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Covid-19 Pandemic – How medical schemes assist members

The financial services industry across sectors have responded in various ways to reduce the economic impact of COVID-19. The unprecedented pressure on consumers brought on by the pandemic has also prompted a quick response from medical schemes who have rallied to grant financial and other assistance to their members.

Lerato Mosiah, CEO of the Health Funders Association, has applauded the medical schemes industry for their speedy response to finding ways to assist their members through this difficult time, while still maintaining compliance with the very tight regulatory framework that governs the funding industry.

Various measures were put in place:

From as early as March, members with a confirmed diagnosis of COVID-19 were assured that their tests and treatment for the disease would be funded in full.
Medical schemes had to allocate unbudgeted funds for extensive testing and treatment, including the often-prolonged funding of high cost, lifesaving treatment in hospital.
There was a rapid implementation of coverage for additional benefits like virtual consultations with health service providers and funding for extra personal protective equipment (PPE) in hospital as well as isolation facilities.
Together with hospital groups, schemes closely monitored the utilisation of high care and ICU hospital beds with a view to redirecting their members to facilities with available space when necessary.
Medical schemes have structured innovative ways, within regulatory parameters and within scheme rules, of accommodating members who are struggling to pay contributions due to an interruption in their earnings.
Some schemes have permitted members to utilise their accumulated savings to pay contributions, while others have offered payment concessions to SMMEs.

Mosiah adds that schemes focus on providing a range of plans to meet medical and affordability needs across their membership, and members are always encouraged to consult their financial advisers to find an option best suited to them and to enable them to retain cover.

For medical schemes, budgeting for 2021 will be challenging. “Protecting members, both through providing adequate benefits and through ensuring that contributions remain affordable is going to require that medical schemes navigate carefully through this complex time”, Mosiah concludes.

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