Lockdown is easing up and South African businesses are gearing for difficult and resilient times ahead. It is therefore important to understand how medical schemes will position themselves in terms of various new regulatory guidelines from the Council of Medical Schemes (CMS), as well as from a fund protection and fund management perspective.
The Regulations issued under the Disaster Management Act included medical scheme administration services as essential services and in Circular 25 of 2020, the CMS announced that all cases of Covid-19 must be regarded as a Prescribed Minimum Benefit (PMB) condition. This means that all Covid-19 cases must be covered in full.
This is in line with the current guidelines as published by the National Institute of Communicable Diseases (NICD), which should cover:
The important aspect to consider, though, is that testing and treatment cannot be regarded as a PMB without a positive diagnosis.
This means that initial testing and treatment may be treated and deemed as normal day-to-day medical claims and only reassessed as a PMB after a positive diagnosis.
Initially, only the state was allowed to do testing, but various private Covid-19 testings are now available. These tests can cost up to a R1 000 each (drive-through screenings/tests are also available at Dis-Chem, with 24-48 hour results), all paid via card facilities from one’s own pocket.
A number of medical schemes have responded swiftly to the CMS’s guidelines to be lenient with businesses who want to downgrade to more affordable options or suspend medical scheme contributions during these trying times.
Stay up to date with these scheme assistance directives via the Simeka Health website to gain more clarity, direction and reassurance in this current, complicated healthcare environment.
Our consultants can assist employers to motivate and recommend such Covid-19 downgrades or suspensions to the said medical schemes. This direction will be needed, as medical schemes consider such applications on merit only and each case will be subject to specific and strict protocols in terms of each scheme’s own rules.
Simeka Health has also negotiated very affordable Employee Assistance Programmes (EAPs) with some of our loyal service providers. These include emotional and psychological support services for your employees in a time when most needed!
Please contact us at email@example.com or contact your Simeka healthcare consultant for wellness or stress-related support.