Medical schemes support members with care access during COVID-19 pandemic - Medshield
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Medical schemes support members with care access during COVID-19 pandemic

Posted in Medshield Medical Scheme   |   April 22nd, 2020

By Thoneshan Naidoo – Medshield Principal Officer 

As the number of confirmed Coronavirus COVID-19 cases rise every day in South Africa, many people are wondering whether they’ll get adequate medical attention should they be diagnosed with the virus.

We want to reassure members that we aim to continue offering excellent support to members during this difficult and uncertain time. We also call for a collaborative approach in the interest of the entire country and in the interest of the wellness of all South Africans.

Serving the interest of our members, we confirm our utmost dedication to ensuring all members and their dependents continue to receive the much-needed quality healthcare amid the COVID-19 pandemic. Our vision is ‘Caring about YOU towards a healthier nation’, and in challenging times like these it is now more important than ever that we come together to fulfil our vision.

We cover our members for testing and treatment as a result of the virus. We are well-placed to weather this storm for and with our members. We have a solvency ratio of 41% (significantly higher than the mandatory 25% and considerably higher than most of the competing open schemes) to ensure that we can meet the demands of increased hospitalisation and heightened burden of care due to COVID-19. We have prepared our business continuity plans to maintain the high levels of service that our members expect from us.

National crisis

It is critical to mention that this is not a selective crisis, COVID-19 is a national crisis and we all need to work together as South Africans. We are proud of our President’s and government’s swift action to mitigate the impact of this crisis. It is true that we are all taking strain economically, but we can always resuscitate a strained economy, but we can never resuscitate the dead bodies of our people. We are in this together and we need to overcome this crisis together.

Flu vaccine

We ensure continued access to care for our members and their holistic well-being, particularly with the onset of the flu season. We find ourselves at the beginning of the seasonal flu and with the COVID-19 impact it is more important than ever, especially for high-risk members, to get the flu vaccine, which is available at Medshield Pharmacy Network providers, Clicks Pharmacies and selected Medshield SmartCare Clinics.

Testing

As more people are tested for the virus, the issue of whether a medical scheme will cover the diagnosis and/or treatment of COVID-19 becomes a concern.

We have embraced the cover for COVID-19 as a Prescribed Minimum Benefit (PMB) before it became the norm to cover COVID-19 as a PMB when a diagnosis is positive.

When visiting a healthcare professional, or being tested for the COVID-19 virus, the costs will be paid from your Day-to-Day/Savings Limit (depending on your chosen benefit option), whether the diagnosis is positive or negative. If the test is positive, we will cover the diagnosis, treatment and care costs from the Risk Benefit pool as a PMB, irrespective of your chosen benefit option – in other words, these costs will not be paid from your current 2020 benefits.

Preventative rules

It is imperative for all members of the public to adhere to the rules announced by the President and the standards of the World Health Organisation (WHO). The decisive measures announced by our President best explains the importance of preventative measures such as social distancing and its role in slowing down the impact of the virus. In support of these measures, we are facilitating for members to access their current doctors via remote consultation (telephonic and video) – without having to consult physically in the doctor’s rooms.

Healthcare

Technology and embracing the 4th Industrial Revolution (4IR) can play a critical role in ensuring members are more empowered to take care of their health while lowering barriers to affordable, quality healthcare and increasing convenience to members. Medshield SmartCare has in fact paved the way for the adoption of telemedicine in South Africa. Sustainable partnerships with clinics and pharmacies, allows a member to see a nurse who will conduct an initial assessment based on the patient needs and if necessary, dial up a GP who does a virtual consultation, and together they decide on how you should be treated and both give you guidance. Since this programme’s launch in July 2019, it has received very positive feedback, as it is not only convenient, but it puts the trust back into healthcare, and more recently is a way of accessing a GP during the current COVID-19 lockdown period.

High-risk members who get infected with the virus are likely to require critical healthcare, but through the preventative and social distancing measures we as South Africans are practising, the timing of their healthcare intervention could be staggered over a longer timeframe of 3 to 6 months. This allows our healthcare system to better cope with the demand of the critically ill at the right time, resulting in overall better and healthier outcomes for all. We need to do what is right and work together as the complete health value chain, not only looking after our own bit.

We have a history that dates back over 51 years. We are driven by our mission to provide access to affordable high-quality healthcare through partnerships at very competitive prices in comparison to the market. We have always been and remain a transparent and sensible supporter of national initiatives to provide greater access to quality healthcare for all South Africans especially during this pandemic.

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