New Year, Same Promise

If there is anything that 2020 has taught us as a Scheme, is the importance of sticking to the basics and doing the right thing. When the COVID-19 pandemic started in South Africa, we made the decision to do right by our members by offering comprehensive cover from prevention to treatment.

We would like to reiterate our stance and remind you of our cover:

Testing:

Out of Hospital Benefits: Physical, Telephonic and Video Consultations

As per the Council for Medical Schemes’ (CMS’) guidelines, Bestmed will fund screening consultations and pathology tests as a prescribed minimum benefit (PMB) from the Scheme risk benefit, whether the test is negative or positive where members comply with both the parameters listed below:

  • The member shows symptoms for COVID-19, and/or was in contact with individuals with the virus; and
  • The member was referred by a healthcare worker (doctor or nurse).

If a member is asymptomatic and is not referred by a healthcare worker, consultations and pathology tests will be paid from the relevant Scheme benefits according to their option rules and benefit availability.

The Scheme is aware of concerns regarding the risk to members that might not be infected with the virus and infected members who may inadvertently spread the virus, however, it should be noted that is medically necessary for members to consult with their healthcare provider. Members are encouraged to take the required safety precautions when visiting their provider as per practice protocols, and members and healthcare providers should keep in mind that Bestmed also covers telephonic and video consultations during the national lockdown. Telephonic and video consultations will be paid in accordance with benefit provision as per the member’s selected Bestmed option, or from Scheme risk as a PMB in line with the parameters listed above.

Treatment:

The Scheme reimburses treatment for COVID-positive members as per the funding protocol which is in line with the NICD’s clinical management of suspected or confirmed Covid-19 disease, Version 5 (24th August 2020).

In-hospital benefits

Bestmed covers hospitalisation at 100% Scheme rates if members are tested positive for COVID-19.

Vaccine:

The Council for Medical Schemes (CMS) recently announced that it will be driving public-private sector collaborations to ensure equitable access to the COVID-19 vaccine. The COVID-19 vaccine has been identified as a Prescribed Minimum Benefit (PMB) by Dr Zweli Mkhize, Minister of Health. This means that the COVID-19 vaccine will be regarded as PMB level of care and needs to be funded in full by the Scheme, regardless of the member’s option or available benefits, when it becomes available.

The National Department of Health (NDoH) will be responsible for the single, centralised procurement of COVID-19 vaccines. Therefore, as it stands, the sourcing and distribution of the vaccine will be a national roll-out project coordinated by the NDoH. NDoH will contract with suppliers to purchase stock and will allocate vaccines to provincial health departments and the private healthcare sector.

Accreditation is required for private providers to administer the vaccines and Bestmed will fund the vaccination cost at any of these accredited providers. Vaccinations will be allocated to various priority groups for administration of the vaccines:

  • Phase I – Healthcare workers: doctors, pharmacists, and allied healthcare workers on the front line are expected to start being vaccinated early February 2021.
  • Phase II – Essential workers, individuals in congregate settings, individuals older than 60 years, and individuals older than 18 years with co-morbidities.
  • Phase III – Other individuals older than 18 years.

Bestmed understands that the national vaccination system will be based on pre-vaccination registration and an appointment for vaccination. There will be a unified Information Technology (IT) platform, including public and private sectors, which will manage patient allocation of the vaccine. This platform will manage who is eligible in terms of the risk algorithm to receive the vaccine in the phased roll out. It is envisaged that all vaccinated individuals will be on a national register and will be given a vaccination card.

All the major pharmacy groups are committed, and are preparing, to be accredited to provide the required vaccination services. We look forward to a successful rollout, with your invaluable partnership and contribution.

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