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New coronavirus changes for South African medical aids

| Legislation

The Department of Health has gazetted changes to the Medical Schemes Act which outlines cover for Covid-19 in South Africa.

The gazette, which was published on Friday (8 May), details the diagnosis and treatment of Covid-19 as a Prescribed Minimum Benefit (PMB) by medical aids.

The regulations state that the following treatments will be covered:

  • Screening;
  • Clinically appropriate diagnostic tests;
  • Medication;
  • Medical management including hospitalisation and treatment of complications;
  • Rehabilitation of Covid-19.

The official classification comes after medical schemes regulator, the Council of Medical Scheme (CMS), issued a circular in April encouraging medical schemes to cover the screening, diagnosis, treatment and care of Covid-19 patients.

It also asked medical aids to consider giving members a premium holiday for three months where certain conditions are met.

CMS chief executive and registrar, Dr Sipho Kabane, also asked medical schemes to ensure that there was continued compliance with their managed care protocols to mitigate the possible negative impact of Covid-19.

At the onset of the pandemic, medical schemes were not obliged to pay for Covid-19 tests where members had tested and received a negative result.  As a result, most schemes only paid for tests and relevant treatment when members had tested Covid-19 positive.

“The CMS lodged a draft amendment to the Prescribed 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,” said Kabane.

“The signing and promulgation of coronavirus in the National Gazette and the publication thereof are being handled by the National Department of Health.”

The CMS also encouraged medical schemes to assist vulnerable members who cannot pay contributions due to loss of income as a result of the coronavirus pandemic and subsequent lockdown.

“Schemes should investigate all disruptions to member contributions on a case by case basis and determine the merits thereof, before suspension or termination of membership,” said Kabane.

Medical Aid Gazette May 2020 by BusinessTech on Scribd


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