Social media users recently voiced their frustrations over medical aid schemes, with some seeking advice regarding which ones to apply for depending on their benefits.
The Covid-19 pandemic worsened these frustrations when people seemed to not know if their medical aids would pay for their tests and treatments.
As the country battles the second wave, Lerato Mosiah, chief executive officer (CEO) of the Health Funders Association, says it is important for consumers to have peace of mind in knowing that the disease is covered by their medical scheme and to understand the benefits which they are entitled to.
Which medical aid are you on?
— MadamTee®️ (@Thokozani_M1) December 6, 2020
While these benefits may differ slightly, depending on the medical scheme plan consumers are on, there are certain benefits which are covered by all schemes, regardless of their plan.
“From as early as May, the Council for Medical Schemes [CMS] offered guidelines in alignment with the Medical Schemes Act. These guidelines were updated to ensure that members are covered for screening, testing and treatment, in accordance with the prescribed minimum benefit regulations. Many schemes also offer cover above and beyond those as part of the scheme rules,” she says.
Certain Covid-19 benefits have been included in the list of prescribed minimum benefits, which means that these are available to all members, regardless of the plan that they are on and that the costs associated with these treatments will be paid by the scheme and will not be deducted from a member’s medical scheme savings account.
Which medical aid is the best option? And why?
— Karabo Nkoana (@KaraboNkoana_za) December 3, 2020
“As long as you are referred for a Covid-19 test by a medical practitioner, your medical scheme will cover the cost of the test, regardless of whether you test positive or not. This includes cases where you may merely have been exposed to the virus and after screening, be referred by your healthcare professional for testing. The cost of both screening and testing in such cases will be covered by your medical scheme,” she said.
Depending on how severe your symptoms are, further tests may be necessary. Where this is the case, these tests will also be covered by your scheme regardless of which plan you are on, provided that the medical practitioner has made the necessary referrals, says Mosiah.
For those with mild-to-moderate cases, which do not require hospitalisation, necessary medications including antibiotics for secondary infections and treatments for chronic comorbidities such as asthma, HIV or diabetes, will be covered by the scheme.
“Where a patient is at a higher risk of developing complications associated with hypoxia [low blood oxygen saturation levels] some schemes may also fund a pulse oximeter, which is a device for measuring the oxygen in your blood,” says Mosiah.
Once an effective vaccine is available, it is likely that this too will be covered by the scheme (as per the scheme rules) once it has been approved and included onto the National Essential Medicine List.
“As we enter the festive season and the Covid risks which that brings, we must realise that the Covid-19 virus is part of our reality now, and will remain a prominent feature of the healthcare landscape for the foreseeable future, perhaps indefinitely,” says Mosiah.