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AGENDA
Scheme Update Claims Experience Why Topmed? Market Awareness 2019 Option Overview & Changes 2019 Contributions
2019 Benefit Launch AGENDA Scheme Update Claims Experience Why - - PowerPoint PPT Presentation
2019 Benefit Launch AGENDA Scheme Update Claims Experience Why - - PowerPoint PPT Presentation
2019 Benefit Launch AGENDA Scheme Update Claims Experience Why Topmed? Market Awareness 2019 Option Overview & Changes 2019 Contributions SCHEME UPDATE 2018 has been exceptionally tough for the industry Hospital claims have seen
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SCHEME UPDATE
- 2018 has been exceptionally tough for the industry
- Hospital claims have seen significant increases in cost
as well as utilisation
- We have also seen a significant increase in high cost
claims
- The state of the economy has played a role in the
stability of membership
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CLAIMS EXPERIENCE
Top 10 Claimers (as at Aug 2018)
Option Age Gender Cost Driver YTD Amount Paid from Risk
ACTIVE SAVER 3 Male Cardiovascular (Congenital Malformation of Heart) 4 233 588.80 ACTIVE SAVER 60 Male Cardiovascular (Old pacemaker became septic) 2 840 168.63 LIMITED 74 Male Oncology (Oesophageal Cancer) 2 605 830.16 COMPREHENSIVE 82 and 78 Male & Female Cardiovascular (Mr) and Gastro-intestinal (Mrs) 2 418 962.44 ESSENTIAL 83 Male Gastro-Intestinal (Hemicolectomy) 2 391 506.63 COMPREHENSIVE 82 Female Musculoskeletal (Gauchers Disease) 1 800 720.61 SAVINGS 64 Female Cerebrovascular (Aneurysm) 1 771 681.93 FAMILY 65 Female Cardiovascular (Unstable Angina & Stroke) 1 760 348.46 EXECUTIVE 89 Female Vascular (Poor circulation & severe cellulitis) 1 575 867.52 ACTIVE SAVER New-born Female Maternity (760g neonate) 1 526 926.17
22 925 601.35
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WHY TOPMED?
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WHY TOPMED?
- Comprehensive range of options tailored to suite
corporate clients, individuals and students
- Financial Stability
▪ Topmed’s financial position remains strong and stable with a solvency ratio well in excess of the statutory solvency requirements
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WHY TOPMED?
- Focus on health and wellness through our
benefit design
▪ Preventative screening tests paid from major medical benefit ▪ Post-hospitalisation benefit available for 5 major medical conditions ▪ Comprehensive Maternity Programme ▪ Additional chronic conditions on certain options ▪ Contraceptives payable from the major medical benefit
- n certain options
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WHY TOPMED?
- Targeted nurse interventions to ensure effective
disease management
▪ Oncology
▪ HIV / AIDS ▪ Diabetes ▪ Organ transplant and dialysis ▪ Mental Wellness ▪ Maternity programme ▪ Lifestyle Management programme
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WHY TOPMED?
- Corporate Care
▪ Corporate client Wellness Nurse offering ▪ Education, advice, counselling, health risk assessments ▪ Employee health management ▪ Healthy employees are productive employees
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WHY TOPMED?
- Corporate Care
Case Study
▪ This member is part of a Corporate Group ▪ Joined Topmed in 2012 ▪ Gender: Male ▪ Age: 52 years ▪ Option: Savings
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WHY TOPMED?
▪ Co-morbidities: Hypertension ▪ Admission History: Admitted on 3 occasions in 2017. His first admission was for rotor cuff syndrome of his shoulder which needed surgical correction. He complicated with pulmonary embolism, pulmonary collapse and adult respiratory distress.
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WHY TOPMED?
▪ Initial Contact: Contact was made with the member when he was first admitted to hospital. At the time he explained that he was admitted for a standard procedure which unfortunately
- complicated. He said that he was diagnosed with
hypertension for which he received medication but as his blood pressure improved, he was advised that he could stop his treatment. Counselling was provided in this regard and he was assisted in registering his chronic condition with the chronic department.
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WHY TOPMED?
▪ Areas of Concern:
- He remains a high risk for re – admissions
- Possible non-compliance to treatment for hypertension
- Poor lifestyle management is evident
- He experiences elevated stress levels at work
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WHY TOPMED?
▪ Goals:
- Getting member to acknowledge and accept his present
health condition and working towards adequate management thereof
- Understanding the need and applying appropriate use of
scheme benefits to manage the risk of possible admissions
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WHY TOPMED?
▪ Outcome: He has since made adjustments to his lifestyle and is making healthy choices as far as possible. He has taken up walking during his lunch times, he plans his meals and he takes small, regular breaks at work which help to lower his stress levels. His weight has improved from 148kg to 128kg and his blood pressure has stabilised between 138/83mmhg - 135/75mmhg.
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WHY TOPMED?
