On 21st September 2022, Discovery hosted their virtual workshop with over 10,000 brokers, to announce Discovery's benefits and contribution updates for 2023. Below is a summary what you need to look forward to in 2023 for Discovery Health and Vitality. Discovery Health No increase in contributions until 01 April 2023 Every year, medical schemes increase contributions by medical inflation to meet the expected cost of healthcare claims in the following year. Discovery Health will only increase contributions for 2023 on 1 April 2023. Members will therefore enjoy 2023 benefits at 2022 rates, for the first three months of the year. The increase on 1 April 2023 will be in line with medical inflation, expected to range between CPI plus 3 - 4%, which would be about 10% increase. Discovery will only confirm the exact increase percentage and new premium in February 2023. 2023 Benefit updates
Introducing Essential Dynamic Smart Plan If you are a tech-savvy, then there’s good news! Discovery Health is introducing a new plan called Essential Dynamic Smart Plan in 2023, it only costs R1450 per month and it is personalized. It will connect a member with the most efficient hospital for their admission at a specific point in time. (Deductible/co-payment will occur if choosing other providers) Introducing the WELLTH Fund The WELLTH Fund enables members to better understand their health status. The fund does this by giving risk funding of up to R10,000 per family for a broad range of health screenings and preventive healthcare services – over and above the yearly Screening and Prevention Benefit. It is going to start from 01st January 2023 for 24 months. Simply unlock the benefit by having one health check-up. Vitality Highlights In 2023, Vitality will enhance its benefits to focus on monetizing healthy behaviour and encouraging good clinical outcomes to drive more engagement and better health. The Vitality HealthyWeight programme This new programme uses the latest trends in behaviour change to help members achieve their ideal and healthy weight through a personal nutrition coach, simple meal plans, recipes and shopping lists. Vitality members can access Vitality HealthyWeight at affordable rates, with all at risk Vitality members receiving higher additional discounts. The Easiest Way to Join Gym
If you have Discovery Bank, you can now join the gym with Vitality without any admin with the gym staff, you can simply activate the gym benefit on the App, and skip the gym activation fee! If you like to know more about your cover or review your current Option contact Tammy in our Health department tel (011) 658-1333 email: service@daberistic.com Source: Discovery
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All Medical aid Options would include: Accidental or emergency medical hospitalisation, maternity benefits, chronic illness benefits, oncology benefits, mammogram screening (once every 2 years), pap smear screening (once every 3 years), and prostate cancer screening (once a year). Below we detail each cover and how it works. Hospitalisation Whether your medical aid option is a hospital plan or a savers plan, as long as you are hospitalized in South Africa and obtain the hospitalization pre-authorization, you are covered. In case of emergency hospitalization, the hospital will contact the Medical aid company directly and obtain authorization When hospitalized, the hospital bill and the doctors’ bills are separate. In the case of elective hospitalization (planned procedure), the Medical Aid company will pay the hospital bill in full (in most of the cases). In terms of doctor's fees, medical aid company will pay according to the scheme rate. For example, if the scheme rate for a certain operation is R5,000, but the doctor can decide how much to charge. If the doctor charges R15,000, the Medical Aid company will only pay R5,000, and the remaining R10,000 is your liability. If you have Gap Cover, the the co-payment can be claimed back. If the patient is hospitalized due to an accident, an emergency or critical illness (such as cerebral hemorrhage), the doctor does not charge more than scheme rate, and the Medical Aid company will pay for the medical cost, and this is unlimited. In addition to applying for pre-authorization for hospitalization, you can also apply for pre-authorization with the Medical Aid company if you need to do endoscopy (as out-of-hospital) so that the Medical Aid company will settle the medical expenses. It should be noted that if your endoscopy is done in a hospital or a day hospital, you will need to pay a co-payment; If it is done in the doctor's room, there won’t be a co-payment. What should you do if the doctor asks you to request for pre-authorization? You need to ask the doctor for the following information and provide it to