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Your Medical Aid on Coronavirus

By Khuthala Nandipha

Diagnosis and management of uncomplicated COVID-19 infection is not included in the Prescribed Minimum Benefits (PMBs) of Medical Aids. However, all medical schemes have been instructed to provide comprehensive cover for all confirmed cases of coronavirus in the interest of public health.

This was announced by Dr Sipho Kabane, Chief Executive Officer of the Council for Medical Schemes (CMS), the regulator of the medical schemes industry in South Africa. This message was sent out to all the medical aid companies in South Africa, following the announcement of the first Coronavirus case in South Africa on Thursday, March 5, 2020.

PMBs are a set of defined benefits that ensures all medical scheme members have access to certain minimum health services, regardless of their benefit option. All medical schemes are required by law to pay for the diagnosis, treatment and care costs of PMB conditions in full irrespective of plan type or option.

“CMS is committed to ensuring that there is effective coverage for all conditions that members may suffer from, including any complications of the coronavirus. They are not allowed to fund PMB conditions from a member’s Medical Savings Account, as this is not in line with the PMB Regulations,” warned Dr Kabane.

Most of the complications of the Coronavirus are included in the PMB and should be treated as specified for the specific condition. One of the most common complications is Pneumonia and it is a prescribed minimum benefit (PMB) condition. “According to the Medical Schemes Act of 1998, medical schemes have to cover the costs related to the diagnosis, treatment and care,” said General Manager for Stakeholder Relations at the Council for Medical Schemes.

If you are experiencing flu-like symptoms, your first point of call is to contact your medical scheme. All testing for the coronavirus will be referred to state laboratories and not private labs, as advised by the Department of Health.

Dr Ryan Noach, CEO of Discovery Health says, “Discovery Health is taking prudent and proactive steps to ensure members are covered in the event that COVID-19 infections. The Discovery Health Medical Scheme benefit, which is immediately accessible to members, provides funding in full, from the scheme’s risk pools, to cover the tests and treatment in the case of a confirmed COVID-19 diagnosis. We must all remain calm,” he said.

Noach added that, “Benefit design, governance and rule changes typically take months to mature, but in light of the urgency, DHMS, together with the Council for Medical Schemes, have finalised a new benefit in a very short space of time.”



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