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Covid -19: New changes regarding Medical Aids

Covid -19: New changes regarding Medical Aids

The gazette that was published on the 8th of May from the Department of Health, indicates changes to the Medical Scheme Act which outlines cover for Covid-19 in South Africa.

 

The gazette details the diagnosis and treatment of Covid-19 as a Prescribed Minimum Benefit (PMB) by medical aids.

 

The following treatments for Covid-19 will be covered:

  • Screening
  • Clinically appropriate diagnostic tests
  • Medication
  • Medical management including hospitalisation
  • Treatment of complications
  • Rehabilitation of Covid-19

 

The Council of Medical Schemes (CMS) issued a circular in April encouraging medical schemes to cover the screening, diagnoses, treatment and care of Covid-19 patients.

 

Dr. Sipho Kabane, CMS Chief Executive asked medical schemes to ensure that there was continued compliance with their managed care protocols.

 

The CMS also asked all medical aids to consider giving members a three month premium holiday, where certain conditions are met.

To encourage medical aids to assist those members who cannot pay their contributions due to loss of income, a result of the national coronavirus lockdown.

 

Kabana added, “Schemes should investigate all disruptions to member contributions on a case to case basis and determine the merits thereof, before suspension of their membership.

 

When the pandemic started in South Africa and members tested negative for the virus, medical aid schemes were not obliged to pay for the Covid-19 tests.

Most medical schemes only paid for tests and treatment when members had tested positive for Covid-19.

 

“The CMS lodged a draft amendment to the Prescribe Minimum Benefit (PMB) regulations with the Minister of Health to cover the screening, diagnosis, treatment and

care of Covid-19 as part of the Prescribed Minimum Benefits package. The signing and promulgation of coronavirus and the publication thereof are being

handled by the National Department of Health,” said Kabane.

 

Source: Businesstech

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