Discovery Health Medical Scheme, the country’s largest open medical scheme, will fund the costs of tests and treatment for its members who contract the coronavirus. 

In order to enjoy this cover, however, your illness must be confirmed as a case of what is known as Covid-19. 

As the flu season starts in mid-March, more people will start showing signs of flu, which are also the first signs of the coronavirus.

If you suspect you have the virus and are sent for tests, but test negative, your scheme will only provide its usual benefits, which for Discovery members means any costs incurred for tests will be paid from their medical savings accounts. 

If you are being tested for the coronavirus, the testing will be done by state laboratories not private labs, however.

As the first case of the virus in South Africa was confirmed this week, the Council for Medical Schemes confirmed that if you are a member of a scheme and have an uncomplicated infection, your scheme is only obliged to pay for your treatment in line with its benefit rules.

Only if the virus progresses and results in complications such as pneumonia and respiratory failure, which are prescribed minimum benefits, will your scheme be obliged to pay for your tests and treatment, Dr Sipho Kabane, the chief executive and registrar of the council said. 

Discovery Health CEO Ryan Noach, however, announced on Thursday that Discovery Health Medical Scheme had developed the DHMS WHO Global Outbreak Benefit to pay for the diagnosis and treatment of the coronavirus in full for all its members.

The scheme worked with the council to quickly change its rules to make the benefit available to all the scheme’s members on all its benefit options, Noach said. 

The WHO Global Outbreak Benefit will cover Discovery members for diagnostic testing, testing for influenza, consultations with healthcare professionals and “defined supportive treatment and medicines”.

Noach says in most people the virus presents in a mild form and that resolves “spontaneously”.

He said policyholders covered by Discovery’s primary care plans who are confirmed Covid-19 cases will also have access to full funding for testing and treatment costs for the duration of the Covid-19 outbreak.

They will be expected to use healthcare professionals in the plan’s network. 

Medical scheme members who have Discovery’s gap cover policy will also be covered for gaps in specialist costs should they be hospitalised with the virus and no waiting periods will apply, Noach said.

He encouraged members, particularly the elderly and those with chronic illnesses, to have this season’s regular flu vaccine as soon as it arrives in South Africa as this year's flu season may overlap with the virus. 

Discovery has set up on its website an information hub on the virus where any one can access regularly updated accurate information that will help you understand the virus and what is happening. 

The administrator has assembled an outbreak committee that is supported by specialists and with the backing of international experts with daily access to the information provided by the WHO and US’s CDC, he says. 

Other schemes

Bonitas, another large open medical scheme, also informed its members that it will pay for the diagnosis, treatment and care of those who contract the coronavirus from its risk pool in line with the WHO global outbreak benefits.

For other scheme members, cover for the virus will be the same as it is for any other flu, Damian McHugh, executive head of sales and marketing at Momentum Health Solutions said.

Tests for the virus will be done by the National Institute for Communicable Diseases (NICD), but are only being done for those who are regarded as under investigation because they meet certain criteria, such as having traveled to affected areas or being in contact with infected people, Lee Callakoppen, principal officer of Bonitas, said.

If you test positive, the NICD will get involved to ensure all your contacts are interviewed and managed, McHugh said, adding that most people will, however, be dealt with through home quarantine.

Should you need hospital treatment, this will be authorised by your scheme in line with your scheme’s rules, McHugh and Profmed principal officer Craig Comrie said.

McHugh confirmed that you can choose private hospital treatment, but the NICD can recommend the treatment outcomes to manage the condition. Various private hospital groups have indicated that they have the capability and processes to comply with NICD protocols.