MMT Consulting

Individuals in a meeting

How Medical Shemes Are Adapting to Covid-19

The COVID-19 pandemic is highlighting the need for health care organizations to evaluate and adapt their care delivery models to move towards a virtual care environment. The industry is collectively working on a vaccine (a Phase 1 Clinical Trial has been initiated), will take time to test, and be granted approval from regulatory bodies. Pharma ingredients from China specifically could have an effect on the global supply chain network; Supply chain disruption could represent an industry opportunity to re-examine current channels. Consumer health divisions of both life sciences and health care companies could benefit as consumers stock up on OTC medications and sanitizing products while medical scheme benefits are depleted. As the Pandemic progresses there will be increasing challenges for healthcare providers / elderly care organizations to maintain a workforce as the impact of the virus is felt in the workforce itself.

Most of the open medical schemes in South Africa were quick to respond to the new challenges relating to the outbreak of the COVID-19 virus and its associated economic challenges due to the lockdown measures announced by the Government.

Source: Deloitte

Medical schemes are governed by laws and regulations, promulgated through a parliamentary process, and overseen by the Council for Medical Schemes. While lockdown started towards the end of March, the first regulations linked to the declaration of a disaster and COVID-19 were already published by 15 March 2020. Through the Disaster Management Act Regulations, the Competition Act, the Medical Schemes Act Regulations, and Council for Medical Schemes Circulars, the landscape for the healthcare industry and medical schemes specifically were changed to adapt to the new normal.

By 7 May 2020, both negative and positive tests for COVID-19 were regulated to be regarded as Prescribed Minimum Benefits (PMB), if certain requirements were met. Schemes are therefore obliged to fund the costs. A further list of COVID-19 treatment codes were published, allowing for the full spectrum of treatment, including hospitalization, ventilator treatment, and even oxygen level monitors, were medically required, to be funded by medical schemes.

At the same time, medical schemes began to allocate resources to telemedicine offerings against the background of the risks associated with contact consultations. Medical schemes also announced special support measures to members who had difficulty affording contributions. These included downgrades, using built-up savings to fund contributions, and even temporary terminations, without underwriting being applied when members re-join later. Similar relief measures were announced to companies experiencing cash flow strain, including premium deferral holidays for qualifying groups.

All medical schemes put out communications about the virus, how to access benefits and how it would be funded. Some offered additional “return-to-work” screening/testing/cleaning support, and new industries emerged where these services were offered to employers at a cost.

Source: Salam

Some of our Medial Aid Providers mentioned this in their response to Covid-19

   Momentum Health 

Momentum Medical Scheme will cover all costs for diagnosis and treatment if it is confirmed that you have Coronavirus (COVID-19), irrespective of your chosen benefit option. It includes cover for both in- and out-of-hospital visits. If you must travel internationally, we will provide cover outside of South Africa, provided you notify us in advance before you leave.

Visit Momentum Medical Scheme to read more on this.

   Discovery Health

Discovery Health has been working tirelessly to keep people informed on the latest news and updates for Covi-19.

Visit Discovery Health







Leave a Comment

Your email address will not be published.