Good health can change the world DISCOVERY 2015 PrimaryCare

Good health can change the world

DISCOVERY 2015PrimaryCare

ACCESS TO PRIVATE HEALTHCARE BENEFITS THE EMPLOYER AND THE EMPLOYEE

Employees Employers

Private healthcare meets employees’ needs

Source: Stats SA IES survey, 2010/2011

Increased productivity of healthier employees

Rank Employees’ needs

1 Transport

2 Housing

3 Food

4 Health

5 Insurance

6 ClothingSource: Discovery research

For employers, the productivity gains derived from improvements in employee health justify the investment in basic occupational and primary care

R 0 R1 000 R2 000 R3 500 R5 000 R6 000 R8 000 R10 000 R20 000 R30 0000%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PRIVATE HEALTHCARE REMAINS UNAFFORDABLE FOR EMPLOYEES EARNING LESS THAN R6 000 PER MONTH

Private healthcare is unaffordable

Monthly income

Medical scheme membership, %

Source: South African Health Review, Health Systems Trust

Medical scheme membership becomes affordable

Discontinuity in health cover due to

affordability

EMPLOYERS AND EMPLOYEES PRIORITISE PRIMARY CARE WHEN FACED WITH AFFORDABILITY CONSTRAINTS

Priority of healthcare services Priority of baskets of services

Employees’ prioritisation

1 Emergency hospital care

2 GP care

3 Optometry

4 In-patient hospital care

5 Dentistry

6 Specialist care

Employees’ prioritisation

1 Primary care services

2 Full hospital cover

DISCOVERY PRIMARYCARE

No exclusions or waiting

periods

No individual

application forms

No chronic application

Seamless billing

integration

Seamless claims

experience

Employer training

Healthcare services for employees• GP visits• Prescription medicine• Chronic medicine• Basic pathology• Basic radiology• Ambulance service

Additional services for employees• Dentistry (R16 per employee per month)• Optometry (R9 per employee per month)• Access to discounted maternity global fee• Discovery Wellness Day (R285 per employee)• Onsite occupational health services

Management service for employers• Integrated billing• Training• Integrated healthcare usage

reports• Communication and

marketing• Seamless claims experience

• Occupational health and wellness consulting on request

D I S C O V E R Y P R I M A R Y C A R E

R199per employee

per month(excl VAT)

Discovery PrimaryCare is not a medical scheme

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VE

PRIM

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ARE

COM

PREH

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PRIO

RITY

SAVE

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CORE

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ARE

EXTENDING AFFORDABLE ACCESS TO PRIVATE HEALTHCARE AT ALL INCOME LEVELS

Threshold % of income to spend on healthcare

Contributionsas % of income

Contributions with a 50% employer subsidy


DISCOVERY HEALTH MEDICAL SCHEME -

4,0

00

6,0

00

8,0

00

10,

000

12,

000

14,

000

16,

000

18,

000

20,

000

22,

000

24,

000

26,

000

28,

000

30,

000

32,

000

34,

000

36,

000

38,

000

40,

000

42,

000

44,

000

46,

000

48,

000

0%

3%

6%

9%

R6 000

DISCOVERY PRIMARYCARE | Legal Framework

#1

…not a medical scheme

…not an insurance product#2

#3 …not a financial product

Discovery PrimaryCare is not a medical scheme as it does not fall within the ambit of the definition of “business of a medical scheme” in section 1 of the Medical Schemes Act. The term “business of a medical scheme” is defined in section 1 of the Medical Schemes Act to mean: “the business of undertaking liability in return for a premium or contribution –a) To make provision for the obtaining of any relevant health service;b) To grant assistance in defraying expenditure incurred in connection with the rendering of any relevant health service; andc) Where applicable, to render a relevant health service either by the medical scheme itself, or by any supplier or group of

suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical scheme.”

There needs to be an undertaking of liability to trigger an inquiry into whether a person is conducting “the business of a medical scheme”. Discovery does not undertake liability in the implementation of Discovery PrimaryCare as Discovery enters into agreements with healthcare professionals as agents for and on behalf of employers and it does not undertake any liability towards healthcare professionals. This position will not be affected when the amended definition of a “business of a medical scheme” in the Financial Services Laws General Amendments Act comes into operation.

Discovery PrimaryCare is not an insurance product as it does not fall within the ambit of either the definition of a “health policy” under the Long-Term Insurance Act or the definition of an “accident and health policy” under the Short-Term Insurance Act.Discovery in its capacity as agent of the employer, is not undertaking to provide benefits upon the occurrence of health events in return for a premium. One of the key elements of insurance is the taking on of liability or risk by the insurer. In the Discovery PrimaryCare model, Discovery does not take on liability or risk.

Discovery PrimaryCare does not fall within the ambit of the definition of a financial product as contemplated in the Financial Advisory and Intermediary Services Act.

Discovery PrimaryCare is…

#4 … an employer-funded primary healthcare service provision model

Discovery PrimaryCare is an employer-funded primary healthcare service provision model, developed, administered, and managed by Discovery, that allows employers to provide employees falling below the stated income threshold with access to quality and affordable primary healthcare.

