The COVID-19 pandemic and the CMS
Find all the latest information from the CMS, and what we are doing to respond to ensure affordable medical care during this global pandemic.
CMS personnel are working remotely from home, except when required by the CMS to perform critical tasks, which cannot be carried out from home. The CMS has followed guidelines issued by the Department of Labour to ensure the safety of these employees.
In the spirit of social distancing, walk-in complaints will not be welcome. Complainants are requested to rather use the online complaints form to submit a complaint. The Complaints and Adjudication unit is working tirelessly to see to all complaints lodged during this period.
Drivers or couriers without wearing the requisite face mask will not be admitted to CMS. At all points of entry, hand sanitising (with 60% alcohol based sanitiser), and temperature screening will be mandatory. In addition, exposure and contact information will be requested prior to admission.
Medical Schemes Act Amendment
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.
Prescribed Minimum Benefit Guideline on Coronavirus
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.
Member guidance on COVID-19 benefits
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.
Keeping the industry updated on COVID-19 developments
Since the beginning of the pandemic, the CMS has been issuing Circulars to the industry on key developments related to statutory requirements, COVID funding, level of care and vaccines.
- Circular 24 of 2020: COVID-19 Update
- Circular 25 of 2020: COVID-19 lockdown measures
- Circular 28 of 2020: COVID-19 Medical Schemes Industry Guidelines
- Circular 29 of 2020: Claims information for beneficiaries treated for COVID-19
- Circular 33 of 2020: Understanding medical scheme reserves
- Circular 50 of 2020: Industry Update on Developments Relating to COVID-19 Exemptions and Guidelines
Press Releases to be uploaded as soon as they are issued.