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 33471.

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.

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

Prescribed Minimum Benefits (PMB)

Afrox Subsidy for 2015

Afrox Company Subsidy for 2015

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

The monthly company subsidy amount has been increased by 6% for 2015 as follows:

Medical Scheme Increases for 2015

Medical Scheme Increases for 2015

Medical scheme Average Increase Range of Increases

8.59% 6.14% - 11.8%

7.2%* 5.4% - 9.8%*

Compcare Wellness 8.9% 8.9%

9.7% 9.9% - 10.9%

10.6% 10.6% - 29.9%

11.5% 0% - 15%

9.5%

12.8%

7.9% 3.5% - 10.8%

*risk increase

Benefit Changes and Product Enhancements for 2015

Benefit Changes for 2015

Limits, thresholds & deductibles 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.

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

P e r s o n a l H e a l t hP r o g r a m m e s

I n t e r n a t i o n a l s e c o n do p i n i o n

D i s c o v e r y H o m e c a r e

V i r t u a l c o n s u l t a t i o n s

H e a l t h y C a r e ( e n h a n c e d t h r o u g h V i t a l i t y )

W e a r a b l e h e a l t h a n d f i t n e s s d e v i c e s

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

1. Available to all DHMS members2. Subject to clinical criteria3. Available from 1 January 2015, limited

to Gauteng initially4. Access to services:

• Treating doctor• Qualified HomeCare Consultant• www.discovery.co.za

DISCOVERY HOMECARE | Quality home-based nursing services for members

• Available to mothers who agree to be discharged one day early from hospital

• Includes three home visits or one home visit and two night nurse visits

• Benefits will pay from risk

• Includes cover for venous ulcers, diabetic foot ulcers and pressure sores

• Cover for dressing, drainage, irrigation, suture removal and vac therapy

• Benefits paid from risk in lieu of hospitalization, no limit applies

• End of life, palliative care offered in partnership with Hospice Palliative Care Association

• Benefits paid from the compassionate care benefit up to the plan benefit limit

• Home IV infusion set up and administration of antimicrobials, biologics, IV iron and immunoglobulins

• Benefits paid from risk in lieu of hospitalization, no limit applies

• Provision of short term care services and includes temporary relief for caregivers looking after members healthcare needs

• Benefits paid for by members

Post- natal care

Palliative care

Home IV infusions

Respite Care

Wound Care

International Second Opinion

Funding for Wearable Health and Fitness Devices

Discovery Health on Call: Virtual Consultations

DISCOVERY HEALTH ON CALL | Virtual Consultations through the member app

A v a i l a b l e f r o m2 0 F E B R U A R Y 2 0 1 5

Members can consult with GPs to whom they have given HealthID consent

Accessed through the Discovery member app

A discounted consultation fee applies and will be paid from day-to-day benefits

Access to alternative 24/7 Health on Call GP if preferred GP has consented and is unavailable

KeyCare and Core plan members will need to self-fund the consultation

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)

• Removed:• Bloemfontein Eye Centre (Free

state)• Barberton Medi-Clinic (MP)

• Added:• Cape Eye Hospital (WC)• Genesis Clinic (Gauteng)• Horizon Eye Centre (Free state)• Barberton Private Hospital (MP)• Life Piet Retief (MP)• Mediclinic Brits (NW)

Discovery Health Product Range for 2015

Discovery Health Product Range

ComprehensiveClassic/ EssentialDelta200%/ 100%Chronic: 61MSA: 0%/15%/ 25%Threshold

PriorityClassic/ Essential200%/ 100%Chronic: 26MSA: 15%/25%Limited Threshold

SaverClassic/ Essential/ CoastalDelta200%/100%Chronic: 26 MSA: 15%/25%

CoreClassic/ Essential/ CoastalDelta200%/100%Chronic: 26No MSA

KeycarePlus/ Core/ Access100%Chronic: 26NetworksPrimary care

Delta Plan Range

Comprehensive Saver Core

10% premium reduction

20% premium reduction

Delta Hospital Network

Gauteng - PretoriaBougainvilleLegaeLittle Company of MaryLouis PasteurFemina

Kwa-Zulu NatalChatsmedEntabeniEthekwiniMidlands Medical Centre WestvillePlus 10 day clinicsWestern Cape

Cape Town Medi-ClinicMitchells PlainPanoramaVergelegenVincent PallottiPlus 19 day clinics

GautengArwypBedford GardensBrenthurstCarstenhofClinix – LesediClinix - SebokengClintonGenesisFourwaysLenmedMorningsideRobinsonRoseacresThe Donald GordonWilgeheuwel+ 49 day clinics

Free StateRoseparkUniversitasHorizon Eye CentrePlus 3 day clinics

Gauteng - VaalMidvaalEmfuleniSuikerbosrand

Eastern CapeLife New Mercantile

Deductible of R5 950 if non-Delta hospital usedMed X-Press must be used for chronic medication, or 20% co-payment

Core Plan Series

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 R200 000, thereafter

20% co-payment• MedXpress designated service provider for chronic medication - new Screening and Prevention• Screening tests – blood glucose, blood pressure,

cholesterol, BMI• Mammogram, pap smear, PSA, HIV

No Day to Day Cover

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• 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

Chronic Illness Benefit• Cover for 26 conditions• Subject to formulary or lower chronic drug amount• MedXpress is DSP on Delta Plan• Oncology Limit R200 000, thereafter 20% co-payment

Trauma Recovery Extender Benefit

Medical Savings Account• Pays day-to-day

medical costs• Full annual deposit

available up front• Classic: 25% • Essential: 15%• Coastal: 25%

No Above Threshold Benefit

Insured Network Benefit GP’s Single

FamilyClassic & Coastal 3 visits

6 visitsEssential 2 visits

4 visits

Maternity BenefitClassic plans 8 antenatal consults

two 2D scans

Screening and Prevention• Screening tests – blood glucose, blood pressure, cholesterol, BMI• Mammogram, pap smear, PSA, HIV

