Update: COVID-19 Benefits

It is important that we continuously monitor the outbreak, as well as our response as a Scheme to the rising numbers. We have updated our cover to ensure that we fully meet our members’ related medical needs.

We offer:

Out-of-hospital Benefits: Physical, Telephonic and Video Consultations

To help members take the necessary measures, Bestmed has funded over 23 000 COVID-19 tests thus far. 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 of 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.

We require that members obtain a referral by a medical professional before taking a COVID-19 test. Members are encouraged to take the required safety precautions when visiting their provider, and to keep in mind that Bestmed also covers telephonic and video consultations with healthcare providers 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.

In-hospital Benefits

We cover hospitalisation at 100% Scheme rates if members have tested positive for COVID-19. It is important to note that pre-authorisation is required for hospitalisation and that they need to use one of our designated service providers if they are on a network option. The list of the dedicated network of services providers can be accessed via the online member portal, as well as via the Bestmed App. In the case of a positive diagnosis, the member, their representative or their healthcare provider must notify Bestmed as soon as possible via telephone on 086 000 2378 or via email at service@bestmed.co.za.

Over-The-Counter Benefits

Bestmed members can also claim refunds for any cash purchases of personal protective equipment such as hand sanitisers and masks purchased from any network pharmacy by sending the proof of purchase to claims@bestmed.co.za. Refunds are paid from the member’s available over-the-counter (OTC) benefit.

We have communicated this update to our members and hope that together, we can allay some of the fears that are natural at this time.

Mental health

Being inundated with constant information about an infectious disease outbreak can have a negative impact on one’s mental health. Hearing, reading, or watching news may create signs of stress. These signs of stress are normal and may be more likely or pronounced in people with loved ones in parts of the world affected by the outbreak. In the wake of an infectious disease outbreak, it is important to monitor your own physical and mental health. Know the signs of stress in yourself and your loved ones.

Know how to relieve stress and know when to get help. Mental health includes our emotional, psychological and social well-being. It affects how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Mental health is important at every stage of life, from childhood and adolescence through to adulthood.

Mental illnesses are serious disorders which can affect thinking, mood and behaviour. There are many different conditions that are recognised as mental illnesses. The more common types include:

  • Substance addiction
  • Major depression
  • Bipolar mood disorder
  • Schizophrenia

Treatment of chemical and substance abuse are covered on all Bestmed benefit options during hospitalisation, subject to the availability of funds.

Benefits are subject to the availability of funds allocated on the different benefit options for services rendered out of hospital. We also cover these conditions from available day-to-day benefits.

We encourage you and our members to conduct regular self-checks to ensure that you are managing the effects of stress as best you can.

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