FAQ on Covid 19 – Medical aid benefits, hospital admission & Claims

When to take a test and when will it get covered? 
You’re covered for 2 COVID-19 Polymerase Chain Reaction (PCR) screening tests every calendar year (1 January to 31 December), regardless of the outcome of the test. 
 
Medical Aid will pay for COVID-19 diagnostic tests, provided that the member who took the test: 

• Showed symptoms for COVID-19 which include 

• Severe acute respiratory illness 

• With a fever or history of fever and/or 
• A cough and / or 
• Sore throat and / or 
• Shortness of breath or difficulty breathing. 

• Was in contact with an individual with the virus; and 

• Was referred by a healthcare practitioner (doctor). 

You’re also covered for pre-admission PCR testing if you’ve been approved to go to hospital, as long as you’re referred by a doctor. 

Will you have to pay upfront and submit a claim for it to be paid from this benefit? 
This depends on the payment arrangements your medical aid have with your healthcare provider. If your healthcare provider submits a claim on your behalf, your medical aid will reimburse them directly subject to meeting the clinical entry criteria of the benefit. If your doctor requires you to pay upfront, you can submit your claim to your medical aid. 

What does it mean if I test positive for the PCR test? 
A positive PCR result confirms that you are infected and that you can spread it to others. You would need to contact your doctor to discuss the implications of this finding and the next steps to take, whether this be to self-isolate at home and/or on your planned hospital admission. 

If I test Positive, how do I self-isolate and for how long do I self-isolate? 
If you are infected and are asymptomatic i.e. you show no symptoms, you must stay at home and self-isolate for 10 days from the date of your positive test. In case of severe respiratory illness or severe shortness of breath you need to immediately consult with your doctor or go to the nearest hospital emergency unit. In case of severe disease, you will probably be hospitalised, and you would need to continue to self-isolate for 10 days after clinical stability is achieved. 

If I test positive for Antibody test, will I have immunity to COVID-19 infections in the future? 
As COVID-19 is a new virus, we cannot tell for sure how long antibodies will last or how well they can protect against future infections. Even though it is believed that a person will have some level of immunity after infection, which is the scientific principle that the development of a vaccine is based on. However, all individuals should still adhere to recommendations by the department of health on social distancing, hygiene, and personal protection, regardless of their antibody test result. 

How am I covered for COVID-19? 
This benefit, available on all plans, is covered by the scheme for cases of outbreak diseases and out of hospital healthcare services related to COVID-19. These healthcare services are covered up to maximum of 100% of your chosen medical scheme’s rate in accordance with Prescribed minimum benefits where applicable. 

Am I covered if I am in a waiting period? 
The scheme resolved to change its’ approach to underwriting for the duration of the outbreak, specifically with regards to cover for COVID-19. Members that are diagnosed with COVID-19 after joining will have access to the benefit, even if they are subject to a waiting period at the time of being diagnosed with COVID-19. 
Members that are diagnosed with COVID-19 before joining the scheme will not have access to the benefit and will be subject to waiting period to protect the scheme and its members against anti-selection. 

Emergency care – When should I call 911 or go to the emergency department? 
Call ER24 on 084124 if you are experiencing potentially life-threatening symptoms. 
These are some of the symptoms for which you should immediately call ER24; 

• Chest pain or pressure, palpitations, shortness of breath or other symptoms of heart attach or other heart problems 
• Sudden numbness, weakness, confusion, loss of vision, problems with speech or balance, or other symptoms of stroke. 

• Unexplained or worsening shortness of breath, or other breathing problems 
• High fever 
• Intense or unexplained pain 
• Heavy bleeding or bleeding without an obvious cause 
• Severe injury or trauma, including deep, large, or severe cuts. 

• Possible fractures or broken bones 
• Any other problems that you consider an emergency. 

​What if I’m afraid to go to the emergency department? 
We understand those fears, but emergency department staff members wear personal protective equipment, and all places are fully cleaned and disinfected. Please note, that waiting too long to seek care for some health care emergencies is a bigger risk than the chance of contracting COVID-19. 
How do I know I won’t get COVID-19 in the emergency department? 
Depending on the urgency of the patient’s medical needs, everyone entering the emergency department is immediately screened for symptoms of COVID-19. 

How do I know I won’t contract COVID-19 if I need to stay in the hospital for treatment? 

• All the hospitals screen patients for COVID-19 at the time of hospital admission and within 72 hours prior to having surgeries and procedures that require testing. 
• The medical staff members know how to care for a patient and how to protect themselves and others. 
• The hospital is fully disinfected by cleaners. 

• All medical staff has expertise in infectious diseases, the training and preparedness to safely care for patients with COVID-19. 

All labour and delivery patients – How are women protected whom come in for labour and delivery? 
In order to prevent the spread of COVID-19 and protect the health of all patients and staff members, testing for COVID-19 and taking precautions for each woman who is admitted to labour and delivery for delivery. The care team will follow special infection prevention procedures and wear proper personal protective equipment. 
Depending on the woman’s COVID-19 test results, she may be cared for in a special room and according to COVID-19 guidance for deliveries. 

What to expect when you go to the hospital 
During the COVID-19 pandemic, we have extra measures in place to prevent the spread. 

• Everyone entering hospital facility is screened for COVID-19 and must wear a face mask. 
• All patients are tested for COVID-19 at the time of hospital admission and within 72 hours prior to having surgeries and procedures that require testing.  
• Once you get to the hospital, please remember to provide the hospital with your medical aid number to be added to your hospital account. Otherwise, your medical aid will not accept it at claim stage. 
• Please be sure to find out, on who may accompany a patient at the care facility as each hospital may have their own operational rules. 

• After you are discharged from hospital, please be sure to ask the reception for a copy of your Hospital account should you require to submit proof to medical aid or gap cover for claim purposes. Please take special care to check if your medical aid number appears on the account. 

Registration for COVID-19 Vaccine 
Acting health minister Mmamoloko Kubayi-Ngubane has announced a major boost to South Africa’s Covid-19 vaccination plans, with vaccines now being made available to more age groups and on weekends. 
Kubayi-Ngubane said that the government had also agreed to open vaccine registrations to people in the 35 – 49 age group. 

• Registration for this cohort will open on 15 July 2021. 

• The rollout for those registered is set to begin on 1 August. 

If you have not registered, please see below link references: 

• Bonitas, Momentum and Fedhealth registration: 
  https://vaccine.enroll.health.gov.za/ 
• Discovery health: 
  https://www.discovery.co.za/d2hp/ui/login?logged-out=true 
  
  

Employer group vaccination will soon be open to companies that have more than 35 staff, please see timeline below: ​

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All staff will be vaccinated, even if you’re not part of Discovery health, if they are part of company staff list, then they are eligible to receive vaccination. Should you be interested, please contact us and we will assist to communicate with Discovery to action Discovery Vaccination programme for employers. 

​Vaccination during riots and civil unrest period 
Please note that some of the vaccination sites that are affected are temporarily closed due to looting, riots and civil unrest. The vaccination rollout will be delayed but still encourage all clients to please use their digital form to register and make appointments. Those that missed their appointment due to recent looting will be rescheduled. 

If you have any other queries please contact our Health department, email [email protected], Tel 011-6581333, Option 2 for Medical Aid.