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 30^th 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 30^th 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