COVID-19 medical aid cover for Discovery Health members

It goes without saying that our lives have changed so dramatically since the lockdown that began early last year. While we all initially hoped for a swift resolution to the pandemic and to get back to our everyday lives, the hard truth is that the coronavirus is here for the long haul. Come 2021, the virus continues to spread at a slow burn and intermittent lockdowns, mask-wearing, sanitising and social distancing have become the new norm. However, in a time of such uncertainty, Discovery Health has taken several important and proactive steps not only to help mitigate the spread of the virus but also to ensure that their members are adequately covered in the event of potential infection. Below are a few facts about how Discovery Health is facing the COVID-19 pandemic head on.

Medical Aid Covers Covid-19 tests

Each member included in a membership gets 2 COVID-19 tests for the year 2021? It is important to take note that in order to have the test done the member must first be referred by a General Practitioner (GP). The member’s available medical savings account will cover the GP. However, if the member does not have a medical savings account or has exhausted the funds in this account, they will need to cover the GP consultation out of their own pocket. The COVID-19 test is, however, covered up to R850.00 each and up to 2 tests per member, provided that the member was referred by a GP first. The member will then need to submit a copy of their Lancet account, reflecting the COVID test result to the Medical Aid.

Cover for those Infected with Covid-19

Did you know that you may have emergency cover while travelling outside of South Africa for 90 days from departure? Should you require COVID-19 related treatment whilst outside South Africa, the cover would be subject to the International Travel Benefit rules and guidelines. You will need to contact the Medical Service Organization International (MSOI) for assistance and approval on +27 11 529 6900.

If you require treatment for COVID-19 in South Africa, the claims are reviewed as part of the WHO Global Outbreak Benefit. This benefit offers cover for out-of-hospital management and appropriate supportive treatment of the global World Health Organization (WHO) recognised disease outbreaks and out-of-hospital healthcare services related to COVID-19. The basket of care includes:

  • Screening consultations with a network GP (either virtual consultations, telephone or face-to-face).

  • COVID-19 PCR screening tests if referred by your doctor, or if referred by a network GP following completion of the Medical Aid risk assessment.

  • A defined basket of pathology tests for COVID-19 positive members.

  • A defined basket of x-rays and scans for COVID-19 positive members.

  • Supportive treatment, including medicine and a home monitoring device to track oxygen saturation levels for at risk members who meet the clinical entry criteria (Oximeter).

  • Accommodation in accredited isolation facilities.

Cover is subject to the Scheme’s preferred providers (where applicable), protocols and the treatment meeting the Scheme’s entry criteria and guidelines. Any recommended treatment and healthcare services not included in the basket of care are covered according to the benefits available on the members’ chosen health plan or in accordance with Prescribed Minimum Benefits (PMB) where applicable.

An Important Note:

This article does not serve as a guarantee of payment or as an authorisation or a guarantee that benefits will be available at the time that services are rendered.

It is also a conservative estimate of how treatment and services may be reviewed for cover, based on the information received. The Claims and Preauthorisation Departments will consider the relevant industry billing guidelines when authorisation is requested or when claims are processed.

For additional information, see attached brochures or contact a broker at PBA Financial Services. Stay Safe!

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