The Minister of Health has, in terms of section 67 of the Medical Schemes Act, 1998 (Act No. 131 of 1998), and after consultation with the CMS, published an amendment to the Medical Schemes Act Regulations in Notice 515 in Government Gazette 43295.

Click to read more on this on Circular 35 of 2020.

This guideline seeks to clarify PMB entitlements of medical scheme beneficiaries within the context of the pandemic, ensuring that there is uniform interpretation amongst all stakeholders. It sets out recommendations for the screening, diagnosis, treatment, and care of individuals with suspected and confirmed COVID-19 as per WHO case definitions.

Click to read more on this Benefit Guideline.

As a member of a medical scheme, you need to know your guaranteed benefits. The CMScript newsletter on Coronavirus will give you details on what is covered under PMB level of care. Screening, diagnosis, and management of COVID-19 infection has been included as a new Diagnosis Treatment Pair included as part of the Prescribed Minimum Benefits (PMBs) diagnoses list.

In addition, any complications arising from infection with COVID-19 are also included in the list of existing PMB conditions and should be treated as specified for each condition. These complications would also usually qualify as emergency medical conditions and are therefore PMBs. All medical schemes are required by law to pay for the diagnosis, treatment and care costs for this condition in full irrespective of plan type or option.

Get member guidance on benefit entitlements for COVID-19 here.