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 710 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

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

Chronic Illness Benefit• Cover for 26 conditions• Subject to formulary or lower chronic drug amount• Oncology Limit R200 000,

thereafter 20% co-payment

Trauma Recovery Extender Benefit

Above Threshold Benefit (ATB)• 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 2015 ATB Limits

PM: 10 980 PM: 9 340

Adult: 8 250 Adult: 6 650Child: 3 590 Child: 3 210

Medical Savings Account• Classic: 25% • Essential: 15%

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 GapScreening and Prevention• Screening tests – blood glucose, blood pressure, cholesterol, BMI• Mammogram, pap smear, PSA, HIV

Deductibles applicable to the following procedures:

Priority Plan In Hospital Deductibles

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

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 R400 000,

thereafter 20% co-payment• Specialised Medicine &

Technology: R200 000• Overseas Treatment

Benefit: R500 000

Trauma Recovery Extender Benefit

Medical Savings Account• Classic: 25% • Essential: 15%• Zero : 0%

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 levelThreshold 2015PM: 12 590

Adult: 12 590

Child: 2 380

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 GapScreening and Prevention• Screening tests – blood glucose, blood pressure, cholesterol, BMI• Mammogram, pap smear, PSA, HIV

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

R4 547 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

The following chronic conditions are covered on all plans:

PMB Chronic Illness Benefit

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

The following additional chronic conditions apply to Comprehensive and Executive plans only:

Additional Chronic Conditions

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

KeyCare Plan Series

KeyCare Hospital Network

Critical hospital

care

Plannedhospital 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

KeyCare Hospital Network

KeyCare Hospital Network Contracted state hospitals KeyCare Hospital Network

KeyCare Plus KeyCare Access KeyCare Core

Cover for antenatal services and specialist consultations

*A network of 32 private hospitals

KeyCare Plan Series

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

Unlimited planned hospitalisation at a network hospital only, otherwise there is no benefitHomecare - newOncology cover for PMB’s

Unlimited emergency hospitalisation - Any hospital, transfer to network hospital once stable

Covers 26 chronic conditions subject to formulary and approved network supplier or their dispensing doctor. A 20% co-pay applies outside of the network.

Critical hospital care

Plannedhospital care

Chronic Illness Benefits

Day-to-day medical care

Screening and prevention

Vitality & KeyFIT

KeyCare Plan Contributions

Plan option Income bracket Main member

Spouse/adult dependant

Child dependant

Keycare Plus (R361 – R7 050) R764 R764 R276

(R7 051 – R10 000) R1 069 R1 069 R300

(R10 001+) R1 592 R1 592 R426

Keycare Core (R0 – R7 050) R611 R611 R158

(R7 051 – R10 000) R762 R762 R187

(R10 001+) R1 176 R1 176 R265

Keycare Access

(R0 – R4 400) R538 R538 R235

(R4 401 – R7 050) R718 R718 R258

(R7 051 – R10 000) R1 036 R1 036 R292

(R10 001+) R1 556 R1 556 R420

KeyCare Income includes basic plus employer retirement fund contribution

Vitality Changes for 2015

Vitality Changes for 2015

E n h a n c e d H e a l t h y L i v i n g b e n e f i t s

E n h a n c e d p h y s i c a l a c t i v i t y p l a t f o r m

M o r e w a y s t o e a r n p o i n t s

HealthyLiving Benefit

10% cash back at both partners 15% cash back at preferred

partnercash back at preferred partner

O N L I N E A C T I V A T I O N

O N L I N E A S S E S S M E N T

P H Y S I C A L A S S E S S M E N T

www.discovery.co.za

www.discovery.co.za

www.discovery.co.za

Online Nutrition Assessment

(www.discovery.co.za)

Vitality Age(www.discovery.co.za)

Online Fitness Assessment

(www.discovery.co.za)

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)

HealthyCare

Up to 25% cashback on only Schedule 1

and 2 medicines

2014 M E D S A V E R C H R O N I C A R E

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

Physical Activity Platform

Wellness Journey through Pregnancy

Admed Gap Cover for 2015

New Admed Gap Cover Range

Option 1 Option 2 Option 3 Option 4

500% of Scheme Tariff 500% of Scheme Tariff 500% of Scheme Tariff 500% of Scheme Tariff

Additional Benefits: Additional Benefits: Additional Benefits: Additional Benefits:

Text – a – doctor Shortfall Benefit - Unlimited Shortfall Benefit - Unlimited Shortfall Benefit - Unlimited

Text – a – doctor Cancer Benefit – R25 000 lump sum on any cancer diagnosis

Cancer Benefit – R25 000 lump sum on any cancer diagnosis

Personal Accident cover – R25 000

Personal Accident cover – R25 000

Text – a – doctor Oncology Benefit – 20% co payments limited to R250 000

Shortfall Sub-limit Benefit – R30 000

Text – a – doctor

R105 per family R113 per family R126 per family R139 per family

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 0860 102 936 or by e-mail on admed@guardrisk.co.za

Admed Gap Cover

For factual product information and first time queries:

Discovery Health Call Centre

Tel: 0860 100 694 (24hrs)

E-mail: healthinfo@discovery.co.za

Website: www.discovery.co.za

For plan advice and escalated queries:

Alexander Forbes Health Member Service Unit

Tel: 011 269 2690 (08h00 to 17h00)

Email: hcclientservices@aforbes.co.za

For more information benefit comparisons and rate calculators visit the Afrox medical scheme website on www.afhealth.co.za/afrox

Important Contact Details

THANK YOU