Discovery 2016 PrimaryCare. To make people healthier and enhance and protect their lives

Discovery 2016 PrimaryCare

To make people healthier and enhance and

protect their lives

Rank Employees’ needs

1 Transport

2 Housing

3 Food

4 Health

5 Insurance

6 Clothing

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

Source: Discovery research

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

Private healthcare remains unaffordable for employees earning less than R6 450 per month

R0 R1,075 R2,150 R3,763 R5,375 R6,450 R8,600 R10,750 R21,500 R32,250 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Discontinuity in

health cover due to affordability

Medical scheme membership, %

Private healthcare is unaffordable

Medical scheme membership becomes affordable

Monthly income

Employers and employees prioritise primary care when faced with affordability constraints

Priority of healthcare services

Priority of baskets of services

Employees’ prioritisation

Employees’ prioritisation

1st

2nd

3rd

4th

5th

6th

Emergency hospital care

GP care

Optometry

In-patient hospital care

Dentistry

Specialist care

1st

2nd

Primary Care services

Full hospital cover

DISCOVERY PRIMARYCARE

No exclusion

s or waiting periods

No individual application forms

No chronic application

Seamless billing

integration Seamless claims

experience

Employer training

Discovery PrimaryCare

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

• Dentistry• Optometry Additional

servicesfor employees• Access to discounted

maternity global fee• Discovery Wellness Day • Onsite occupational health

services (quotation on request)

Management service for employers• Integrated billing• Training• Integrated healthcare usage reports• Communication and marketing• Seamless claims experience

• Occupational health and wellness consulting on request

R209 per employee

per month excl. VAT

Discovery PrimaryCare is not a medical scheme

3,000 4,000 5,000 6,000 0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Extending affordable access to private healthcare through Discovery PrimaryCare


PrimaryCare

Contributions with a 50% employer subsidy

Contributions

Pro

port

ion o

f in

com

e

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.


Healthcare services for employees

• GP visits• Prescription medicine• Chronic medicine• Basic pathology• Basic radiology• Ambulance service

• Dentistry• Optometry

R209 per 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


Healthcare services for employees• GP visits

• Prescription medicine• Chronic medicine• Basic pathology• Basic radiology• Ambulance service


R209 per employee

per month excl. VAT

• Dispensed by employee’s PrimaryCare GP

• Dispensed from defined list of medication


Healthcare services for employees• GP visits• Prescription medicine

• Chronic medicine• Basic pathology• Basic radiology• Ambulance service


R209 per employee

per month excl. VAT

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

• Dispensed from formulary through Clicks


Healthcare services for employees• GP visits• Prescription medicine• Chronic medicine

• Basic pathology• Basic radiology• Ambulance service


R209 per employee

per month excl. VAT

• Access to a network of providers

• Available through referral by employee’s PrimaryCare GP


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

• Ambulance service


R209 per employee

per month excl. VAT

• Access to ambulance services in case of an emergency

• Employees will be transported to the nearest state facility




R209 per employee

per month excl. VAT

• Included in the standard contract fee

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




R209 per employee

per month excl. VAT

• Included in the standard contract fee

• One eye test every year in our designated optometry network

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


Additional servicesfor employees• Access to discounted

maternity global fee• Discovery Wellness Day • Onsite occupational health



Additional servicesfor employees

• Access to discounted maternity global fee

• Discovery Wellness Day • Onsite occupational health


• R12 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



maternity global fee

• Discovery Wellness Day

• Onsite occupational health services (quotation on request)

• 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 (quotation on request)

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






Management service for employers

• Integrated billing• Training• Integrated healthcare usage reports• Communication and marketing• Seamless claims experience


R209per employee

per month excl. VAT

• Single billing platform

• Billing and reconciliation integrated with Discovery Health Medical Scheme


Management service for employers• Integrated billing

• Training• Integrated healthcare usage reports• Communication and marketing• Seamless claims experience


R209per employee

per month excl. VAT

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 marketing• Seamless claims experience


R209per employee

per month excl. VAT

• Monthly healthcare utilisation reporting

• Integrated with existing Discovery Health Medical Scheme wellness reporting, if applicable


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

• Communication and marketing

• Seamless claims experience


R209per employee

per month excl. VAT

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


Management service for employers• Integrated billing• Training• Integrated healthcare usage reports• Communication and marketing

• Seamless claims experience


R209per employee

per month excl. VAT

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




R209per employee

per month excl. VAT

Discovery can arrange for an occupational health and wellness review on request



• Dentistry• Optometry Additional

servicesfor employees• Access to discounted

maternity global fee• Discovery Wellness Day• Onsite occupational health




R209 per employee

per month excl. VAT

*Figures quoted inclusive of VAT Discovery PrimaryCare is not a medical scheme

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 R6 138 per month, there is no tax implication 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 25 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?

Discovery PrimaryCare | New business process

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

1

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

2

Discovery will draw up the Discovery PrimaryCare employer contract once we get confirmation that the quote has been accepted. The Discovery business consultant will be assigned to engage on implementation.

3

Discovery PrimaryCare | Implementation process

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

Discovery 2016 PrimaryCare

Documents

Discovery 2016 PrimaryCare. To make people healthier and enhance and protect their lives