Covid-19

The Covid-19 benefit covers the out-of-hospital management and appropriate supportive treatment of global WHO recognised disease outbreaks and out-of-hospital healthcare services related to COVID-19. This benefit offers funding for the Prescribed Minimum Benefits (PMB) as well as additional funding and does not affect a member's day-to-day benefits, as long as it meets the Scheme's clinical and benefit entry criteria. Hospitalisation for Covid-19 is funded from the hospital benefit.

Other Benefits in addition to the Prescribed Minimum Benefits

• Pre-admission Covid-19 test: Should you need to be admitted for a non-COVID-19 diagnosis.
• Pulse Oximeters for high-risk patients as per Scheme clinical criteria.
• Oxygen via an oxygen concentrator as per Scheme clinical criteria.

Scheme funding for Covid-19 testing

Requirement for funding: screening and referral by a doctor
You always need to be screened by a doctor and get a referral to a pathology laboratory for the test to be paid by the Scheme. Whether the result is negative or positive, the test will be paid by the Scheme and not from your normal day-to-day benefits. The benefit limit for negative tests is one test a year. If the test is positive, it will be funded as a Prescribed Minimum Benefit (PMB).

Self-referral to a pathology laboratory

If you self-refer (without a referral by your doctor) to a registered pathology laboratory like Ampath, Lancet, Pathcare, etc., the Scheme will not fund the test. The Medical Savings Account can be used on the Managed Care Plan if performed by a registered pathology laboratory. Members on the Standard Care Plan will have to pay for these tests from their own pocket.