Increases for 2016
New Products
YourHealth Platform
Introducing the YourHealth Platform – Restructuring of Supplementary and Preventative Benefits. Bonitas market feedback indicates that the current Supplementary Benefits within the suite of Bonitas’ options
serve as a differentiation to competing products. In order to enhance this differentiation, the Supplementary
Benefits have been redesigned and enriched as part of the 2016 product offering.
The YourHealth platform comprises of four components:
4. Wellness Extender
This component serves as an incentive to encourage all adult beneficiaries to complete the twopart
HRA. Completion of the HRA will:
Introducing the YourHealth Platform – Restructuring of Supplementary and Preventative Benefits. Bonitas market feedback indicates that the current Supplementary Benefits within the suite of Bonitas’ options
serve as a differentiation to competing products. In order to enhance this differentiation, the Supplementary
Benefits have been redesigned and enriched as part of the 2016 product offering.
The YourHealth platform comprises of four components:
- Preventative Care
- Provides access to a range of tests, with a focus on primary screening and immunisation.
- Managed care policies are applied to ensure that access is limited to those who derive greatest benefit from these tests (E.g. the pap-smear benefit is limited to females between the ages of 21 and 65 years.)
- The range of tests has been extended to all other options, whilst maintaining a level of differentiation between the options to ensure affordability.
- Provides access to certain healthcare providers for specific screening and consultations.
- Current supplementary benefits have been included in this component, including the International Travel benefit.
- In line with the theme of beneficiary activism, the online “YourHealth Portal” will be promoted as part of this component. This portal contains health-related information that is available to all beneficiaries on the Scheme.
- Provides access to a health risk assessment (HRA) that provides a “dipstick” health status for each beneficiary.
- Allows for the early identification and management of lifestyle diseases.
- A lifestyle questionnaire: This includes a behavioural change readiness component and provides members with an immediate view of their cardiovascular risk, their lifestyle risk factors and mental health status.There is no charge for this online assessment, and this can be completed by beneficiaries at any time.
- Wellness screening,The clinical tests that are covered in this assessment include the following:
- Blood Pressure
- Body Mass Index
- Finger prick random cholesterol test
- Finger prick random glucose test
4. Wellness Extender
This component serves as an incentive to encourage all adult beneficiaries to complete the twopart
HRA. Completion of the HRA will:
- Provide access to additional consultations at select healthcare professionals for continued care based on the results of the health risk assessment, subject to the overall limit.
- Provide access to wearable devices and smoking cessation programmes, subject to the overall limit.
- Ensure completion of the HRA prior to accessing this component. Beneficiaries will have to register to access this benefit. (This component is not available to beneficiaries on BonCap).
- The Wellness Extender benefit limit progresses from Essential to BonComprehensive to ensure
Product ENHANCEMENTS
Option Changes
Standard: Simplify Day-to-day Benefit Structure
The Fund has maintained the savings benefit for the 2016 year, but has simplified the structure of the dayto- day benefits by separating the various sub-limits into stand-alone benefits.
• The GP benefit will now be a stand-alone benefit, paid exclusively from risk.
• The savings component will also increase by CPI inflation.
• Non-GP day-to-day claims will be paid from current savings first. Once savings are depleted, the member can access the Non-GP day-to-day risk benefit, which will be a separate benefit limit over and above savings.
• The overall day-to-day benefit (including savings) is the sum of the GP and Non-GP sub-limits and thus increases from 2015 to 2016 by an inflationary 5.2%, as shown below. However, from the 2014 level, the overall benefits have increased by 29.6% from R6 800 to R8 812
The Fund has maintained the savings benefit for the 2016 year, but has simplified the structure of the dayto- day benefits by separating the various sub-limits into stand-alone benefits.
• The GP benefit will now be a stand-alone benefit, paid exclusively from risk.
• The savings component will also increase by CPI inflation.
• Non-GP day-to-day claims will be paid from current savings first. Once savings are depleted, the member can access the Non-GP day-to-day risk benefit, which will be a separate benefit limit over and above savings.
• The overall day-to-day benefit (including savings) is the sum of the GP and Non-GP sub-limits and thus increases from 2015 to 2016 by an inflationary 5.2%, as shown below. However, from the 2014 level, the overall benefits have increased by 29.6% from R6 800 to R8 812
BonComprehensive: Removal of co-payments in Threshold
A BonComprehensive principal member currently has to self-fund R997 worth of day-to-day claims (the‘self-funding gap’) once their savings are depleted. Thereafter, the benefit is unlimited and paid from the
Threshold benefit, subject to a 25% member copayment.Due to the profile of members on BonComprehensive placing great value on convenience and simplicity, the Scheme has received feedback that members would prefer not to pay a copayment in Threshold and rather have a higher self-funding gap.
For 2016, the co-payment in Threshold is removed, while the self-funding gap is increased to R3 428 per principal member. The revised self-funding gap is expected to allow for additional utilisation in Threshold
due to the removal of co-payments.The 2016 BonComprehensive Threshold restructure is shown below:
A BonComprehensive principal member currently has to self-fund R997 worth of day-to-day claims (the‘self-funding gap’) once their savings are depleted. Thereafter, the benefit is unlimited and paid from the
Threshold benefit, subject to a 25% member copayment.Due to the profile of members on BonComprehensive placing great value on convenience and simplicity, the Scheme has received feedback that members would prefer not to pay a copayment in Threshold and rather have a higher self-funding gap.
