Here are the big medical aid changes coming to Discovery
Discovery Health Medical Scheme (DHMS) has announced a number of changes and additions which it will be introducing to customers over the coming months.
“The Covid-19 pandemic has led the headlines in defining the challenge facing our healthcare systems this year,” said chief executive officer of Discovery Health, Dr Ryan Noach.
“We have closely followed and analysed the local and global trajectory of the pandemic and have identified a tipping point for healthcare consumers to access healthcare differently, revealing opportunities for greater efficiencies in the future.”
Below he outlined some of the key changes coming to the scheme.
Connected Care
Care for members at home aims to revamp the virtual consultation experience by bringing it closer to a face-to-face doctor visit, said Noach.
“We are proud to announce that, for the first time in South Africa, Discovery Health is giving access to a remotely guided doctor visit by connecting the internationally acclaimed TytoHome device to the member’s virtual consultation.”
Noach said that this device enables remotely-guided, clinical-grade virtual consultations with a GP anywhere at any time.
“The TytoCare device sends the doctor a live feed clinical-grade images and sounds during a virtual consultation so that the GP can accurately diagnose and prescribe treatment for common conditions, no matter where the patient is located.”
The kit includes an examination camera, thermometer, otoscope and stethoscope and allows a user to capture and share not only ear, throat and skin images but also lung and heart auscultations (sounds typically heard with a stethoscope) and share these easily with a doctor in the TytoCare Doctor Network.
“Members are able to access trusted medical advice and accurate clinical diagnosis from a nationwide network of experienced healthcare providers who are trained in and equipped to facilitate Tyto-enabled virtual consults,” said Dr Noach.
“Members also received a post-consultation dashboard including their updated Electronic Health Record, e-script, treatment plan, sick note and relevant referral appointments.”
Other Connected Care changes include:
- In 2021, the diabetes care, cardiac care and mental health programmes will be enhanced through the connected care platform as members will access digital condition-specific clinical content, integration with remote health monitoring devices appropriate for their condition and personalised health coaching.
- Connected care for acute care at home provides qualifying members with clinically appropriate and patient-centric hospital-level care in their homes, as a substitute for acute hospital care.
Mental health programme
From 2021, Discovery Health’s existing mental health programme has been enhanced to offer:
- A relapse prevention programme which will provide clinical support and benefits for members that are at risk of a recurrence of a major depressive episode;
- Enhanced out-patient care benefits to manage the transition from hospital to out-of-hospital care for major depression, including additional mental healthcare services for an extended period;
- Free access to Vitality active rewards personal health goals for DHMS members at risk of or diagnosed with major depression. The personal health goals will allow members to track their own health progress and be rewarded for completing their mental health checks and tracking their mental wellbeing.
Launch of cover for infertility treatment
“The inability to fall pregnant is a stressful problem affecting over 100 million couples worldwide,” said Dr Noach.
“With medical advances in the infertility treatment field, the majority of fertility cases are treatable with therapies such as drug treatment, surgical repair and assisted reproductive techniques such as Intra-Uterine Insemination (IUI) and In-vitro fertilisation (IVF).
“Fertility treatment is highly individualised. Treatment plans vary considerably as every patient case is unique. With an average cost of between R65,000 – R85,000 for a single IVF cycle, the cost of infertility can be prohibitive.”
To support members affected by infertility, in 2021 DHMS is introducing the Infertility and Assisted Reproductive Therapy benefit, to provide cover for Assisted Reproductive Technologies, such as:
- In-vitro fertilisation (IVF)
- Intra-uterine insemination (IUI)
- Frozen embryo transfer (FET)
- Intra-cytoplasmic sperm injection (ICSI)
Female members aged 25-42 years old, on Executive and Comprehensive Plans (who have been members for at least two years) will have access to the benefit, with cover for up to two cycles of ART.
Expansion of day surgery network
Discovery currently covers a defined and clinically appropriate list of elective day surgery procedures in the day surgery network for priority, Saver, core, Smart and KeyCare plans.
In 2021, the day surgery network will be expanded to the Comprehensive plans and, to maintain appropriate coverage, will see the addition of two more hospitals in Johannesburg, four in Pretoria and one in Rustenburg.
Discovery said that new hospitals will be added to plan-specific hospital networks and some hospitals within the networks will be replaced. Details will be released in due course.
Formula changes for chronic drug amounts
From 1 January 2021, certain formulary changes and Chronic Drug Amount updates will be applied.
“We have been communicating these changes to impacted members. These members will have until the end of 2020 to make changes to their treatment and to avoid or reduce co-payments,” said Dr Noach.
Limits, co-payments and deductibles
For 2021, co-payments and deductibles are increased by 3.5% to 4%. And, benefit limits are increased by 3%, with the exception of the following, for which there is no increase in 2021:
- Oncology Threshold;
- Specialised Medicine and Technology Benefit;
- International Travel Benefit;
- Overseas Treatment Benefit;
- KeyCare mobility Benefit.
Co-payments for endoscopic procedures
Currently, the scheme applies a co-payment of between R3750 and R4550 to in-patient gastrointestinal scopes on all of its plans except the KeyCare plans.
No co-payment applies to gastroscopies, colonoscopies, proctoscopies and sigmoidoscopies performed in the doctor’s rooms and for confirmed PMB cases.
In 2021, to ensure that scopes are performed in the appropriate setting and to promote improvement in quality outcomes the following updates to the co-payment structure apply:
- DHMS will continue to apply no co-payment where scopes are performed in doctor’s rooms and/or endoscopic suites;
- A reduced co-payment of R3,650 on all plans (except KeyCare) for scopes performed in day clinics;
- A co-payment of between R5,300 and R6,250 (depending on the chosen plan) will be applied for scopes performed in acute hospitals;
- Where an out-of-network deductible also applies for scopes performed outside of the Day Surgery Network, the higher of the benefit deductible or the out-of-network deductible applies;
- Where both a colonoscopy and gastroscopy are performed in the same admission, the higher co-payment applies.
Read: Here are all the big changes coming to Discovery Vitality
