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Medical schemes now obliged to pay all cholera treatment costs – regulator

Medical schemes now obliged to pay all cholera treatment costs – regulator
A nurse speaks to a patient recovering from cholera at Jubilee District Hospital in Hamanskraal, 22 May 2023. (Photo: Felix Dlangamandla)

Cholera was officially declared as a prescribed minimum benefit (PMB) by the Council for Medical Schemes on Friday, 26 May.

This means that going forward, medical schemes must pay for all consultations in and out of hospital, tests, medication, follow-up consultations and treatment in full if you received such treatment for cholera via a designated service provider (DSP).

Read more in Daily Maverick: Hammanskraal cholera outbreak

A number of medical scheme options restrict you to the use of a designated service provider, which could be a specific hospital or doctor network. However, the Council for Medical Schemes (CMS) has also noted that in case of an emergency, treatment must still be paid in full by the medical scheme, even if you did not use a DSP. Healthcare practitioners such as doctors are expected to help you by completing the forms you need to register for a PMB.

Under the Medical Schemes Act, medical schemes are bound to pay all costs for 271 PMBs including asthma, epilepsy and hypertension or high blood pressure. Medical expenses for these conditions are paid out from the scheme’s combined risk pool and not from your day-to-day benefits or your medical savings account. 

The last condition to be added as a PMB was Covid-19 and the addition of cholera brings the number of PMBs to 272.

“PMBs must be funded by the medical scheme from the risk benefit. Funding of PMB claims from the Medical Savings Account contravenes the Medical Schemes Act,” the regulator warns.

Eyewitness News reports that by Saturday afternoon, the total number of deaths from cholera was 24. The Gauteng Health Department says 75 patients had been admitted by last Friday for diarrhoea, with 15 cases confirmed as cholera.

Jubilee Hospital in Hammanskraal has admitted 215 patients and set up a makeshift ward with 300 beds to screen patients, with an additional 35-bed ward for confirmed cases. DM

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