2019 Discovery Keycare Rates

Keycare GP Nework Rates: 2019

 

 

 

 

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How Does MMAP (Maximum Medical Aid Price) Work

MMAP DESCRIPTION AND PATIENT IMPACT: MMAP® (Maximum Medical Aid Price) is a reference price model that is wholly owned and maintained by MediKredit.

MMAP® serves as a guide to determine the maximum medical scheme price that medical schemes will reimburse for an interchangeable multi-source pharmaceutical product.

An interchangeable multi-source pharmaceutical product is a product that has exactly the same active ingredient/s and salt/s combination, strength of the active ingredient/s and dosage form (for example tablets versus capsules) as other pharmaceutical products that can be obtained from manufacturers or suppliers.

Products are excluded from the MMAP® listing if they are designated as non-substitutable by the South African Medicine Control Council (MCC), as well as substitutability data from international sources such as Australia, USA (FDA) and Europe.

Prices are determined to allow flexibility when selecting a pharmaceutical product. It is also important to note that the MMAP® price levels do not necessarily equate to the prices of any specific pharmaceutical product brands.

The provider must charge the actual price of the brand supplied to the patient and not the MMAP® amount. The Provider is entitled by law to supply any alternative interchangeable multi-source pharmaceutical product (“generic substitution”) unless:

· Specifically indicated otherwise by the prescribing doctor; or

· Expressly forbidden by the patient to do so; or

· The price of the interchangeable multi-source pharmaceutical product is higher than that of the prescribed medicine.

 

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Changes to Keycare Plans 2019

Important changes to Keycare plans for 2019

In 2019, DHMS will balance the increasing demand for supply of healthcare services against the need to maintain competitive contributions and enhance benefits for members. The scheme will also expand access to private healthcare and enhance the digital healthcare experience for members.

KEYCARE SERIES 2019

  • The KeyCare Series has been restructured for 2019
  • Changes have been made to maintain benefits for members with significant healthcare needs on KeyCare Plus and KeyCare Core, while retaining affordable access to private healthcare through KeyCare Start
  • Funding of all endoscopes on KeyCare will be limited to PMB cover
  • KeyCare Access has been renamed KeyCare Start with a redesigned benefit structure
  • The 2018 income bands below R13,050 on KeyCare Plus and KeyCare Core have been consolidated into one income band
  • Below are the 2019 revised income bands:

KeyCare Start:

  • Premiums for the KeyCare Start plan begin from R839 per month
  • The plan offers extensive day to day and hospital cover and preventative care benefits through an innovative combination of healthcare networks
  • KeyCare Start members will access healthcare through innovative hub and spoke’ regional networks, arranged around 17 unique regions
  • Each regional network is designed around an anchor ‘hub’e. a KeyCare Start hospital offering an array of medical, surgical and emergency services
  • The hubs are surrounded by the KeyCare Start GP Network as well as a network of facilities and healthcare professionals providing routine services

KeyCare Start Benefits:

  • Unlimited cover for admissions in the member’s chosen KeyCare Start Network hospital
  • Cover for emergencies outside the KeyCare Start Network hospital
  • Unlimited cover for a list of procedures in the regional KeyCare Start Day Surgery Network
  • Full cover for specialists and healthcare professionals contracted to KeyCare, and up to 100% of the Discovery Health Rate for non-contracted specialists and healthcare professionals
  • Cover for after-hours emergency visits to the member’s KeyCare Start GP
  • Unlimited GP visits at the member’s selected KeyCare Start GP
  • 2 out-of-network visits to a KeyCare Start GP
  • Acute medicine dispensed by the member’s KeyCare Start GP
  • 2 specialist visits covered up to R2,000 per beneficiary, if referred by the member’s KeyCare Start GP
  • Formulary driven radiology and pathology
  • Defined conservative dentistry at Dental Risk Company (DRC)
  • Defined optometry at IsoLeso
  • Chronic medication, oncology treatment and renal dialysis through a state facility
  • Annual health check at a wellness provider for adults and children
  • Funding of all endoscopes on KeyCare Smart will be limited to PMB cover
  • As no chronic benefit is available on this option, member will be allowed to upgrade upon diagnosis, within 30 days

Existing KeyCare members – Plan selection process for 2019:

KeyCare members will receive detailed, personalised communication during October.