the Medical Aid company: • Medical aid membership number • Name the patient • Reasons for hospitalization or surgical items • Date and time of admission • Name and practice number of doctor • Hospital name and practice number • ICD10 codes and procedure codes Maternity Benefit If you have confirmed your pregnancy with your doctor, you can activate the maternity benefits with the Medical Aid company. After that, your medical aid would compensate 8 maternity check-ups up to scheme rate (about R480). Each obstetrician and gynecologists' charges different fees, you will then need to pay the amount exceeding the scheme rate. If your Gap Cover is with Sirago Ultimate option, 4 out of the 8 times, you may claim back the difference paid. Chronic Benefit If you are diagnosed with chronic illness, you can ask your medical aid broker for a chronic illness benefit application form, and ask your doctor to fill it out and send it to the Medical Aid company (or send it to the broker, who will send it to the Medical Aid company). In this way, you can go to the pharmacy for medicine every month, and the Medical Aid company will pay for the medicine. Cancer If you are diagnosed with cancer, you need your oncologist to provide a treatment plan and histology report to the Medical Aid company. Once the oncology benefit is activated, the first R200k of each cycle (12 months) will be paid in full, up to scheme rate. After that, Medical Aid company will pay 80%, and the remaining 20% will be your own expense. (if you have Gap Cover, the 20% co-payment amount can be claimed back) If your Gap Cover is Sirago's Ultimate option, the Gap cover will also compensate you R25k. Day-to-day Medical Expenses - Medical Savings If you are on a Savers option (or higher), you can enjoy day-to-day benefits. Every January, Discovery gives you your full-year savings which you may use throughout the year, if the savings are not used up by the end of the year, it gets rolled over to the next year and you can accumulate it and earn interest. If you are on a Priority, Comprehensive, or Executive plan, you also enjoy the Above Threshold Benefits, given that you have paid up the Self Payment Gap. What can you use Medical Savings for? You can use your Medical Savings for any out-of-hospital medical-related expenses, including but not limited to doctors' consultations, over-the-counter medication, dentists, glasses, certain co-payments (scopes, out-of-hospital CT/MRI scans), etc. Once the savings are used up, you will then need to pay for the medical expenses from your own pocket, until January the following year. Written by: Tammy Hua If you would like to review your Medical Aid option contact Tammy email: service@daberistic.com (tel)11)658-1333 Ext 106 The concept of day hospitals is gaining popularity – particularly because of high hospital stay costs. Day Hospital are there to drive down the cost of procedures affordable. They are also known as Outpatient Surgery Centres which is option of having short stay/day surgical. A day hospital satisfies the patient’s need for a convenient, efficient and lean-cost facility, without compromising on quality clinical care. Advantages of day hospitals 1. No overnight stay – patients are admitted, operated on, and discharged on the same day 2. Child-friendly wards and facilities – day hospitals are the ideal alternative for children requiring same day surgery as the trauma of overnight stays are eliminated. 3. Lower risk of infection – since patients return home on the same day, the risks of cross infection are reduced, which results in a shorter recovery 4. Improved surgery scheduling – decrease in waiting lists 5. More efficient Doctors - Surgeons and anaesthetists are able to plan operating times, thereby increasing their productivity. Internationally there is a trend in increased day surgery for multiple reasons including: • Improved anaesthesia (with quicker recovery period) • Improved pain control (anaesthetic blocks and improved medication) • Instrumentation and procedures (keyhole surgery). Examples of price differences There remains a difference in costs between day and acute hospitals,’ says Callakoppen. The table below represents savings across some of the most prevalent surgeries. Examples of price differences There remains a difference in costs between day and acute hospitals,’ says Callakoppen. The table below represents savings across some of the most prevalent surgeries. This is probably why the percentage of day cases, split between acute hospitals and day hospitals, is still biased toward acute hospitals. Currently the split of day cases being done in acute hospitals is 74% and 26% in day hospitals. This implies that 74% of all procedures which could be performed in a day hospital are currently performed in acute facilities.
