Home South African Coronavirus: Medical aids decide to go the extra mile

Coronavirus: Medical aids decide to go the extra mile

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A virus of this nature would not normally be covered under the prescribed minimum benefits (PMBs), but the council’s registrar and chief executive Sipho Kabane confirmed that most schemes would provide extra cover.

Cape Town – Medical aid schemes will cover people affected by the Covid-19 virus, a decision the Council for Medical Aid Schemes (CMS) said would ease the burden of many South Africans.

A virus of this nature would not normally be covered under the prescribed minimum benefits (PMBs), but the council’s registrar and chief executive Sipho Kabane confirmed that most schemes would provide extra cover.

“We have been talking to schemes and some of them have come forward saying they want to extend their rules to cover coronavirus as part of their risk pool and almost provide comprehensive cover. We’re encouraging other schemes to do that as well.”

PMBs are a set of defined benefits that ensure all medical scheme members have access to certain minimum health services, regardless of their benefit option.

According to a report by the council: “All medical schemes are required by law to pay for the diagnosis, treatment and care costs for these conditions in full, irrespective of the 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,” the regulation states.

“As the virus progresses it may result in various complications, such as pneumonia and respiratory failure which then, should be treated as a prescribed minimum benefit level of care,” said Kabane.

Earlier this month, the World Health Organisation urged all countries to take immediate action as the virus spreads rapidly.

“We are calling on all countries to invest urgently in preparedness for the arrival of cases and to prioritise the protection of health workers and individuals at risk and to communicate better the risks of transmission to their people,” said Matshidiso Moeti, WHO regional director for Africa.

“These cases should be a wake-up call for governments across Africa. Governments must do all they can to prepare for an eventual outbreak: time is critical.”

Most concerning for the CMS, apart from the global spread of the virus, is that the epidemic is fuelled by human transmission, leading to extra hygiene caution needed.

“Of concern is the fact that the virus can be spread by individuals who show no symptoms of the infection,” said 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,” he added.

Kabane urged anyone who suspects contracting the virus or experiencing flu-like symptoms to contact their medical aid scheme immediately.

However, he confirmed that all testing for the coronavirus should be referred to state laboratories and not private labs, as advised by the Department of Health.

Health Minister Zweli Mkhize said there were now 24 confirmed cases of the virus in the country. The six latest cases included four in Gauteng, one in Kwa-Zulu-Natal and three in the Western Cape.

Weekend Argus