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UNDERSTANDING
WHAT YOU'RE PAYING FOR
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Wading
through the details of any health insurance plan can be a frustrating
experience. Helping members to understand their Destiny Health Plan is
the first step to giving them the confidence and satisfaction they
deserve. After all, purchasing a Destiny Health Plan is buying our
promise to give members total comfort with their healthcare decisions.
Destiny
Health uses a triangle to describe an important relationship in
healthcare: that is, the relationship between how often members receive
healthcare and how much they pay for it. The width of the triangle
represents the frequency with which members use healthcare services; the
height of the triangle shows the cost or severity of these services.
Typically, the bottom portion of the triangle is where the
lower-cost, higher-frequency services are - things like routine office
visits, eyeglasses and non chronic prescription medication. In general,
these healthcare needs are more controllable and affordable. Moving up
the triangle, medical services typically cost more, as they tend to be
less frequent and more serious in nature - hospitalization, surgery, and
transplants are examples of this type of care.
The
Destiny Health Plan approaches the frequency/cost relationship with a
common sense solution: provide insurance coverage for the higher-cost,
lower-frequency services that are less controllable; and a way to budget
and plan for the day-to-day services that people can reasonably control.
This common sense insurance solution gives our members incentives to
manage their healthcare costs intelligently; it also allows us to offer
the control, affordability, value and flexibility not available with
conventional health plans.
So, it
makes sense to view the upper and lower parts of the triangle
separately:
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INSURED
BENEFITS
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The Insured
Benefits are structured to protect members during those times when they
clearly need insurance.
These
benefits are divided into three distinct components: the Hospital and
Surgery Benefit; the Chronic Medication Benefit; and the PMF Safety Net.
The PMF
Safety Net recognizes that even day-to-day expenses can accumulate to a
costly level. So, Destiny has established Annual Threshold levels. Beyond
these levels, the PMF Safety Net provides further insurance to protect the
member against unexpected and potentially cost-prohibitive events. Once a
member's cumulative day-to-day claims exceed their Annual Threshold, they
become eligible for insurance benefits.
By
integrating the Personal Medical Fund and Insured Benefits, Destiny Health
provides a comprehensive health insurance plan that covers all areas of
healthcare in a unique, simple and sound way. It's health insurance that
makes sense.
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PERSONAL
MEDICAL FUND
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Most
day-to-day healthcare costs are generally within the member's control.
The
Personal Medical Fund (PMF) is an ideal solution for financing these
costs. Members have complete freedom to choose any provider without a
referral. In addition, Destiny Health has put together an extensive
network of providers who have agreed to discounted fee schedules. These
discounts are applied to benefits paid through members' Personal Medical
Funds.
Contributions
to the PMF are made monthly and any remaining balance may be carried
forward to the following year. Also, members may withdraw the cash if and
when they leave the plan. This changes the value proposition of the plan
from "use it or lose it" to "use it or keep it" - from
member restriction to member empowerment. |
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Look at
Destiny's advantage over conventional insurance:
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