DISCOVERY PRIMARYCARE | Flexible, affordable healthcare services for employees


R199per employee

per month(excl VAT)

• Unlimited access to chosen* PrimaryCare GP

• National network of PrimaryCare GPs

*Employees must choose a GP from the network to be their allocated GP



R199per employee

per month(excl VAT)

• Dispensed by employee’s PrimaryCare GP

• Dispensed from defined list of medication



R199per employee

per month(excl VAT)

• Medicine for:‒ Hypertension‒ Hyperlipidaemia‒ Asthma‒ Diabetes‒ HIV

• Dispensed from formulary by PrimaryCare GP or network provider



R199per employee

per month(excl VAT)

• Access to a network of providers

• Available through referral by employee’s PrimaryCare GP



R199per employee

per month(excl VAT)

• Access to ambulance services in case of an emergency

• Employees will be transported to the nearest state facility

Additional services for employees• Dentistry• Optometry• Access to discounted

maternity global fee• Discovery Wellness Day• Onsite occupational health

services




services


• R16 per employee per month including VAT

• Consultations, fillings and tooth removals at a dentist in our national network



services


• R9 per employee per month including VAT

• One eye test every year in our designated optometry network

• One pair of glasses or the contact lens equivalent every 24 months



services


• R10 000 once-off cost• Package of private care for

maternity, including consultations and delivery, in a network of private hospitals

• Funded by employer or employee



services


• R285 per employee per year incl VAT• Access to the Discovery Wellness Day

which covers all essential biometric and health screenings (incl HIV VCT)

• Post-Wellness Day reporting is provided, giving employers valuable insight into their employees’ state of health and wellbeing


maternity global fee• Discovery Wellness Day• Onsite occupational

health services


Discovery Health and its preferred sub-contracted providers can provide a comprehensive range of workplace health and wellness services



marketing• Seamless claims experience• Occupational health and

wellness consulting on request







• Single billing platform• Billing and reconciliation

integrated with Discovery Health Medical Scheme






Discovery will provide the employer with the required training to assist employees in accessing their benefits

Management service for employers• Integrated billing• Training• Integrated healthcare

usage reports• Communication and




• Comprehensive annual healthcare reporting

• Integrated with existing Discovery Health Medical Scheme health and wellness reporting






Discovery will provide the employer with appropriate marketing material to communicate the available services to employees



marketing• Seamless claims

experience• Occupational health and



Discovery will pay the healthcare provider directly and therefore:• there is no need for employees to

submit claims to Discovery; and• the employee experiences no out-

of-pocket expenses on the services provided






Discovery can perform an occupational health and wellness review on request


Additional services for employees• Dentistry (R16 per employee per month)• Optometry (R9 per employee per month)• Access to discounted maternity global fee• Discovery Wellness Day (R285 per employee)• Onsite occupational health services



marketing• Seamless claims experience

• Occupational health and wellness consulting on request

D I S C O V E R Y P R I M A R Y C A R E

R199per employee

per month(excl VAT)


DISCOVERY PRIMARYCARE | Tax implications

Employer

Employee

• The extent to which the employer subsidises the monthly PrimaryCare fee represents a fringe benefit in the hands of the employee

• If an employee earns less than R5 892 per month, there is no tax implaction for the employee

• The full cost of the PrimaryCare fee is tax deductible for the employer, irrespective of whether it is fully subsidised or not

• The employer will be able to claim back the VAT portion of the service fee

DISCOVERY PRIMARYCARE | Eligibility criteria

A minimum of 100 employees to be enrolled on Discovery PrimaryCare

Defined in line with the employer’s recruitment criteria

Employees’ spouses and dependants will not be eligible

Discovery PrimaryCare can only be accessed through an employer that is contracted to Discovery Health

Employers will need to provide access to these services on a compulsory basis to existing employees (with a three month open period) as well as all new qualifying employees

Which employees are eligible to join Discovery PrimaryCare?

D I S C O V E R Y P R I M A R Y C A R E | N e w b u s i n e s s p r o c e s s

Financial adviser completes Discovery PrimaryCare service request form for eligible employers and submits it via their Discovery business consultant.

1

Discovery will issue a Discovery PrimaryCare offer letter to the financial adviser and employer with details on:• Services to be provided• Implementation date• Fees

2

Discovery will draw up the Discovery PrimaryCare service agreement and the Discovery business consultant will be assigned to engage on implementation.

3

D I S C O V E R Y P R I M A R Y C A R E | I m p l e m e n t a ti o n p r o c e s s

1 On-boarding employeesDetermining the list of employees that will be making use of the contracted healthcare services

2

3

4

5

Employer trainingTraining will be provided to employer representatives on healthcare services available, service rules, network of healthcare providers and servicing of the contract

Employee communicationDiscovery will provide the employer with marketing collateral, information on participating healthcare providers and healthcare services which can be used to educate employees on the services that they have access to through Discovery PrimaryCare

Ongoing administrationThe employer will be invoiced on a monthly basis based on up-to-date staff records in accordance with current Discovery Health billing arrangements

Annual contract renewal and price reviews• The contract will automatically renew at the start of the calendar year• One calendar month’s notice of termination of the contract is required• The employer will be notified of the calendar year increase in the last quarter of the year• On contract renewal, the fee per employee per month will automatically adjust to reflect the increases in cost of

providing these services

Good health can change the world

DISCOVERY 2015PrimaryCare

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Good health can change the world DISCOVERY 2015 PrimaryCare