Suspicion of Infections and Medical Scheme Coverage
At this time, South Africa has over 1,170 confirmed COVID-19, commonly known as Coronavirus, cases and the numbers are expecting to increase before they get better as we progress through the lockdown. The important thing is that we do not panic.
This email answers two important questions:
- What if I contract COVID-19?
- Will my medical scheme pay for COVID-19 treatment?
I feel ill or I’ve been exposed
The major symptoms of COVID-19 are:
- A Fever
- Shortness of breath.
If you feel you have been exposed to COVID-19, or are showing slight symptoms, please avoid contact with other people in your family, your community and self-isolate – as per the lockdown.
Please ensure that you do not go to your doctor’s consulting rooms as you risk exposing other patients to COVID-19.
If you feel you are ill and need non-urgent medical care, call your doctor to ask how to be tested. They will need to follow certain steps to get you the specific care you need.
If you are feeling very ill and need urgent medical care, call your emergency services or go to the emergency department.
When seeking care, follow these steps:
- Call your doctor, medical scheme Telemedicine emergency number, or nearest healthcare facility and tell them that you have, or are being evaluated for, COVID-19
- Put on a face mask before you enter the healthcare facility- if you have a cough
- Your healthcare professional is not required to inform the NCID when they do a test. Instead, the testing lab will send the results through to the NCID.
I’m concerned my medical scheme won’t cover COVID-19
The short answer is that the medical schemes are compelled to pay for your test.
The Council for Medical Scheme’s has instructed all medical schemes in South African to cover positive COVID 19 cases from the risk, and not day-to-day or savings.
In line with clinical protocols and benefit guidelines, this should cover:
- All consultations
- All clinically appropriate diagnostic tests including Viral PCR
- All clinically appropriate medication
- Costs of hospitalisation including all complications and rehabilitation.
It is important to note that, if you get tested for COVID-19 and it is negative, the schemes may take this from your day-to-day or savings benefit, or you may have to pay for the test out of your pocket – but you will not be liable if you test positive.
We urge all our members to practice social distancing and remain under lockdown during this trying time.
Isolation, physical distancing, the closure of schools and workplaces are challenges that affect us, and it is natural to feel stress, anxiety, fear and loneliness at this time.
If you are feeling uncomfortable, please reach out to any Employee Wellness Programmes which may be on offer, or keep in telephonic contact with friends, family or co-workers.