For 2016, the co-payment in Threshold is removed, while the self-funding gap is increased to R3 428 per principal member. The revised self-funding gap is expected to allow for additional utilisation in Threshold
due to the removal of co-payments.The 2016 BonComprehensive Threshold restructure is shown below:
BonCap: Unlimited GP visits subject to managed care protocols
Based on this improving performance trend, the Scheme has decided not to make any drastic changes to the structure of the BonCap option for 2016, in order to avoid instability.
The only enhancement that will be made will be the changing of the GP consultation benefit from 12 visits per beneficiary to unlimited visits at network GP’s. However, the following managed care protocols will be
introduced:
• Pre-authorisation required from the 8th visit.
• Beneficiaries can see up to 2 different family practitioners.
• Beneficiaries identified as seeing more than 2 providers will be contacted and managed.
The more intensive management of the utilisation of the GP benefit is expected to reduce over-utilisation and ‘GP-hopping’, promote coordination of care and ultimately reduce downstream hospitalisation costs.
Repositioning of the chronic disease lists
In order for chronic disease lists per option to align with benefit richness, Bulimia Nervosa, Motor Neuron Disease and Thromboangitis Obliterans will be removed from the BonClassic chronic disease list. No members are currently registered for these diseases. Cystic Fibrosis, Deep Vein Thrombosis and Dermatomyositosis will be removed from BonClassic and added to BonComprehensive. Furthermore, Alzheimer’s disease will be added to the BonComprehensive chronic disease list.
Implementing a single chronic medicine formulary for the Standard option
Currently, a Comprehensive formulary is applied when a member claims from the chronic benefit limit. A Restricted formulary is then applied for claims beyond the chronic benefit limit. In 2016 the Comprehensive
medicine formulary will be applied throughout in order to ensure that there are no breaks or unnecessary changes in the treatment of the individual’s chronic disease.
Increased cochlear implant benefit limits
Cochlear implant benefit limits will be increased in 2016 from R168 000 to R250 000 on the BonComprehensive, BonClassic and Standard options. This will ensure that the benefit is better aligned to
the average market cost of cochlear implants.
Removal of co-payment associated with laparoscopic nephrectomy
There is currently a R2 500 co-payment associated with laparoscopic nephrectomy procedures on theBonSave, Primary and BonEssential options. In 2016, this co-payment will be removed. The cost of the
laparoscopic procedure has declined in recent years and as a result, is now cheaper than the open
procedure in most cases.
Introduction of ICPS as the preferred provider for hip and knee replacements on the BonClassic option
In 2016, ICPS will be introduced as the preferred provider for hip and knee arthroplasty on the BonClassic option, with a R5 000 co-payment if ICPS is not used. The co-payment for when ICPS is not used for hip
and knee arthroplasty on the Standard option will be increased from R1 500 to R5 000. This is to further incentivise members to use the more efficient ICPS providers for these procedures. All other monetary
benefit limits are to be indexed with an inflationary increase of 5.2%.
Based on this improving performance trend, the Scheme has decided not to make any drastic changes to the structure of the BonCap option for 2016, in order to avoid instability.
The only enhancement that will be made will be the changing of the GP consultation benefit from 12 visits per beneficiary to unlimited visits at network GP’s. However, the following managed care protocols will be
introduced:
• Pre-authorisation required from the 8th visit.
• Beneficiaries can see up to 2 different family practitioners.
• Beneficiaries identified as seeing more than 2 providers will be contacted and managed.
The more intensive management of the utilisation of the GP benefit is expected to reduce over-utilisation and ‘GP-hopping’, promote coordination of care and ultimately reduce downstream hospitalisation costs.
Repositioning of the chronic disease lists
In order for chronic disease lists per option to align with benefit richness, Bulimia Nervosa, Motor Neuron Disease and Thromboangitis Obliterans will be removed from the BonClassic chronic disease list. No members are currently registered for these diseases. Cystic Fibrosis, Deep Vein Thrombosis and Dermatomyositosis will be removed from BonClassic and added to BonComprehensive. Furthermore, Alzheimer’s disease will be added to the BonComprehensive chronic disease list.
Implementing a single chronic medicine formulary for the Standard option
Currently, a Comprehensive formulary is applied when a member claims from the chronic benefit limit. A Restricted formulary is then applied for claims beyond the chronic benefit limit. In 2016 the Comprehensive
medicine formulary will be applied throughout in order to ensure that there are no breaks or unnecessary changes in the treatment of the individual’s chronic disease.
Increased cochlear implant benefit limits
Cochlear implant benefit limits will be increased in 2016 from R168 000 to R250 000 on the BonComprehensive, BonClassic and Standard options. This will ensure that the benefit is better aligned to
the average market cost of cochlear implants.
Removal of co-payment associated with laparoscopic nephrectomy
There is currently a R2 500 co-payment associated with laparoscopic nephrectomy procedures on theBonSave, Primary and BonEssential options. In 2016, this co-payment will be removed. The cost of the
laparoscopic procedure has declined in recent years and as a result, is now cheaper than the open
procedure in most cases.
Introduction of ICPS as the preferred provider for hip and knee replacements on the BonClassic option
In 2016, ICPS will be introduced as the preferred provider for hip and knee arthroplasty on the BonClassic option, with a R5 000 co-payment if ICPS is not used. The co-payment for when ICPS is not used for hip
and knee arthroplasty on the Standard option will be increased from R1 500 to R5 000. This is to further incentivise members to use the more efficient ICPS providers for these procedures. All other monetary
benefit limits are to be indexed with an inflationary increase of 5.2%.
Source:Bonitas