  1. Members on KeyCare Access in 2018 will be transferred to KeyCare Start in 2019 (based on their income band as at 31 December 2018). These members have the option to change their plans until 30th June 2019
  2. Members on the lowest income band of KeyCare Plus in 2018 will remain on the lowest income band of KeyCare Plus in 2019; these members will have the option to change their plan until 30th June 2019
  3. Members on the lowest income band of KeyCare Core in 2018 will remain on the lowest income band of KeyCare Core in 2019; these members will have the option to change their plan until 30 June 2019

2019 Contribution Increase:

  • Medical inflation for 2018 is expected to be between 11.2% – 12.2%, with the variation due to plan-specific utilisation effects
  • Risk management interventions by Discovery Health & ongoing positive impact of Vitality on members’ health is expected to reduce medical inflation by 2%
  • The resulting medical inflation is therefore between 9.2% – 10.2%, which is 3% to 4% above CPI after allowing for the adjustment of VAT

The 2019 weighted average contribution increase for Discovery Health Medical Scheme (DHMS) is 9.2% (including 1% to account for the VAT increase), which is within the expected range for medical inflation, and maintains the competitive price advantage of the Scheme in 2019.

The contribution increases for 2019 are linked to medical inflation and the increase in VAT, but reflect the plan-specific elements of medical inflation:

  • Tariff inflation is on average equivalent to CPI, and is consistent across all plans
  • Utilisation inflation reflects plan-specific experience -Executive, Comprehensive and Coastal Plans have higher increases due to greater demand-side and supply side inflation

2019 Contribution increases per plan type:

  • The cumulative annual contribution increases relative to CPI (2010-2018) for DHMS members has remained within 3% to 4% of Consumer Price Inflation over the period.
  • The cumulative annual contribution increases for DHMS have remained approximately 1% below that of the rest of the open scheme industry
  • Maintaining this differential over time means that members of the Scheme on average contribute 4% less in 2018 than members of other open medical schemes for equal or better benefits

DISCOVERY DAY SURGERY NETWORK

  • Discovery Day Surgery network has been introduced for a range of medical procedures that can be performed on a same day basis
  • This network will become the Designated Service Provider (DSP) for Priority, Saver, Core, Smart and KeyCare plans in 2019
  • The DSP will apply for a defined list of day procedures
  • Network facilities to be published on the web site in November
  • Members will be liable for a R5,000 deductible for out of network procedures (Smart and Delta plans will encounter a deductible of R8,800 or R6,650 respectively)
  • In an event of an emergency, the deductible is waived
  • KeyCare members have no cover should they not utilise the DSP

 

Medscheme Administered Scheme Increases 2019

Medscheme Administered Scheme Increases 2019

Date: 31 Dec 2018    

High-level changes to Medscheme-administered medical schemes for 2019

1. Tariff increases
After due consideration by each individual medical scheme’s Board of Trustees, the following tariff increases will apply to the Medscheme-administered medical schemes listed below. These increases will come into effect as of 1 January 2019.
Scheme
% Increase
AECI Medical Aid Society
5.4%
Barloworld Medical Scheme
5.0%
Bonitas Medical Fund
5.0%
Fedhealth
5.1%
Horizon Medical Scheme
6.0%
Hosmed Medical Scheme
5.2%
MBMed Medical Aid Fund
5.0%
Nedgroup Medical Aid Scheme
5.0%
Old Mutual Staff Medical Aid Fund
5.2%
Parmed Medical Aid Scheme
4.9%
SABC Medical Scheme
5.0%
SAMWUMED
5.4%
Sasolmed
5.0%
Note: The above mentioned Scheme rate increases are not applicable where special rates have been agreed upon directly with the medical scheme(s).
Important: Scheme tariffs are VAT inclusive. The tariff increases will also be made available on the Medscheme website. Go to www.medscheme.com and log in as a Provider, click on Look up Tool > Scheme Rates > 2019.
2. Scheme option changes effective 1 January 2019
Bonitas Medical Fund
Primary Select and BonEssential Select are two new options for 2019. The Hospital Plus option will no longer be available from 1 January 2019.
Fedhealth
The Fedhealth 2019 benefit options have a new look and feel; their names have also changed. Certain options have merged to give a more complete selection. Attached is a more detailed explanation about the mapping of the current options to the new options.
Kind regards,
Medscheme: Healthcare Provider Relations Department
(unsigned due to electronic submission)

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MMI Health Schemes Rates – 2019

MMI Health Schemes – 2019 scheme rates

MMI Health would like to thank you for your substantial contribution and continuous provision of quality world class healthcare services to our members, your patients. In return herewith the annual inflationary adjustment of reimbursement rates for 2019.

