Medical schemes voluntarily expanding rules to cover coronavirus – Council

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The SA Council for Medical Schemes (CMS) says some medical schemes are voluntarily expanding their rules to cover coronavirus, also known as COVID-19.

This is according to Dr Sipho Kabane, the Chief Executive and Registrar of CMS, who spoke to Cape Talk on Monday.

He said, “Traditionally, when you look at medical cover on conditions such as flu, including coronavirus, these would not be regarded as part of your prescribed minimum benefits (PMB) and would be paid by the schemes in terms of their own rules, and most of the time it’s done from your savings rather than from the risk pool.”

Members advised to contact funders

Kabane added, “So, we are advising members of schemes [that] when they have a condition that is flu-like, they need to contact their funder and ensure that there is sufficient funding for that.

“What is covered as PMBs are basically complications, like pneumonia, respiratory failure and other complications that would arise from flu or even coronavirus.

“But we have been talking to schemes and some of the schemes have come forward and said, ‘We want to extend our rules to cover coronavirus as part of our risk pool and provide almost comprehensive cover,’ and we have accepted that and we are encouraging all the other schemes to do that in the interest of public health.”

In a press release issued last week, Kabane also said once coronavirus causes serious complications, those complications “should be treated as PMB level of care.”

3 confirmed cases so far

He explained, “All medical schemes are required by law to pay for the diagnosis, treatment and care costs of PMB conditions in full irrespective of plan type or option.

“They are not allowed to fund PMB conditions from a member’s Medical Savings Account, as this is not in line with the PMB Regulations.”

Minister of Health Dr Zweli Mkhize has confirmed three cases of coronavirus in South Africa so far, all of them related to a recent trip to Italy by a group of 10 travellers.

The first case was identified last week as a 38-year-old man in KwaZulu-Natal. His wife became the third confirmed case on Sunday.

A 39-year-old woman from Gauteng tested positive on Saturday. She was also part of the same travel group to Italy.

In his statement on Sunday, Mkhize said, “We expect the results of the other six group members who had travelled to Italy within the next 48 hours.”

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