If you would like to know if your option covers for a Day procedure, please contact Jo or Namhla in our Health Department email: service@daberistic.com tel(011)658-1333 When to take a test and when will it get covered? You’re covered for 2 COVID-19 Polymerase Chain Reaction (PCR) screening tests every calendar year (1 January to 31 December), regardless of the outcome of the test. Medical Aid will pay for COVID-19 diagnostic tests, provided that the member who took the test:
Will you have to pay upfront and submit a claim for it to be paid from this benefit? This depends on the payment arrangements your medical aid have with your healthcare provider. If your healthcare provider submits a claim on your behalf, your medical aid will reimburse them directly subject to meeting the clinical entry criteria of the benefit. If your doctor requires you to pay upfront, you can submit your claim to your medical aid. What does it mean if I test positive for the PCR test? A positive PCR result confirms that you are infected and that you can spread it to others. You would need to contact your doctor to discuss the implications of this finding and the next steps to take, whether this be to self-isolate at home and/or on your planned hospital admission. If I test Positive, how do I self-isolate and for how long do I self-isolate? If you are infected and are asymptomatic i.e. you show no symptoms, you must stay at home and self-isolate for 10 days from the date of your positive test. In case of severe respiratory illness or severe shortness of breath you need to immediately consult with your doctor or go to the nearest hospital emergency unit. In case of severe disease, you will probably be hospitalised, and you would need to continue to self-isolate for 10 days after clinical stability is achieved. If I test positive for Antibody test, will I have immunity to COVID-19 infections in the future? As COVID-19 is a new virus, we cannot tell for sure how long antibodies will last or how well they can protect against future infections. Even though it is believed that a person will have some level of immunity after infection, which is the scientific principle that the development of a vaccine is based on. However, all individuals should still adhere to recommendations by the department of health on social distancing, hygiene, and personal protection, regardless of their antibody test result. How am I covered for COVID-19? This benefit, available on all plans, is covered by the scheme for cases of outbreak diseases and out of hospital healthcare services related to COVID-19. These healthcare services are covered up to maximum of 100% of your chosen medical scheme’s rate in accordance with Prescribed minimum benefits where applicable. Am I covered if I am in a waiting period? The scheme resolved to change its’ approach to underwriting for the duration of the outbreak, specifically with regards to cover for COVID-19. Members that are diagnosed with COVID-19 after joining will have access to the benefit, even if they are subject to a waiting period at the time of being diagnosed with COVID-19. Members that are diagnosed with COVID-19 before joining the scheme will not have access to the benefit and will be subject to waiting period to protect the scheme and its members against anti-selection. Emergency care – When should I call 911 or go to the emergency department? Call ER24 on 084124 if you are experiencing potentially life-threatening symptoms. These are some of the symptoms for which you should immediately call ER24;
What if I’m afraid to go to the emergency department? We understand those fears, but emergency department staff members wear personal protective equipment, and all places are fully cleaned and disinfected. Please note, that waiting too long to seek care for some health care emergencies is a bigger risk than the chance of contracting COVID-19. How do I know I won’t get COVID-19 in the emergency department? Depending on the urgency of the patient’s medical needs, everyone entering the emergency department is immediately screened for symptoms of COVID-19. How do I know I won’t contract COVID-19 if I need to stay in the hospital for treatment?
All labour and delivery patients – How are women protected whom come in for labour and delivery? In order to prevent the spread of COVID-19 and protect the health of all patients and staff members, testing for COVID-19 and taking precautions for each woman who is admitted to labour and delivery for delivery. The care team will follow special infection prevention procedures and wear proper personal protective equipment. Depending on the woman’s COVID-19 test results, she may be cared for in a special room and according to COVID-19 guidance for deliveries. What to expect when you go to the hospital During the COVID-19 pandemic, we have extra measures in place to prevent the spread.
Registration for COVID-19 Vaccine Acting health minister Mmamoloko Kubayi-Ngubane has announced a major boost to South Africa’s Covid-19 vaccination plans, with vaccines now being made available to more age groups and on weekends. Kubayi-Ngubane said that the government had also agreed to open vaccine registrations to people in the 35 – 49 age group.
All staff will be vaccinated, even if you’re not part of Discovery health, if they are part of company staff list, then they are eligible to receive vaccination. Should you be interested, please contact us and we will assist to communicate with Discovery to action Discovery Vaccination programme for employers.
