An Update on COVID-19 Cover

After receiving CMS guidelines, gazetted on 5 May 2020, we have updated our COVID-19 funding decisions.

  1. We have taken the following funding guideline decisions:

Irrespective of the result, the following will be paid as a PMB from Risk benefits:

  • Confirmed cases (ICD UO7.1)
  • PUI (Person under investigation) (ICD UO7.2)
  • Probable case (ICD UO7.2)
  • High-risk individuals

These tests will be assumed as being symptomatic, screened and referred.

If a COVID-19 test is not requested by the provider, the consultation is paid from Scheme benefits.

  1. How will pre-admission COVID-19 tests be paid for?

We have taken the following funding guideline decisions:

  • Routine pre-admission COVID-19 PT-PCR testing for asymptomatic patients which turn out negative will be paid from Scheme benefits.
  • If a pre-admission COVID-19 test is positive, it will be paid as a PMB from Risk benefits.
  • If a member is admitted and has no day-to-day Scheme benefits, the negative test will be paid from Risk benefits or as part of hospital benefits.
  1. How will COVID-19 “drive-through” tests be paid for?

We have taken the following funding guideline decisions:

  • If it is known that the negative COVID-19 test is from a drive-through, we will assume the member to be asymptomatic, unscreened and unreferred and will, therefore, pay from Savings or Scheme benefits.
  • If the COVID-19 test is positive, it will be paid as a PMB from Risk benefits.
  • If it is not known that the negative COVID-19 test is from a drive-through, we will assume the member to be asymptomatic, unscreened and unreferred and the test will be paid from Savings or Scheme benefits.
  • If Savings or Scheme benefits are not available, the member will be liable.

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