- Go Digital
▪ Robomed ▪ Our self-service facilities on our website and mobile app provide 24 hour access to statements, savings balances, tariff calculator, provider search function and more ▪ Health Blog
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WHY TOPMED?
▪ Robomed
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WHY TOPMED?
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WHY TOPMED?
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WHY TOPMED?
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WHY TOPMED?
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WHY TOPMED?
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WHY TOPMED?
- Additional Products
▪Employee Assistance Programme ▪IGAP gap cover ▪JustRewards loyalty programme
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MARKET AWARENESS
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MARKET AWARENESS
▪ Individuals between 18 and 45 ▪ Family size ▪ Option specific ▪ Focus on Digital Marketing & Brand Awareness
Target Market
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MARKET AWARENESS
Facebook Advertising
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MARKET AWARENESS
Blog Articles (Newsletters)
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MARKET AWARENESS
Google - Organic Search – Page 1
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MARKET AWARENESS
Google - Paid Search – Number 1
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MARKET AWARENESS
▪ Raising Awareness Digitally (Aug 2018)
Newsletter 51,149 Opens Facebook 4,111,134 Views Google 324,652 Views
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2019 OPTION OVERVIEW & CHANGES
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2019 OPTION OVERVIEW & CHANGES
▪ Our Comprehensive option is for those with considerable healthcare needs ▪ Unlimited Private Hospital cover at up to 300% TT ▪ Comprehensive Out of Hospital cover is unlimited after Threshold is reached ▪ Unlimited Chronic benefits
Comprehensive Option
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2019 OPTION OVERVIEW & CHANGES
Benefit Changes 2019:
▪ Benefit Limits increased by an average of CPI ▪ No other changes
Comprehensive Option
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2019 OPTION OVERVIEW & CHANGES
▪ Our Executive option is a top end plan for the higher claimer ▪ Unlimited Private Hospital cover at up to 200% TT ▪ Out of Hospital cover is provided through a 25% Medical Savings Account and generous Above Threshold Benefits
Executive Option
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2019 OPTION OVERVIEW & CHANGES
Benefit Changes 2019:
▪ Benefit Limits increased by an average of CPI ▪ No other changes
Executive Option
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2019 OPTION OVERVIEW & CHANGES
▪ Our Family option is an option for the family with mid to high healthcare needs ▪ Unlimited Private Hospital cover at up to 150% TT ▪ Comprehensive Out of Hospital cover with a generous Above Threshold Benefit
Family Option
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2019 OPTION OVERVIEW & CHANGES
Benefit Changes 2019:
▪ Benefit Limits increased by an average of CPI ▪ No other changes
Family Option
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2019 OPTION OVERVIEW & CHANGES
▪ Our Savings option is for the younger family with low to medium healthcare needs ▪ Unlimited Private Hospital cover at up to 100% TT ▪ 16% Medical Savings Account for Out of Hospital Cover
Savings Option
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2019 OPTION OVERVIEW & CHANGES
Benefit Changes 2019:
▪ Benefit Limits increased by an average of CPI ▪ No other changes
Savings Option
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2019 OPTION OVERVIEW & CHANGES
▪ Our Essential option is a pure hospital plan for younger members wanting cover for catastrophic events and who are happy to cover their Out of Hospital needs themselves ▪ Unlimited Private Hospital at up to 100% TT at a DSP
Essential Option
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2019 OPTION OVERVIEW & CHANGES
Benefit Changes 2019:
▪ Benefit Limits increased by an average of CPI ▪ No other changes
Essential Option
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2019 OPTION OVERVIEW & CHANGES
▪ Our Network option is an exceptionally affordable option designed to cover the Primary Care needs of the younger family and students ▪ Cover is through a defined network of providers (In and Out of Hospital) ▪ Hospitalisation is limited to PMB ▪ Contributions are income based
Network Option
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2019 OPTION OVERVIEW & CHANGES
Benefit Changes 2019:
▪ Benefit Limits increased by an average of CPI ▪ Restructuring of premium income bands ▪ No other changes
Network Option
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2019 OPTION OVERVIEW & CHANGES
▪ Our Active Saver option has been designed specifically for active individuals and young families ▪ Unlimited Private Hospital cover at up to 100% TT (Benefit exclusions and deductibles apply) ▪ 16% Medical Savings Account for Out of Hospital Cover
Active Saver Option
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2019 OPTION OVERVIEW & CHANGES
Benefit Changes 2019:
▪ Benefit Limits increased by an average of CPI ▪ Unlimited GP consults at Network GP once Savings is depleted √ ▪ Preventative Dentistry Benefit available once Savings is depleted √ ▪ Out of hospital MRI/CT scans (co-pay & pre-auth apply) √ ▪ Elective Caesarean Sections (co-pay applies) √
Active Saver Option
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2019 CONTRIBUTIONS
Average contribution increase 9.98%
(excl. Network Option income band restructure)
Subject to CMS approval
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