Helping you in your time of need with affordable and comprehensive Gap Cover
The Covid-19 virus has arrived on our shores here in South Africa and we are seeing and feeling the effects of this pandemic in our everyday life. Our daily narratives have changed to include words and terms like social distancing, self-quarantining, washing your hands with soap and water, hand sanitizing, coughing or sneezing into the crook of your arm, face masks, surgical gloves, toilet paper, and a whole lot more. Countries all over the world are struggling to come to terms with Covid-19 and how best to curb the spread of this virus, while still having to deal with treating those patients who have unfortunately been positively diagnosed with it.
The worst of Covid-19 is yet to come for South Africa
Our President has had to take some bold decisions here in SA to try and mitigate the risk of the virus spreading to all parts of our country. Our Department of Health appears to be on point with the setting up of the testing and treatment protocols, however, the fact is that it is still early days here and the worst may still be yet to come.
So, the question that is being asked by many medical aid members at the moment is whether their medical aid will cover the cost of being treated for the covid-19 virus? The Council for Medical Schemes has recently published a circular that sets out the manner in which medical schemes will deal with the issue of the cost of treatment of this virus.
As the virus progresses it may result in various complications, such as pneumonia and respiratory failure which then, should be treated as Prescribed Minimum Benefit (PMB) level of care,” said Dr Kabane. In cases of uncomplicated infection where there are no PMB-eligible conditions, the medical scheme may fund all health care costs as per scheme rules.
“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,” concluded Dr Kabane.
PMBs are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. They are a feature of the Medical Schemes Act of 1998, and medical schemes have to cover the costs related to the diagnosis, treatment and care.
(An extract from the CMS Press Release 3 of 2020: Medical schemes and the coronavirus)
Are you prepared?
This all sounds very encouraging in theory but shouldn’t you also consider enhancing your current medical aid cover by investing in a gap cover policy through CompliMed? At least then you’ll have the peace of mind knowing that even if the unthinkable should happen, you have a policy in place to cover the shortfalls that may occur as a result of the in-hospital treatment and procedures? Apply here online today.