any hospital, transfer to network hospital once stable Unlimited planned hospitalisation at a network hospital only, otherwise there is no benefit Homecare - new Oncology cover for PMB’s Covers 26 chronic conditions subject to formulary and approved network supplier or their dispensing doctor. A 20% co-pay applies outside of the network. Day to day benefits through Discovery Health provider network: GP consultations and minor procedures Medication subject to formulary Basic blood tests and x-rays Basic dentistry Basic optometry, frames and lenses Members may elect a secondary GP per beneficiary One out of network visit per beneficiary per annum Specialist Benefit- R3 000 pppa Antenatal benefit- 4 consults; 1scan, selected blood tests Mobility device benefit – R4 700 per family Casualty benefit - fee for all Keycare casualty units is R250 Trauma Recovery (Access and Plus) & screening benefit Antenatal Benefit covers you at 100% of the Discovery Health Rate for the following healthcare services: • Four visits to a GP or gynaecologist at a network hospital • One routine scan (between 10 and 20 weeks) • Selected blood tests requested by your gynaecologist or GP We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 450 for each family.

KeyCare Plan Contributions
Plan option Income bracket Main member Spouse/ adult dependant Child dependant Keycare Plus (R361 – R7 050) R764 R276 (R7 051 – R10 000) R1 069 R300 (R ) R1 592 R426 Keycare Core (R0 – R7 050) R611 R158 R762 R187 R1 176 R265 Keycare Access (R0 – R4 400) R538 R235 (R4 401 – R7 050) R718 R258 R1 036 R292 R1 556 R420 KeyCare Income includes basic plus employer retirement fund contribution

Vitality Changes for 2015

Vitality Changes for 2015 Enhanced HealthyLiving benefits
Enhanced physical activity platform More ways to earn points Antenatal Benefit covers you at 100% of the Discovery Health Rate for the following healthcare services: • Four visits to a GP or gynaecologist at a network hospital • One routine scan (between 10 and 20 weeks) • Selected blood tests requested by your gynaecologist or GP We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 450 for each family.

HealthyLiving Benefit
10% cash back at both partners 15% cash back at preferred partner ONLINE ACTIVATION ONLINE ASSESSMENT PHYSICAL ASSESSMENT Online Nutrition Assessment ( Vitality Age Online Fitness Assessment Body Composition Assessment (Can be completed as part of the Vitality Health Check or Vitality Fitness Assessment) Vitality Health Check (Can be completed at a wellness day, Clicks or Dis-Chem pharmacy, or other accredited providers) Vitality Fitness Assessment (Can be completed at a biokineticist within the Vitality Wellness Network) Antenatal Benefit covers you at 100% of the Discovery Health Rate for the following healthcare services: • Four visits to a GP or gynaecologist at a network hospital • One routine scan (between 10 and 20 weeks) • Selected blood tests requested by your gynaecologist or GP We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 450 for each family.

HealthyCare Up to 25% cashback on only Schedule 1 and 2 medicines 2014 MEDSAVER CHRONICARE 25% cashback on ChroniCare items Available to all DHMS members Available to DHMS members registered for CIB Over-the-counter medicine Baby care Dental care Eye care Foot care Sun care Clinic services Chronic care Fitness and wellbeing Self care Emergency care Products to stop smoking 2015 10% for all DHMS members and up to 25% back for Vitality members on over 12,000 HealthyCare items: AND Antenatal Benefit covers you at 100% of the Discovery Health Rate for the following healthcare services: • Four visits to a GP or gynaecologist at a network hospital • One routine scan (between 10 and 20 weeks) • Selected blood tests requested by your gynaecologist or GP We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 450 for each family.

Physical Activity Platform
Antenatal Benefit covers you at 100% of the Discovery Health Rate for the following healthcare services: • Four visits to a GP or gynaecologist at a network hospital • One routine scan (between 10 and 20 weeks) • Selected blood tests requested by your gynaecologist or GP We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 450 for each family.

Wellness Journey through Pregnancy
Antenatal Benefit covers you at 100% of the Discovery Health Rate for the following healthcare services: • Four visits to a GP or gynaecologist at a network hospital • One routine scan (between 10 and 20 weeks) • Selected blood tests requested by your gynaecologist or GP We cover wheelchairs, wheelchair batteries and cushions, transfer boards and mobile ramps, commodes, long-leg calipers, crutches and walkers on the medical equipment list, if you get them from a network provider. There is an overall limit of R4 450 for each family.

Admed Gap Cover for 2015

New Admed Gap Cover Range
Option 1 Option 2 Option 3 Option 4 500% of Scheme Tariff Additional Benefits: Text – a – doctor Shortfall Benefit - Unlimited Cancer Benefit – R lump sum on any cancer diagnosis Personal Accident cover – R25 000 Oncology Benefit – 20% co payments limited to R Shortfall Sub-limit Benefit – R30 000 R105 per family R113 per family R126 per family R139 per family

Admed Gap Cover All existing Admed members to be defaulted to Option 4 effective 1 January 2015, if no option change form stating otherwise is submitted. All existing employees have the option to join Admed effective from 1 January 2015 – debit order application form to be completed. The following waiting periods will apply to all employees electing to join Admed effective from 1 January 2015: Birth related claims – 10 months Specific procedures (unless as a result of an accident) – 0% benefit for first six months and 50% benefit for second six months Existing Admed members wishing to change or cancel their Admed coverage are to contact Guardrisk directly on or by on

Important Contact Details
For factual product information and first time queries: Discovery Health Call Centre Tel: (24hrs) Website: For plan advice and escalated queries: Alexander Forbes Health Member Service Unit Tel: (08h00 to 17h00) For more information benefit comparisons and rate calculators visit the Afrox medical scheme website on

So folks, I trust that we have spurred your thinking today.
THANK YOU

Client Sign Off Client Name: _____________________________
Date of presentation: ______________________ Presented by: ____________________________ Signature: _______________________________ Designation: _____________________________

DISCOVERY HEALTH 2015.

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