How will Fedhealth cover coronavirus tests and treatment?
All beneficiaries on all plans will be covered for the testing and the management of COVID-19 once a positive diagnosis is confirmed. If you or one of your dependants tests positive for COVID-19, the benefit cover applies according to the Scheme Rules:
| Medical intervention | Where? | Covered from which benefit? |
| Diagnostic testing according to agreed protocols | Treating doctor will collect specimen or private laboratory | Risk/ Prescribed Minimum Benefits |
| Consultations with your healthcare professional | At the practice | Risk/ Prescribed Minimum Benefits |
| Telemedicine consultations | Telephonic | Risk/ Prescribed Minimum Benefits |
| Defined supportive treatment and medicine | In-hospital or out-of-hospital | Risk/ Prescribed Minimum Benefits. Formularies and other managed care protocols apply |
What if the test outcome is positive?
In the case of a positive diagnosis, you, your representative or your healthcare provider must notify us of the diagnosis as soon as possible. Your healthcare provider will prescribe the necessary care, depending on the severity of your symptoms. Fedhealth will cover out-of-hospital and/or in-hospital treatment as PMB from Risk in line with formularies and other standard managed care protocols.
What if the test outcome is negative?
If the diagnosis is negative, the related tests will be covered from your day-to-day benefits. Any consultations with medical practitioners will be covered from the day-to-day benefits available on your option. There is no need to be tested more than once, but if you do this, it will also be covered in line with available day-to-day benefits.
To recap what Fedhealth covers and from which benefit:
- Only positive tests will be paid from Risk; if the test is negative, it will be paid from your day-to-day benefit.
- If you test positive and have a mild case that does not require hospitalisation, any treatment will be paid from your day-to-day benefits (similar to what happens in case of the flu).
- If you test positive and have a complicated case that requires hospitalisation, these expenses will be covered from your in-hospital benefit according to the benefits on your option.
Using CT scans to diagnose COVID-19
Fedhealth will NOT cover CT chest scans to diagnose COVID-19. However, CT chest scans will be covered for the management of COVID-19 positive members.
USEFUL RESOURCES
Covid-19 online resource and news portal: https://sacoronavirus.co.za/
The National Institute for Communicable Diseases (NICD): https://www.NICD.ac.za/
