Private medical aid? Here’s how Covid-19 costs will be deducted
Private testing can be expensive, with COVID-19 tests estimated to be around R1 500.
The country’s largest open medical aid scheme, Discovery Health Medical Scheme (DHMS), in line with many other medical schemes, has created a new benefit package to cover DHMS members diagnosed with the Corona virus, called the WHO Global Outbreak benefit.
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It covers all members on all plans where infections occur within South Africa, giving them access to diagnostic testing for both the coronavirus and influenza. Consultations and treatments will be covered from the scheme’s risk pool as opposed to their day-to-day benefits and savings for those who test positive. Testing negative, however, tests will be covered from day-to-day benefits and infections that occurred while members were travelling abroad, will be covered by the DHMS International Travel Benefit.
Testing of asymptomatic and low risk people tested to allay anxiety, will, however, overwhelm the healthcare system, according Discovery Health CEO Dr Ryan Noach.
Bonitas Medical Fund will cover diagnosis, treatment and care for the coronavirus from the risk pool as well and members meeting the criteria of being a person under investigation by the NICD qualify for these test benefits. Treatment protocol for members who test positive will be in line with the WHO Global Outbreak Benefits.
“The test to confirm the diagnosis is not covered from member benefits. If it’s pneumonia or respiratory failure, it will be covered by prescribed minimum benefits (PMBs),” Lee Callakoppen, principal officer of Bonitas Medical Fund, said.
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. PMBs 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.
Momentum Medical Scheme will cover the cost of diagnostic tests and treatment and hospitalisation, where necessary, for all members from its risk benefits.
Profmed, Fedhealth, and GEMS, have all indicated their members would be covered for coronavirus testing.
Confirmed cases of Covid-19 are covered for:
- Diagnostic testing;
- Consultations; and
- Defined supportive treatment and medicines
It is important to note that full coverage will only be implemented should you test positive for the virus. Testing and treatment will not be charged from your medical savings account. Should the test come back negative, the cost will however be charged to your medical savings.
Private testing can be expensive, with COVID-19 tests estimated to be around R1 500.
According to projections by the South African Centre for Epidemiological Modelling and Analysis, around 80% of cases are projected to be mild, while 15% to 20% of those infected may develop pneumonia and may require hospital admission.
Public hospitals in the country serve 80% of the population and struggle as it is to deal with the number of patients dependent on the state for care, and it is expected that not all who need hospitalisation could be admitted.
JSE-listed RH Bophelo Group with eight hospitals, offered the Department of Health a full isolation facility at a huge discount should government run out of capacity.
* Patients are requested to contact the emergency department of their hospital or their healthcare provider before going for a consultation if there are concerns that he/she may be infected with the Corona virus, enabling them to take appropriate precautionary measures to ensure that staff and others at the facility are safeguarded while the patient is assessed, treated or admitted, until it can be confirmed whether he/she have tested positively or not for COVID-19.
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