COVID: The role your medical aid plays in Covid testing

By Danielle van Wyk

A lot of emphasis has been placed on the importance of Covid-19 testing if you suspect that you might have been in contact with the virus. However, this has also caused a surge of confusion, with people not being sure about where to get tested, the cost involved, and whether medical aid makes provision for this.

In this part of our Covid-19 Content series we chat to industry experts to understand the role your medical aid plays when it comes to getting tested.

Tip: Thinking of changing medical aid options or wanting to invest in a medical aid? Start by clicking here.

Is provision being made?

Yes, all medical schemes will be providing cover in terms of Prescribed Medical Benefits (PMB) regulations. But not everyone may have access to it.

“Each member may qualify for the test but this is only if they pass the National Institute for Communicable Diseases (NICD) assessment criteria,” says Craig Comrie, CEO of Profmed.


“Many schemes may request a copy of the NICD assessment before they cover your test. I’m not aware of any co-payments, but schemes may reject a second or third test where the first test was negative. Best is to check your scheme regulations,” he says.

Discovery Health adds to this by saying that while it’s understandable that many South Africans want access to Covid-19 testing it’s impossible to test everyone.

“We must therefore take care not to overwhelm testing centres with inappropriate demands for tests. It’s very important that we ensure that we make test kits available to those healthcare providers and patients who really need them. In this way we ensure that we allocate resources within the healthcare system in a structured and responsible way,” Discovery adds.

Who has access?

Let’s break it down further.

To gain access to testing you must meet certain clinical criteria. These criteria are based on the clear testing guidelines set out by the World Health Organization (WHO) and the NICD, which is mandated by the National Department of Health. There is also a specific process you have to follow to undergo testing.

Patients who are candidates for testing must have been assessed by their doctor or healthcare provider and found to be needing a Covid-19 test.

According to Discovery Health, these patients must meet the Covid-19 case criteria which stipulate that they:

  • Have a severe acute respiratory illness, with fever or history of fever and coughing with pneumonia.
  • Have acute respiratory distress syndrome (based on the clinical signs or X-ray findings) that requires you to be admitted to hospital.
  • Have a documented travel history to any country where Covid-19 has occurred within 14 days before symptoms start.
  • Have had close physical contact with a person with Covid-19 while they exhibited symptoms.
  • Have had close contact with patients with severe acute respiratory infections.
  • Specifically, if you’re a healthcare professional dealing with patients who have severe acute respiratory infections and where the cause of the patients’ symptoms hasn’t been confirmed.

What’s also important to remember is that people who contract the virus may take from 1 to 14 days to develop symptoms, which include:

  • Fever
  • Coughing
  • Shortness of breath or difficulty breathing

The financial implications

It’s no secret that testing has added significantly to the costs of medical schemes.

“For a scheme like Profmed testing each member once per year can add 5% to our premiums or R62.5 million in cost per year. This is only for testing and not for other treatments,” adds Comrie.

For context, most of the tests currently cost between R700 to R850.  

“Sure, there are a number of new scenarios in terms of budgeting for funding testing and treatment. Because schemes do not make profits and any surplus left over at year end supplement future contribution increases, but these scenarios need to play out in terms of all the uncertainties,” Comrie continues.

According to him, Covid testing and treatment may in fact also impact claims costs anywhere from 2% to 12%, and that can often translate to similar premium increases before considering other inflation-related increases. Additional exchange rate deterioration in 2020 will also put pressure on 2021 claims costs.

“There’s still a lot of uncertainty and some of the above projections are based on assumptions only. It’s going to be a careful balance of limited funding and resources versus the care for each member that plays out over the coming months,” explains Comrie.

For your information

“Covid-19 is diagnosed by a laboratory test called a polymerase chain reaction (PCR) molecular test. The test investigates a sample taken from a patient’s respiratory tract – nose, throat, or chest. All requests for tests must be facilitated by healthcare professionals. No private individual can approach a pathology lab and ask for a test to be done,” states Discovery Health.

Your healthcare provider will then send your sample to a South African pathology lab for assessment.

Below is a list of the laboratories that offer testing, including drive-through facilities:

Pathcare

Ampath

Lancet

Vermaak

You don't need to have yourself tested if:

  • You present with or have experienced no symptoms

  • You’re just looking for reassurance

  • You think you were in contact with someone who was in contact with a corona-infected person - i.e. a distant contact. "Contacts of contacts" don’t need to be tested.

    Contact your medical aid or doctor directly, or click here, for more information.

To access other parts in our Covid-19 Content series, click here.

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