Coronavirus and PMB treatment
According to the Medical Schemes Act of 1998, medical schemes must cover the costs related to the diagnosis, treatment and care of PMBs. The defined list of conditions must be paid for from the medical scheme’s risk pool and not from your savings account. It is also important to note that PMBs are covered in-hospital, so your medical scheme is mandated to pay for treatment if you are admitted.
At this time, the diagnosis and management of COVID – 19 is not included in the list of PMBs. However, most of the complications associated with the virus are PMBs and need to be treated accordingly. In such cases, you will be covered in full by your medical scheme for testing and treatment of COVID-19 should you test positive.
What if there is an additional payment associated with the diagnosis and treatment?
As an Ambledown gap cover policy holder, we will continue to cover your authorised in-hospital and specified out of hospital shortfalls according to the rules and regulations as per your policy document and prevailing legislation. Further details on our various plans are available on our website, which you can access by clicking here.
As is always the case, our aim is to provide you with the financial security that should you or your family suffer an insured event, you and your family will be covered, allowing you to focus on your or your family member’s recovery.
If you have been exposed to the Coronavirus, please contact the 24-hour hotline number 0800 029 999.
The information relating to PMBs has been provided by the CMS (Council for Medical Schemes) and was correct at the time of publishing. Please click here to view or download the full document with additional information relating to Coronavirus.
Ambledown Financial Services