Our administered schemes will be increasing scheme tariff rates for 2019 by the percentages indicated in the table below. The increase in scheme rate will apply to all existing tariff codes, applicable to your discipline.

Note: If you have a specific agreed rate confirmed in writing, this will supersede the normal scheme rate.

Medicine and consumable items (nappi items) will be funded at a 30% markup with a maximum of R36 (excl VAT) per item based on SEP (medicine items) and cost price (consumables). This is applicable to scheduled or non-scheduled items.

The 2019 Tariff Schedules and Benefit Guides are available on our websites for your reference (see links below for your reference). Major software vendors will be informed of the increases.

Important: Please note that the information can be accessed at

http://providerlogin.mmihealth.co.za/schemenavigator/scheme-navigator-main.html

Scheme, Fund or Health Product % increase
BP Medical Aid Society 5%
Fishing Industry Medical Scheme 5%
Golden Arrow Employees Medical Scheme 5%
Imperial Group Medical Scheme 6.05%
MEDiPOS Medical Scheme 5.4%
Moto Health Care Medical Aid 5%
PG Group Medical Aid 5.2%
Pick n Pay Medical Aid 5.4%
Transmed Medical Aid 5%
Wooltru Healthcare Fund 5.3%
Momentum Health 5%
Health4Me, OCSA, Domesticare* 5%
Sisonke Health Medical Scheme 5%
Medimed Medical Scheme 5%
Suremed Health 5%
RUMed 5%
Impala Medical Scheme 5%
Impala Medical Services (mine house) 5%
Sibanye Health Care (mine house) 5%
South Deep (mine house) 5%
AngloGold Ashanti Health (mine house) 5%
Thebemed 5%

* This is not a medical scheme, but an insurance product

Should you have any queries please email us at network@mmiholdings.co.za.

We thank you once again for making your time and skills available for our members’ healthcare needs and wish you and your staff a prosperous 2019.

Medical schemes administered by Universal Healthcare

For more information about any of our medical schemes, please follow the links to:

AECI Medical Scheme AECI 
» About Us                      » Contact Us
» Member Login
The Building & Construction Industry Medical Aid Fund (BCIMA) THE BUILDING & CONSTRUCTION INDUSTRY MEDICAL AID FUND (BCIMA)
» About Us                      » Contact Us
CompCare Wellness Medical Scheme
COMPCARE WELLNESS MEDICAL SCHEME
» About Us                      » Contact Us
» Member Login
gems medical scheme GOVERNMENT EMPLOYEES MEDICAL SCHEME 
» Home
Makoti Medical Scheme MAKOTI MEDICAL SCHEME (Previously Good Hope Medical Aid Society)
» About Us                      » Contact Us
Massmart medical scheme MASSMART HEALTH PLAN
» Home
Old Mutual Medical Scheme OLD MUTUAL STAFF MEDICAL AID FUND 
» Home                      » Services Offered
Grintek Electronics Medical Aid Scheme SAAB GRINTEK ELECTRONICS MEDICAL AID SCHEME
» About Us                      » Contact Us
» Member Login
Tiger Brands Medical Scheme
TIGER BRANDS MEDICAL SCHEME
» About Us                      » Contact Us
» Member Login
Transmed Medical Scheme TRANSMED 
» About Us                      » Contact Us
» Member Login
Umvuzo Medical Scheme UMVUZO HEALTH 
» About Us                      » Contact Us
» Member Login
Witbank Coalfields Medical Aid Scheme WITBANK COALFIELDS MEDICAL AID SCHEME 
» Home                      » Contact Us