Covid-19 and your medical aid

Since the Coronavirus entered the country, we have been told to take precautionary measures like washing your hands and not touching your face but one precaution that has been overlooked is checking your medical aid. With lockdown a reality, now is a good time to check what you are covered for or how you could save money during and beyond the Covid-19 crisis.

The question that has been on South African’s minds lately: “Are medical aids covering COVID-19 related claims?”

The answer to this question is not that clear and often depends on the following:

  • The type of cover you have – members on hospital plans do not have access to day-to-day benefits.
  • If you have any saving left – members that find themselves in a self-payment gap may incur out-of-pocket medical expenses.
  • How sick you get from the virus – in some cases members will show mild flu-like symptoms while in other cases emergency and/or in-hospital treatment may be required.

Quite soon after the first confirmed case of Covid-19 in South Africa, the Council for Medical Schemes (CMS) released a statement saying most medical health insurance providers would pay for tests for the novel coronavirus.

As of 18 March 2020, Discovery Health, Momentum Health, Profmed, Fedhealth, and GEMS, have all released statements confirming that their members would be covered for coronavirus testing.

BUT there are some T’s and C’s attached to this commitment:

  1. If your test for Covid-19 comes back negative, then the claim will be paid out of your savings.
  2. If you have no savings account linked to your plan, or you have run out of savings for the year, you will have to pay for the test out of your own pocket. This amount is estimated at just under R1,500 per test, excluding the doctor’s consultation fee.
  3. If your test for Covid-19 comes back positive, you will be covered for the cost of the test, any consultations associated with the diagnosis and supportive treatment and medicines.
  4. In some cases, as with Discovery Health, members will be able to access Discovery Health’s “WHO Global Outbreak Benefit” which is opened up when a declared global outbreak like Covid-19 occurs. At the point of a positive diagnosis, members are covered for out-of-hospital costs for related treatment from the Scheme and not from their day-to-day benefits. Most of South Africa’s larger medical schemes hold reserves specifically for events like Covid-19. The challenge however is, if an outbreak goes on for too long then those reserves could deplete.

In most cases, schemes rules for members whose symptoms to Covid-19 do not result in emergency type treatment, will likely be no different to if they presented with a flu virus.

Covid-19 in itself is not a PMB and mild presentations of this disease do not form part of the conditions covered as a Prescribed Minimum Benefit (PMB). In other words, you need to be really ill and present with various COVID-19 complications like pneumonia and respiratory failure before treatment will be covered as part of PMBs. In addition, you will need to be hospitalised to have access to any hospital benefits.

Paying for Covid-19 tests and medical treatment is not the only consequence facing South African consumers.

The imposed 21-day lockdown from midnight on Thursday, March 26 until midnight on Thursday, April 16, 2020 will have significant implications for business and individuals. While this measure is intended to slow down the spread of infections and save the lives of hundreds of thousands of South Africans, it will result in additional financial strain for households.

With the complete shutdown of non-essential businesses for 21 days, the question is how many, especially small businesses, will survive – and the real question, how many jobs will be lost, particularly those employed in the travel and tourism and related industries. Should these businesses survive, they will be faced with additional ‘resurrection’ costs when they reopen and may not have sufficient cash reserves to pay their employees beyond a month or two of the lockdown. While there is some talk of loan restructuring from financial institutions, it may not be enough for already over-indebted consumers that have had to dig into their own savings and reserves to fund ‘emergency shopping’ and feeding kids that are now in ‘holiday mode’.

As disposable income starts to diminish, consumers may be looking to cut out some of their bigger monthly expenses in order to fund their households. With medical aid premiums being one of the biggest household expenses, the concern is that consumers may feel the temptation to cancel their medical aids. This is by far the worst time to be without private medical cover. Covid-19 is going to be around for some time still.

For right now, those that are under financial pressure, there are options:

  1. Check your medical aid cover – you may be over insured and could pay less monthly by eliminating cover you don’t need.
  2. Do a price check on your medical aid and compare your premium with other medical aids that could be offering the same cover for less.
  3. Switch from a medical aid to medical insurance. It’s a much better alternative than having no cover at all.
  4. If you are able to, consider adding Gap Cover to your plan. This way if you do end up in hospital, you will be covered for any shortfalls incurred from in-hospital specialist treatment. Just remember there is a 3-month waiting period, so rather act now.

You can do all this at The service is free and supported by a team of expert consultants that can assist you with saving money.