• Local medical schemes are adapting their member’s benefits ahead of the spread of coronavirus in SA. 
  • The first case of coronavirus in SA was reported on Thursday. 
  • Discovery Health, Momentum Health and Profmed have all indicated that their members will be covered in case of coronavirus. 
  • For more stories go to www.BusinessInsider.co.za.

South African medical schemes are preparing for the spread of coronavirus, or Covid-19, in the country, with most promising that their members will be covered under existing benefits.

This after reports emerged in the United States (US) that insurers refused to pay for coronavirus tests, or government mandated quarantines.

The first known case of coronavirus in South Africa, a 38-year old male from KwaZulu-Natal travelling back from Italy, was identified this past week, the South African health department confirmed on Thursday afternoon. 

Also read: The novel coronavirus has landed in South Africa – here is everything we know

The patient's doctor and his family have also been placed under quarantine, with the department working to quarantine and test fellow South Africans he might have been in contact with. 

Coronavirus was declared a public health emergency of international concern by the World Health Organisation (WHO) in January 2020, a month after it was first detected in the Chinese city of Wuhan.

Discovery Health, South Africa’s largest medical health insurer, Momentum Health and Profmed have all indicated that their members would be covered for coronavirus testing in South Africa. 

Discovery Health CEO Ryan Noach said the medical aid’s board approved a specific Covid-19 benefit on Wednesday which would cover all diagnostic testing and supportive treatment.

However, Noach said, coverage for quarantine in third party facilities will depend on the state’s designated quarantine plans, but quarantine is typically at home. 

“It is notable to point out that benefit design, governance and rule changes typically take months to mature. In this case, [Discovery Health] has been nimble and proactive to meet members’ potential needs,” Noach told Business Insider South Africa. 

Also read: There’s a run on hand sanitiser in South Africa - but experts say it won’t entirely help against coronavirus

Momentum Health’s Marketing head Damian McHugh said coronavirus coverage will depend on their members’ plan. 

Someone can therefore for example not visit a doctor on a hospital plan, as hospital plans do not contain day-to-day benefits. 

McHugh said the most important arrangements Momentum can make ahead of the spread of coronavirus is to share factual information with our members. “The virus is manageable and the fatality rate is low, based on the infection rate.”

The Council for Medical Schemes, which regulates all medical schemes in South Africa, on Thursday said depending on the nature of an individual's medical aid, they may be required to pay for both diagnosis and treatment of coronavirus out of their own pocket, 

However, if an individual contracts pneumonia as a result of coronavirus, it will be covered as a prescribed minimum benefit (PMB) condition in South Africa, the council said. 

"All medical schemes are required by law to pay for the diagnosis, treatment and care costs for this condition in full, irrespective of plan type or option.” 

"Medical schemes are not allowed to fund PMB conditions from a member’s Medical Savings Account".