Discovery releases 2017 fees

Discovery Health Medical Scheme has released its fees for 2017. The new fees come into effect on 1 January 2017. Medical aid fees for the scheme will increase between 10 and 15%, this falls within the estimated industry increase of 10 and 20%.

“The focus for Discovery Health Medical Scheme going into 2017 is to maintain the solid financial status of the Scheme whilst continuing to add value for members of the Scheme. This will be achieved through fair contribution and benefit increases, while developing solutions that keep healthcare affordable, and creating networks and benefits that enhance the quality of care, especially for those with heightened health risks,” said Milton Streak, principal officer of Discovery Health Medical Scheme.

The growth of the Smart Plan Series

The Smart Plan Series offers a cheaper health plan option. The medical scheme noted that innovations in technology are making it possible to develop healthcare plans that use smartphones to offer digitally enabled health plans.

Dr Jonathan Broomberg, CEO of Discovery Health, the administrator of the medical scheme, revealed the following about the growth of the Smart Plan Series in 2017: “Digital technology powered by smart algorithms and smart use of data are transforming the healthcare system. The smartphone environment allows a broader base of new members to access digitally enabled health plans with comprehensive benefits. We are excited about expanding the Smart Series to include the Discovery Health Medical Scheme Essential Smart Plan, which will offer access to a network of hospitals and GPs, with additional essential day-to-day benefits, such as dental check-ups, eye tests and screenings, for only R1 100 a month.”

The increases

Despite the growth and development of this affordable plan, there are a number of challenges facing the industry. Broomberg pointed out that one of these is the persistent and sharp rise in medical inflation.

With regards to the increases for 2017, Streak said: “The financial strength of Discovery Health Medical Scheme allows it to absorb the impact of adverse claims experience to a degree. Taking into account rising medical inflation heightened further by the increased use of medical services, contribution increases across options have been made equitable to maintain benefits and to ensure the long-term sustainability of the Scheme.”

According to Discovery, member contribution increases for 2017 are linked to medical inflation and healthcare tariff increases, taking into consideration the increased use of hospital and other services on certain plans. The increases are as follows:

• Executive and Comprehensive Plan contributions will increase by 11.9%
• The Coastal Core Plan will increase by 14.9%
• The Coastal Saver Plan will increase by 7.8%
• The remaining plans will increase by 9.9%

The medical aid highlighted that eight out of ten members of the scheme will experience an increase of 9.9% or lower, with the weighted average increase at 10.2%.

Streak added: “Across the range, benefits have increased and new services are being introduced, while Discovery Health Medical Scheme contribution increases have been on average one percent below the industry average since 2008. This has resulted in contributions that have remained up to 15% below the industry average. We expect Discovery Health Medical Scheme to maintain this competitive advantage, while continuing to give its members access to the best quality networks, cover and benefits in 2017.”

The changes

In 2017 there will be increases in affordability, cover and benefits.

The Smart Plan Series will expand to enable a lower price point through the use of networks, digital tools and health informatics. The Essential Smart Plan is an addition to the Smart Plan range, while the Smart Plan is being rebranded as the Classic Smart Plan.

Discovery medical scheme is also introducing DiabetesCare, which will comprise of four key elements:

1. A network of GPs who will provide diabetes care
2. Cover for biokineticist and dietitian visits
3. Integration with Vitality to encourage health promoting activities
4. A progress dashboard with information across providers and activities

“DiabetesCare aims to achieve well-coordinated care, and to provide information and motivation to manage diabetes,” said Discovery.

In other developments, Discovery noted: “Discovery Health Medical Scheme pays nearly R1 billion each year for major joint replacements. To improve the level and consistency of quality, a national network of doctors and hospitals have been contracted for elective hip and knee replacements. Members using this network will have full cover with no co-payments.

“In 2015, nearly 2 000 members were admitted to hospital each month for psychiatric reasons, many of them to non-specialised hospitals which do not have the facilities or resources to provide the care required for these patients. To improve the quality of care for psychiatric admissions, the Specialised In-hospital Psychiatry Network will be introduced. Admissions to hospitals in the Specialised In-hospital Psychiatry Network will be funded at 100% of the Discovery Health Medical Scheme’s rate.”

The medical scheme is also enhancing its screening and prevention benefits. This benefit will provide clinically appropriate screening for all members, with enhanced screening benefits for those at a higher risk.

“From April 2017, additional tests will be covered for members with blood glucose or cholesterol test results that are outside the recommended range. Members who need external medical items will also have access to an additional list of high-end items as part of the External Medical Items Extender Benefit. Thresholds for the Annual Threshold Benefit will be increased in line with plan-specific contribution increases,” added Discovery.

Broomberg concluded: “Discovery Health will continue its work to ensure Discovery Health Medical Scheme and other client schemes continue to deliver exceptional performance for the benefit of members. Discovery Health Medical Scheme offers extraordinary financial security, confirmed through exceeding the regulatory solvency requirement of 25% of gross annual contribution income and through its highest-possible credit rating of AA+ by Global Credit Rating. The enhancements and updates for 2017 reflect our commitment to maintain excellent affordability, sustainability and benefit levels.”

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