How will my medical aid cover the costs of COVID-19 testing and treatment?

How will my medical aid cover the costs of COVID-19 testing and treatment?

– Tanya Motlafe (Head of  Cornerstone Healthcare Consulting Services)

With the nationwide COVID-19 lockdown in full swing, many South Africans are home bound for the next few weeks at least. Cornerstone Healthcare Consulting Services has always been at your side to answer any medical aid questions, to advise you on the best course of action to ensure that you and your family stay protected and healthy. Our responsibility to you will remain unchanged even amidst these strange and trying times.

Many of our clients and members of the public has approached us asking about whether they are covered for diagnosis and treatment of COVID-19. The answer is yes. In a recent publication by the Council for Medical Schemes (CMS), they have confirmed that all treatment and diagnosis of COVID-19 must be treated as a Prescribed Minimum Benefit (PMB).

Prescribed Minimum Benefits (PMB) is a set of defined benefits as featured in the Medical Schemes Act to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.

The CMS publication states that all medical schemes are required by law to pay for the diagnosis, treatment and care costs for this condition in full irrespective of plan type or option. Medical schemes are not allowed to fund PMB conditions from a member’s Medical Savings Account, as this is not in line with the PMB Regulations. In cases of uncomplicated Covid-19 infection where there are no PMB-eligible conditions, the scheme may fund all health care costs as per scheme rules. You can find the full publication by clicking here.

Please note the treatment guideline may vary depending with a medical scheme for example, preferred providers to be used and the rate of reimbursement. We are contracted with all major medical schemes, and if you want t know more as per your preferred scheme, please contact us.

Also, please remember that we are fully operational during the lockdown period and will gladly assist with any medical aid query, whether it’s COVID-19 related or otherwise. Get in touch with Cornerstone Healthcare Consulting Services today on 011 794 6611 or email info@cshcs.co.za

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