Covid-19 will be covered by all medical aid plans

Neil Kirby, director and head of the Healthcare & Life Sciences practice at Werksmans Attorneys, says the effect of the amendment is that all medical schemes are obliged to cover all the costs of members – regardless of their plan – who contract Covid-19 and subsequently suffer respiratory illness complications associated with the treatment.

“Where it might previously have been unclear whether or not medical schemes would cover the costs for the treatment of Covid-19 for members on lower plans, the amendment, arguably, relieves financial pressure on the health department because the state is obliged to cover the costs of citizens who are not covered by medical schemes,” says Kirby.

Testing a member with no symptoms and who is negative will be “funded according to scheme rules”, which appears to imply such testing will be funded from a member’s available benefits, not the prescribed minimum benefits . The PMB will not cover follow-up treatment of a person with symptoms who tests negative.

Kirby says the Council for Medical Schemes has recommended that, rather than patients being seen at doctors’ rooms, telehealth be delivered through online platforms and be reimbursed as a PMB level of care in line with recommendations made by the Health Professions Council of SA.

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