Vaccination during riots and civil unrest period Please note that some of the vaccination sites that are affected are temporarily closed due to looting, riots and civil unrest. The vaccination rollout will be delayed but still encourage all clients to please use their digital form to register and make appointments. Those that missed their appointment due to recent looting will be rescheduled. If you have any other queries please contact our Health department, email service@daberistic.com, Tel 011-6581333, Option 2 for Medical Aid. Please be reminded that Medical aid upgrades for 2021 will end soon, please make sure you have submitted your change by 30 November. For clients on Discovery KeyCare plan, Momentum Ingwe plan, Bonitas Boncap plan and have been selected to do income verification, please make sure all required documents are submitted to prevent your service provider resulting to default to the highest income band and therefore the highest contribution will apply.
Please note: Members joining Momentum health Ingwe option with effect 01 October 2020 onwards will not be required to submit information for income verification (declaration and proof of income). They will remain on their current income bracket moving into 2021 and the new premium will automatically be applicable from 01 January 2021. For more information on medical aid plans, please see below videos, brochures and links to assist you with change of option decision. Discovery Plan series and videos
Below are Discovery Health Plan Guides Brochures for 2021
To help you stay healthy and informed on the COVID-19 situation, Discovery will continue to provide the most up-to-date information and guidance through COVID-19 Information Hub Below are Momentum Health Plan Guides Brochures for 2021 Below are Bonitas Plan Guides Brochures for 2021 It is now time to review your medical aid scheme cover for 2021. This means you have a window within which you can switch to a different plan for the new year. This window usually closes at the end of November (depending on your current provider), so don’t delay collecting the necessary information. This is not a decision to be rushed.
Why do I have to decide now? Medical aid providers allow you to switch to a higher plan once a year (at the end of the year) without penalties or consequences. If you want to save on premiums or you need to increase benefits, now is the time to do it. Generally, medical schemes give you until the end of the year to change your plan. What if I want to change providers altogether? If you are unhappy with your medical aid provider, you can switch to another at any time of the year. But before you do, consider the following: Waiting Periods Medical Aids by law must accept anyone who applies to join their scheme. To protect themselves from older or sickly members that join without having contributed to the risk pool, they usually impose a waiting period of between 3 and 12 months. Waiting periods will apply if 1) you have not been a member of another South African medical aid for the past three months or more, 2) if you change medical schemes before 2 years of being covered with your previous medical aid provider and 3) if you have a pre-existing medical condition. Finding out about any waiting periods is extremely important before deciding to change providers. Late joiner penalty As an additional means to manage the risk of older or sickly members joining without having contributed to the risk pool, medical schemes (according to the Medical Schemes Act) are entitles to add a late joiner penalty to your premium if you were not part of a medical scheme before 01 April 2001. The late joiner penalty is calculated (using a prescribed formula) based on the number of years that you were not on a registered South African medical scheme. The late joiner fee can range between 5% and 75% of the total contribution, depending on the number of years that you were not covered by a medical scheme. It is important to keep proof of all your previous medical scheme membership, as it would help reduce or remove the Late Joiner Penalty. General considerations When reviewing your medical aid plan, you should consider the following factors: - benefits - exclusions - co-payments and deductibles - provider network restrictions - financial soundness of the medical scheme - the medical scheme's service and ability to pay claims - premium (affordability) - gap cover product to supplement your medical aid. Please contact our health team, Tel 011-658-1333, Option 2, or email service@daberistic.com , to find out about different medical aid options. Momentum Medical Scheme focuses more than ever on keeping benefit design stable and ensuring that their members continue to enjoy comprehensive and affordable benefits. The 3rd largest open medical aid scheme in South Africa, Momentum Medical Scheme has announced an average annual contribution increase of 3.9% for 2021. This is substantially lower that the weighted average annual contribution increase of 8.2% for 2020.
If you have any queries or are interested in joining Momentum Medical Scheme, please contact us on 011-658-1333, 076-200-5488 or email service@daberistic.com. |
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