Bonitas enhanced the Wellness and Screening Benefit for 2016

Summary for the busy professional:
The enhancement was implemented to further entrench the concept of Population Health Management. Improved benefits include the expansion of the range of screening tests to include all options.

The Wellness Extender Benefit is an industry first, that supplements the existing health-risk assessment benefit by promoting continuity of care. Therefore, depending on the results of the member’s health risk assessment, members can consult with the Family Practitioner (FP), these consultations do not deplete their savings or day-to-day benefits. In addition, the family practitioner can refer the member to other healthcare practitioners e.g. physiotherapist, biokineticist or dietician, if necessary, as consultations are also funded from the Wellness Extender benefit.

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Full article:
Bonitas has enhanced the Wellness and Screening Benefit for 2016 to further entrench the concept of Population Health Management. These enhancements are documented below and are aimed at facilitating the early identification of common risk factors that will be managed by the appropriate care pathway.

  • Preventative tests
    The range of screening tests has been expanded to include all Options as per the table below.

Screening tests(Eligibility criteria is applied to the above tests to promote cost-effective care)

  • Wellness Extender Benefit
    Bonitas has created an industry first, Wellness Extender Benefit that supplements the existing health-risk assessment benefit by promoting continuity of care. Therefore, depending on the results of the member’s health risk assessment, members can consult with the family practitioner and these consultations do not deplete their savings or day-to-day benefits. In addition, the family practitioner can refer the member to other healthcare practitioners e.g. physiotherapist, biokineticist or dietician, if necessary, as these consultations are also funded from the Wellness Extender benefit.

  The Wellness Benefit is tabulated below:
Wellness benefit

The Wellness Extender Benefit can only be accessed if:

  1. The member has completed a health risk assessment
  2. The member has pre-registered for the Wellness Extender Benefit Claims will be funded from Wellness Extender Benefit if accompanied with valid consultation tariff codes and ICD 10 code of Z00.0. (Please ensure that your claims has this specific ICD 10 code)

Bonitas Medical Fund (BMF) views the FP as the coordinator of care for its members. With this principle in mind, the following operational plan is recommended that ultimately ensures that “at-risk” beneficiaries are supported and encouraged to consult with their FP and subsequently registered on the various managed care programmes.

There will be repeat interventions (email, SMS and phone call) targeted at those beneficiaries who have not consulted a FP in the past 12 months. The intervention is aimed at encouraging these beneficiaries to make use of the Health Risk Analysis (HRA).

Ravi_Pillay_1_jpgAuthor: Ravi Pillay – Senior Manager: Clinical Risk Management