File: More people are going to need to test for the coronavirus as the rate of infection increases.JOHANNESBURG - With lockdown easing, people are heading back to work and school which means a sharp rise in COVID-19 infections is inevitable.It is therefore important to understand exactly how medical schemes will cover COVID-19 testing, hospitalisation and treatment in order to avoid unexpected medical expense shortfalls.
Should a patient choose not to use a DSP, then the medical scheme is only required to pay in line with medical aid rates. Regardless of test results, as long as the member was screened by a healthcare professional and was deemed necessary by a medical professional and the RT-PCR test is used, it must be funded from the medical aid’s risk-benefit as a PMB.Where the person tests negative, any follow-up care is not covered.
Here, the cost of testing would most likely come from the members day-to-day benefit or be self-funded.Should a person voluntarily choose to make use of a non-DSP then, that member is likely to be exposed to a medical expense shortfall for the in-hospital treatment.