New coronavirus guidelines for medical aids in South Africa

The Council for Medical Schemes (CMS) has published a new circular focusing on how Covid-19 should be covered by the country’s medical aids.

The circular covers a range of issues including how Covid-19 is transmitted, the risk factors most prevalent in South Africans, the most common symptoms, how to manage children and pregnant mothers, and testing protocols.

The circular also outlines which services do not fall under ‘PMB level of care’ for Covid-19.

Prescribed Minimum Benefits (PMB) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.

The Council for Medical Schemes said that the following is not recommended as PMB level of care:

  • Follow-up treatment and care for any person (symptomatic) who tests negative for Covid-19 (RT-PCR test);
  • Follow-up care for any person (asymptomatic) who tests negative for Covid-19 (RT-PCR test);
  • Routine RT-PCR testing of asymptomatic, unscreened and unreferred patients which turns out negative is based on scheme rules;
  • Routine preadmission (including elective admissions) RT-PCR testing for asymptomatic patients which turns out negative is based on scheme rules;
  • Personal protective equipment (PPE) is not currently recommended as PMB level of care;
  • Off-label medication is not PMB level of care;
  • Serological and point of care testing for COVID-19 is not currently PMB level of care;
  • Testing of asymptomatic people returning to work is not PMB level of care.

The circular also notes that babies in good health, who are born from a Covid-19 infected mother do not need a Covid-19 test, and such testing is therefore not PMB level of care.

“Unwell or symptomatic babies should have a Covid-19 test on day three of life if the case definition is met, or at another time if clinically indicated,” it said.

You can read the full directive below.


Read: Here’s how big South Africa’s coronavirus test backlog is: NHLS

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New coronavirus guidelines for medical aids in South Africa