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COVID-19 – New PMB guidelines for medical aids

The Council for Medical Schemes recently published PMB definition guideline: COVID-19 v3, a guideline that clarifies PMB entitlements of medical scheme beneficiaries within the context of the pandemic, ensuring that there is uniform interpretation amongst all stakeholders. It further sets out recommendations for the screening, diagnosis, treatment and care of individuals with suspected and confirmed COVID-19 as per WHO case definitions.

Major changes in the guideline elaborates on the following:

Reporting of confirmed cases only, and not both confirmed and suspected cases
Changes in the case definition to align with NICD guidelines
Defining close contacts and removal of high-risk persons criteria
More clarity on funding of RT-PCR testing is provided as a separate section
Addition of specific criteria for CT scan
Cough suppressants not PMB level of care for COVID-19
More clarity on funding of out of hospital symptomatic medication for COVID-19
Funding guidance on people living with HIV, children, new-borns, pregnant and breastfeeding women
Funding of personal protective equipment (PPE) and asymptomatic people returning to work

Click here to download the guidelines.

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