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Discovery Health Medical Scheme (DHMS) has announced a number of changes and additions that it will introduce to customers in the coming months.
“The Covid-19 pandemic has made headlines in defining the challenge facing our healthcare systems this year,” said Discovery Health CEO Dr. Ryan Noach.
“We have closely followed and analyzed 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 efficiency in the future.”
He then outlined some of the key changes that will be made to the schema.
Connected care
Care for Members at Home aims to renew the virtual consultation experience by bringing it closer to a face-to-face doctor visit, Noach said.
“We are proud to announce that, for the first time in South Africa, Discovery Health is providing access to a remotely guided doctor visit by connecting the internationally acclaimed TytoHome device to the member’s virtual office.”
Noach said this device enables remotely guided clinical grade virtual consultations with a GP anywhere, anytime.
“The TytoCare device delivers live clinical-quality images and sounds to the physician during a virtual consultation so 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 the user to capture and share not only ear, throat and skin images, but also lung and heart auscultations (sounds normally heard with a stethoscope) and easily share them. with a doctor in the TytoCare doctor network.
“Members can access trusted medical advice and accurate clinical diagnoses from a nationwide network of experienced healthcare providers who are trained and equipped to facilitate Tyto-enabled virtual consultations,” said Dr. Noach.
“Members also received a post-consultation panel that included their updated electronic medical history, electronic script, treatment plan, illness note, and relevant referral appointments.”
Other Connected Care changes include:
- In 2021, diabetes care, cardiac care and mental health programs will be enhanced through the connected care platform, as members will access condition-specific digital clinical content, integration with remote health monitoring devices suitable for your condition and personalized health advice.
- Acute Home Care Connected Care provides members who qualify clinically appropriate, patient-centered hospital care in their homes as a substitute for acute hospital care.
Mental health program
As of 2021, Discovery Health’s existing mental health program has been enhanced to offer:
- A relapse prevention program that will provide clinical support and benefits to members who are at risk for a recurrence of a major depressive episode;
- Enhanced outpatient benefits to manage the transition from inpatient to out-of-hospital care for major depression, including additional mental health care services over an extended period;
- Free access to Vitality active rewards personal health goals for DHMS members at risk or diagnosed with major depression. 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 well-being.
Launch of coverage for infertility treatment
“The inability to get pregnant is a stressful problem that affects more than 100 million couples around the world,” said Dr. Noach.
“With medical advances in the field of infertility treatment, most cases of fertility can be treated with therapies such as drug treatment, surgical repair, and assisted reproductive techniques such as Intrauterine Insemination (IUI) and Injection Fertilization. vitro (IVF).
“Fertility treatment is highly individualized. Treatment plans vary considerably as each 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 will introduce the benefit of Infertility and Assisted Reproductive Therapy, to provide coverage for Assisted Reproductive Technologies, such as:
- In vitro fertilization (IVF)
- Intrauterine insemination (IUI)
- Frozen embryo transfer (FET)
- Intracytoplasmic Sperm Injection (ICSI)
Affiliated women from 25 to 42 years old, in Executive and Comprehensive Plans (who have been affiliated for at least two years), with coverage of up to two ART cycles will access the benefit.
Expansion of the ambulatory surgery network
Discovery currently covers a defined and clinically appropriate list of elective ambulatory surgical procedures in the ambulatory surgery network for Priority, Saver, Core, Smart and KeyCare plans.
In 2021, the ambulatory surgery network will be expanded to comprehensive plans and, to maintain adequate coverage, two more hospitals will be added in Johannesburg, four in Pretoria and one in Rustenburg.
Discovery said new hospitals will be added to the plan’s specific hospital networks and some hospitals within the networks will be replaced. Details will be released in due course.
Formula changes for chronic amounts of medications
Beginning January 1, 2021, certain formulary changes and chronic drug quantity updates will apply.
“We have been communicating these changes to affected members. These members will have until the end of 2020 to make changes to their treatment and avoid or reduce copayments, ”said Dr. Noach.
Limits, copays and deductibles
By 2021, copayments and deductibles increase by 3.5% to 4%. And, the benefit limits are increased by 3%, with the exception of the following, for which there is no increase in 2021:
- Oncology threshold;
- Specialized Medicine and Technology Benefit;
- International travel benefit;
- Treatment benefit abroad;
- KeyCare mobility benefit.
Endoscopic procedure copays
Currently, the scheme applies a copayment of between R3750 and R4550 for inpatient gastrointestinal endoscopes in all of its plans, except KeyCare plans.
There is no copayment for gastroscopies, colonoscopies, proctoscopies, and sigmoidoscopies performed in doctor’s rooms and for confirmed cases of PMB.
In 2021, to ensure that scopes are made in the right environment and to promote improvement in quality results, the following updates are applied to the copayment structure:
- DHMS will continue to apply no copay when endoscopes are performed in physician rooms and / or endoscopy rooms;
- A reduced copayment of R3,650 on all plans (except KeyCare) for outreaches made at day clinics;
- A copayment of between R5,300 and R6,250 (depending on the chosen plan) will be applied for the scopes made in acute hospitals;
- When an out-of-network deductible also applies for scopes performed outside of the Ambulatory Surgery Network, the higher benefit deductible or out-of-network deductible applies;
- When a colonoscopy and gastroscopy are performed on the same admission, the higher copayment applies.
Read: Here are all the big changes coming to Discovery Vitality
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