COVID-19 is a Prescribed Minimum Benefit (‘PMB’) and is defined as an acute respiratory disease. This means that medical schemes need to cover all members irrespective of plan type or option and does not affect the member’s day-to-day benefits.

Benefits for members and their beneficiaries on medical schemes include screening, diagnostic tests, medication, hospitalisation, and rehabilitation. A defined basket of care per medical scheme may vary.

Screening and testing for COVID-19

Members are covered for COVID-19 screening and testing. A member will be required to obtain a referral from a healthcare practitioner to be covered for the test. Medical schemes have different protocols in place regarding the number of tests available.

Diagnostic and consultations for COVID-19 positive members

Members diagnosed with COVID-19 have access to a defined basket of diagnostic and consultations, up to the scheme rate.

X-rays and scans

Members have access to a defined basket of x-rays and scans, up to the scheme rate.

Supportive medicine

Defined supportive medicines prescribed by the member’s doctor for symptom management and treatment of COVID-19, up to the scheme rate.

In-hospital

Hospital admission is subject to approval and preauthorisation. Sub-limits and clinical guidelines apply to certain healthcare services in hospital. In-hospital treatment related to COVID-19 for approved admissions is covered from the Hospital Benefit based on the chosen health plan and in accordance with Prescribed Minimum Benefits (PMB) where applicable.

Vaccinations

COVID-19 vaccinations are funded in full by medical schemes for all scheme members and their beneficiaries. Please click here to find your nearest vaccination centre.

The content in this communication is for information purposes and is not intended to be detailed advice, you should seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.