coronavirus medical aid schemes

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Coronavirus SA: Will your medical aid cover an infection?

The coronavirus is officially in SA. What better way to prepare than to know how your medical aid will have your back.

coronavirus medical aid schemes

Image via Adobe Stock

As of 5 March, the coronavirus has officially landed in South Africa and nobody can say that it’s not a tad intimidating. You might be trying to stay calm in the midst of all the panic or you could be running around like a chicken with its head cut off. Either way, it’s important that you take the proper precautions early in the game, such as checking your medical aid to see whether it would cover you in this particular instance. 

The Council for Medical Schemes (CMS) is concerned by the global spread of the coronavirus, particularly that the epidemic is being fuelled by human-to-human transmission. 

“Of concern is the fact that the virus can be spread by individuals who show no symptoms of the infection,” said CMS chief executive and registrar Sipho Kabane. 

“We, therefore, encourage all who have travelled to areas with confirmed cases, or have come into close contact with someone who has travelled, and thereafter experience flu-like symptoms and a fever, to seek immediate medical attention,” added Kabane. 

Coronavirus SA: Make contact with medical aid schemes 

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

“As the virus progresses it may result in various complications, such as pneumonia and respiratory failure which then, should be treated as Prescribed Minimum Benefit (PMB) level of care,” said Kabane. 

In cases of uncomplicated infection where there are no PMB-eligible conditions, the medical scheme may fund all health care costs as per scheme rules. 

High-risk individuals — members with pre-existing conditions such as pregnancy, diabetes mellitus, asthma, cancer, HIV and other immunosuppressive conditions — are urged to keep up with their routine medication and screenings. 

Individuals over the age of 50 and children under the age of 10 years are also encouraged to visit the doctor’s office regularly. 

All medical aid schemes required to pay for treatment of coronavirus  

Kabane went on to say that by law, all medical aid schemes must provide diagnosis, treatment and care costs of PMB conditions in full, irrespective of plan type or option. 

“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,” he added. 

PMBs are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. They are a feature of the Medical Schemes Act of 1998, and medical schemes have to cover the costs related to the diagnosis, treatment and care.

“We encourage medical schemes to provide comprehensive cover for all confirmed cases, in the interest of public health,” added Kabane. 

First confirmed case in SA  

Health Minister Dr Zweli Mkhize has officially confirmed that a 38-year-old patient, said to be from KwaZulu-Natal (KZN), contracted the disease while visiting Italy. He returned home on 1 March and was isolated due to the symptoms he was showing.

Here’s what Mkhize had to say about the incident: 

“This morning, Thursday 5 March, the National Institute for Communicable Diseases (NICD) confirmed that a suspected case of coronavirus has tested positive. The patient is a 38-year-old male who travelled to Italy with his wife. They were part of a group of 10 people and they arrived back in South Africa on 1 March 2020.

“The patient consulted a private general practitioner on 3 March, with symptoms of fever, headache, malaise, a sore throat and a cough. The practise nurse took swabs and delivered it to the lab. The patient has been self-isolating since 3 March. The couple also has two children,” he added. 

The doctor has also been self-isolated, as she may have picked up the coronavirus too.