18 MAY 2020 UPDATE: How COVID-19 tests are covered

Hospitals are increasingly insisting on any patients, including those admitted for non-COVID-19 issues, to be tested before admission. Some are even stating that patients would have to pay for such tests from their own pockets. This development requires that we clarify and confirm how tests are covered by the Scheme.

At this point, tests are covered as follows:

  • If you test POSITIVE for COVID-19, the cost of the test will be covered in full from the overall annual benefit. This will apply irrespective of why the test was done. The test will be claimed under claiming code U07.2 (PUI).
  • If you are screened by a healthcare worker and referred for testing by that healthcare worker and the diagnosis is NEGATIVE, the related tests will also be covered in full from the overall annual limit. In this case you would be regarded as a Person Under Investigation (PUI) and the test will also be claimed under claiming code U07.2 (PUI).
  • If you are not a PUI (in other words the test is only done as a precaution before admittance to a healthcare facility, for example) and the diagnosis is NEGATIVE, the claiming code will be Z11.5 (screening code) and it will be covered from available benefits, as follows:

    HOSPITAL PLAN – A negative test will have to be paid from the member’s own pocket, as there are no out-of-hospital benefits on this Plan.

    SAVINGS PLAN – A negative test will be paid from the member’s available savings.

    TRADITIONAL AND COMPREHENSIVE PLANS – A negative test will be paid from the member’s available pathology benefit.

    PLATINUM PLAN – A negative test will be paid from the member’s available Routine Medical Benefit.

REMINDER: If you need to have a test done before going for an elective procedure, and the diagnosis is positive, it will be covered in full from your overall annual limit.

We encourage you to continue washing your hands often, practising social distancing and wearing a cloth mask when you have to go out in public.