COVID-19 - how to access the basket of care

What you need to know about benefits for COVID-related illness

The Fund provides excellent benefits to cover costs related to the COVID-19 pandemic. We provide benefits for in- and out-of-hospital healthcare services related to the virus.

This WHO Benefit ensures you have access to screening consultations, testing, and management and appropriate supportive treatment as long as they meet the Fund's Benefit entry criteria.

Know your risks

Find out what your risk status is by completing the COVID-19 risk assessment. The questions in the assessment will help you find out if you have symptoms that are linked to COVID-19 or if you may have been exposed to COVID-19 and need a consultation with a doctor. Once you have successfully completed the risk assessment, you get access to additional funding for screening consultations and tests.

What you are covered for

The WHO Benefit offers cover for out-of-hospital healthcare services related to COVID-19. This means that you have cover for COVID-19 diagnosis and treatment when you are not admitted to hospital. This is in addition to any hospital benefits if you are admitted to hospital for COVID-19 treatment.

The basket of care includes:

• Screening consultations with a nurse or network GP (either virtual consultations, telephone or face- to-face), after you have completed a risk assessment
• Two COVID-19 PCR screening tests, if referred by your doctor, or referred by a network GP when you may be at risk of having contracted COVID-19
• Two pre-admission COVID-19 tests required by hospitals before admitting you for treatment not related to COVID-19
• A defined basket of care for COVID-19-positive members, which includes pathology, X-rays and scans, chest physiotherapy and psychotherapy benefits
• Cover for a list of supportive medicines
• Consultations with a nurse or Network GP (virtual consultations, telephone consultations or face-to-face consultations)
• Benefits for the home monitoring of COVID-19-positive members, which includes a pulse oximeter and up to three consultations for each person every year
• COVID-19 vaccinations and booster shots
• Benefits for out-of-hospital treatment and care of long COVID-19 in cases where the symptoms carry on after 21 days of the initial infection

Your cover depends on the following

• You must use the Fund's designated service providers (DSPs), where applicable.
• You must meet certain clinical entry criteria.

Any recommended treatment and healthcare services that are not included in the basket of care are paid from your available day-to-day benefits, or in accordance with Prescribed Minimum Benefits, where applicable.

Approved in-hospital treatment related to COVID-19 is covered from the Hospital Benefit in accordance with Prescribed Minimum Benefits (PMBs), where applicable.

COVID-19 vaccine

The COVID-19 vaccine is aimed at preventing COVID-19-related disease and deaths, and to prevent transmission between individuals. If you have not yet been vaccinated or need your booster shot, it is a good idea to take action now, and get vaccinated.

Even if you get the virus, the vaccine is designed to help prevent you from getting seriously ill. The vaccine contains weakened or inactive parts of the virus, which teach the body's immune system to recognise the virus as a threat when it attacks, and to promptly fight the virus.

It typically takes a few weeks after vaccination for the body to build protection (immunity) against the COVID-19 virus. That means it is possible that a person could still get COVID-19 just after vaccination. This is because the vaccine has not had enough time to provide protection. Sometimes after vaccination, the process of building immunity can cause symptoms, such as fever. These symptoms are normal and are a sign that the body is building immunity.

Vaccines are critical in the battle against COVID-19, but as we learn how they work best, it is still important to continue to protect yourself by washing your hands regularly, wearing a mask and practising safe social distancing.

The cost of COVID-19 vaccines, which includes the cost of administering the vaccine, is covered as Prescribed Minimum Benefits (PMBs).

You must register on the National Department of Health's Electronic Vaccine Data System (EVDS) to be vaccinated.

Get the facts and follow preventive steps

COVID-19 and the flu season overlap in South Africa, so it is crucial to have the seasonal flu vaccination as protection against influenza. Please visit the COVID-19 information hub to understand the facts around COVID-19 and the preventive measures that help protect your health.

You can get vaccinated at any facility that provides the service.