CAMAF Member Option Guides & Info

Council for Medical Schemes on COVID-19

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3 CMScript 1/2020 • In cases of symptoms suggestive of respiratory ill- ness either during or after travel, travellers are en- couraged to self-report or seek medical attention, and share their travel history with their health care provider. • Healthcare facilities should enhance their standard infection prevention and control practices in hospi- tals, especially in emergency departments. Treatment and management Anyone who experiences flu-like symptoms with a travel history or contact with someone who has recently trav- elled to high risk countries, should seek immediate medi- cal attention at their nearest clinic, GP or hospital. All individuals with suspected COVID-19 infection should: • Perform hand hygiene frequently, particularly wash- ing hands thoroughly with soap and water. If this is not possible using alcohol-based antiseptic hand rub is an alternate option; • Keep distance from well individuals as much as pos- sible (at least 1 meter); • Wear a medical mask that should be provided to the individual and be worn as much as possible, if it can be tolerated to contain respiratory secretions. For in- dividuals who cannot tolerate a medical mask, he/ she should rigorously apply respiratory hygiene, i.e. cover mouth and nose when coughing or sneezing with disposable paper tissue. Dispose of the material after use. Clean hands immediately after contact with respiratory secretions; • Improve airflow in living space by opening windows and doors as much as possible. Management of individuals with suspected COVID-19 infection centres around prompt diagnosis and notifica- tion, categorisation of disease (mild, moderate, severe), prevention of spread as well as supportive care. In all cases, hospitalisation with isolation or quarantining of all infected individuals and treatment with anti-viral medica- tions are indicated. All testing for the coronavirus should be referred to State laboratories and not private labs, as advised by the De- partment of Health. What is covered under PMB level of care? Diagnosis and management of uncomplicated COVID-19 infection is not included in the Prescribed Minimum Ben- efits (PMBs). COVID-19 infection may, however, result in various complications as listed above. Most of the complications are included in the PMBs and should be treated as specified for the specific condition. One of the most common complications of COVID-19 infection - Pneumonia - is a prescribed minimum benefit (PMB) condition under the Diagnosis and Treatment Pair (DTP) code 903D. This DTP refers to "Bacterial, viral, fungal pneumonia". The treatment component for this condition is specified as "Medical management, ventilation". All medical schemes are required by law to pay for the diagnosis, treatment and care costs for this condition in full irrespective of plan type or option. Medical schemes are not allowed to fund PMB conditions from a member's Medical Savings Account, as this is not in line with the PMB Regulations. In cases of uncomplicated COVID-19 infection where are no PMB-eligible conditions, the scheme may fund all health care costs as per scheme rules.

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