| GIB NEWS |
| Discovery Health Increase 2010 |
20 October 2009 |
 Discovery Health Increase 2010
The average increase across the Discovery Health plans is 9.8%.
The following table reflects the increase per Plan for 2010:
| Options 2010 | Average Increase | | Executive | 10.0% | | Classic Comprehensive | 9.9% | | Classic Priority | 9.8% | | Classic Saver | 9.8% | | Classic Delta Saver | 9.8% | | Classic Delta Core | 9.8% | | Classic Core | 9.9% | | Essential Comprehensive | 9.8% | | Essential Priority | 9.9% | | Essential Saver | 9.9% | | Essential Delta Saver | 9.9% | | Essential Delta Core | 9.8% | | Essential Core | 9.8% | | Coastal Saver | 9.9% | | Coastal Core | 9.8% | | KeyCare Plus | 9.9% | | KeyCare Core | 9.9% |
Key Plan Changes for 2010
Thresholds
Thresholds, pertinent only to Executive, Comprehensive and Priority Plans, have changed as per the table below:
| Plan Type | Threshold (Adult) | Threshold (Child) | | Executive | R8 580 | R1 632 | | Comprehensive | R7 700 | R1 450 | | Priority | R6 800 (P) R5 070 (Sp) | R2 250 |
Insured Network Benefit
Members on the Executive, Comprehensive and Priority plans will have unlimited GP consultations in the Discovery GP network and blood tests requested by a GP or specialist who use the Discovery Health pathology form.
Once members on the Saver plans have depleted their annual MSA, blood tests requested by a GP or specialist who use the Discovery Health pathology form will be paid for from risk and will have the following number of GP consultations in the Discovery Health GP network:
| Plan | Single Member | Member plus dependants | | Classic Saver | 3 GP visits per year | 6 GP visits per year | | Coastal Saver | 3 GP visits per year | 6 GP visits per year | | Essential Saver | 2 GP visits per year | 4 GP visits per year |
Oncology Benefit 2010
The Oncology benefit has been enhanced for 2010 so that all members except those on KeyCare will have access to the latest cancer treatments available subject to authorization:
| Plan | Enhanced Cover | | Executive and Comprehensive | 100% of cover up to R400 000, thereafter a 20% co-payment will apply with no overall annual limit. | | Priority, Saver and Core | 100% of cover up to R200 000, thereafter a 20% co-payment will apply with no overall annual limit. |
These limits will apply over a 12 month cycle from date of registration on the programme.
Priority Plan
The in-hospital upfront deductibles in 2010 are as follows:
| Procedure | Deductible | | Cataract surgery | R1 500 | | Conservative back and neck treatment | R1 500 | | Myringotomy (grommets) | R1 500 | | Tonsillectomy, adenoidectomy | R1 500 | | Gastroscopy | R2 000 | | Colonoscopy, sigmoidoscopy, proctoscopy | R2 000 | | Arthoscopy | R3 600 | | Functional nasal procedures | R3 600 | | Hysterectomy (not applicable to pre-operatively diagnosed cancer) | R3 600 | | Laproscopy, hysteroscopy, endometrial ablation | R3 600 | | Spinal (back and neck) surgery | R7 300 | | Joint replacements | R7 300 | | Nissen fundoplication (reflux surgery) | R7 300 |
Once you reach your annual threshold, Discovery will pay claims from the combined limited Above Threshold Benefit as per the following table:
| Principal Member | Spouse or Adult Dependant | Per Child (up to three children) | | R5 800 | R4 100 | R2 000 |
The Delta Range
In 2009 Discovery launched the Delta Range which comprised of the Saver and Core plans. This has now been extended to include the Comprehensive plans. The Delta Range comprises of a defined network of hospitals providing members access to quality private healthcare. As a member you are covered in full at a Delta Network Hospital for planned admissions. Should you choose to make use of one of the hospitals not in the Delta Hospital Network, you will pay an excess of R3 850 per event. In an emergency situation you will be taken to the closest private facility for treatment and will not be liable for the excess.
The KeyCare Series
• The Casualty Network co-payment has been reduced from R185 to R95.
• Scopes will be covered in doctor’s rooms, day clinics or in the KeyCare network of hospitals. Members will be advised when they phone the call centre to confirm benefits.
• Optipharm will be the designated service provider for KeyCare chronic members. Members may also obtain their chronic medication from their selected dispensing KeyCare GP. Members who choose to use other providers will have to pay a 40% co-payment on their medicines.
Discovery Health’s Financial Position
Discovery Health has reached its 25% solvency requirement and now has in excess of R6 billion rands in reserve. Additionally, they are currently the only Medical Scheme to have achieved the industry ceiling for their claims paying ability i.e. +AA rating from an independent rating agency, Global Credit Ratings.
Look out for the 2009 GIB Vitality newsletter which will be out next week.
Should you have any questions or queries on any of the above then please do not hesitate to contact your GIB Health Care consultant on 011 483 1212.
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