Basic medical aid members only covered for Covid-19 if complications arise


128 days ago

The Council for Medical Aid Schemes is urging medical schemes to provide comprehensive cover for all confirmed cases of coronavirus Covid-19.

Contracting Covid-19 can lead to complications such as pneumonia and respiratory failure – these should be treated as a Prescribed Minimum Benefit (PMB).

PMBs are a set of defined benefits to ensure that all medical scheme members can access some minimum health services, no matter what benefit option they choose.

The law compels medical aids to pay all costs involved in diagnosing, treating and providing of care when dealing with PMB conditions.

Medical aids may not fund PMB conditions from a member’s Medical Savings Account.

If the infection is mild without any PMB-eligible complications, the medical scheme must fund all healthcare costs according to the scheme’s rules.

Refilwe Moloto interviewed Dr Sipho Kabane, CEO of the Council for Medical Schemes.

Kabane spoke about his organisation’s recommendations and guidelines to medical schemes with regards to patients infected with coronavirus Covid-19.

Once it complicates - whether from flu or coronavirus - it gets treated in full as a PMB.

Dr Sipho Kabane, CEO - Council for Medical Schemes

We encourage scheme members, once you get a whiff of any flu-like symptoms, make sure you consult with a General Practitioner, contact your scheme to check if there’s funding available… wash hands, avoid contact, quarantine yourself…

Dr Sipho Kabane, CEO - Council for Medical Schemes

Listen to the interview in the audio below.

This article first appeared on CapeTalk : Basic medical aid members only covered for Covid-19 if complications arise

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