Discovery Health Medical Schemes has outlined some of the benefit changes its members can expect in 2020.
The scheme is the largest in the country by some margin with some 1.335 million members and 2.79 million beneficiaries.
The benefit changes will have an effect on a number of members on specific plans as well as general members on the scheme.
“In 2020, we will prioritise your healthcare and wellness by offering unmatched benefits with unlimited private hospital cover and full cover in our networks, at the most affordable cost,” the group said.
You can find the biggest changes outlined below.
Screening for adults
This benefit covers certain tests such as blood glucose, blood pressure, cholesterol, body mass index and HIV screening at one of our wellness providers.
Discovery said that it will also cover a mammogram every two years, a Pap smear once every three years and a PSA test (prostate screening) each year.
In 2020, the group said it will also cover bowel cancer screening tests every two years for members between 45 and 75 years.
Members who meet the clinical entry criteria may also qualify for additional tests that include a colonoscopy.
Updates to limits, co-payments, deductibles and thresholds
Discovery said that co-payments and deductibles will be increased by 9.5%.
It added that benefit limits will be increased by 9.5% with the exception of the following where there is no increase for 2020:
- Oncology threshold;
- Specialised Medicine and Technology Benefit limit;
- Cochlear and auditory brain implants;
- International Travel Benefit;
- Overseas Treatment Benefit;
- Hip, knee, shoulder and spinal prostheses limit;
- External Medical Items limit and
- KeyCare Mobility Benefit.
Updates to funding of MRI, CT Scans, and scopes for the executive plan
The scheme said will be introducing a co-payment for all out-of-hospital MRI/CT scans, scans not related to an approved admission or scans related to conservative back and neck treatment.
“The first R3,040 of the MRI/CT scan will be funded from your available day-to-day benefits (with accumulation to the Above Threshold Benefit) and the balance of the account from the Hospital Benefit, up to 100% of the Discovery Health Rate,” it said.
“Co-payments will not apply to scans forming part of Prescribed Minimum Benefit (PMB) entitlements.”
The scheme said will also introduce a co-payment for certain endoscopic procedures performed in-hospital.
“The co-payment will apply to gastroscopies,colonoscopies, sigmoidoscopies and proctoscopies only.
“The first R4,100 in respect of the hospital account will be funded from your available day-to-day benefits (with accumulation to the Above Threshold Benefit) and the balance of the account from the Hospital Benefit, up to 100% of the Discovery Health Rate.
“The deductible does not apply to PMB admissions and for children under 12 years or to endoscopic procedures performed in the doctor’s rooms. These endoscopic procedures will continue to fund from the Hospital Benefit as occurs today.”
Changes to chronic illness benefit
From 1 January 2020, certain formulary changes and chronic drug amount updates will be applied, it said.
“We have been communicating these changes with impacted members. If you are impacted you will have until the end of 2019 to make changes to your treatment to avoid or reduce co-payments.”
Changes to extender benefit
The Day-to-day Extender Benefit pays for certain day-to-day benefits after you have run out of money in your MSA and before you reach the annual threshold, Discovery said.
“In 2020, the Day-to-day Extender Benefit will cover video call consultations with a network GP as well as pharmacy clinic consultations in our defined wellness network.
“Members will also have cover for consultations with a network GP when referred. Consultations are unlimited for Executive, Comprehensive and Priority plans, while Saver plans have limited cover for up to six consultations depending on the chosen plan.”
You can also find a more detailed list of changes in the document included below.