Sirago and the State of Disaster Declared by the President on 15 March 2020
As a responsible employer, we are taking the threat and associated risks related to the COVID-19 pandemic seriously.
Firstly, we will remain attentive and ensure that business carries on as usual (where appropriate), maintaining service standards and levels for all our valued broker partners and all our clients. For the foreseeable future, it is business as usual unless we are mandated to take alternative measures.
Should the virus infiltrate our business, we are geared and have taken some measures to ensure service standards. In the event that this happens, we will communicate the processes to you immediately.
As a precautionary measure, we are suspending all domestic and local travel of our staff, meaning that our Broker Consultants (BCs) will not physically be calling on any brokerages or brokers in person for the foreseeable future. The BCs will however be available as usual via phone, email and any other media available to our brokers.
Operationally, we remain at your disposal as per normal, unless we are faced with a challenge.
SO, HOW WILL SIRAGO BE HANDLING ANY CLAIMS RECEIVED RELATED TO COVID-19?
On Thursday, the 5th of March 2020, the Council for Medical Schemes released communication (Issue 1 of 2020) related to the Coronavirus Disease, in which information about the disease, including the identification thereof, was provided. In addition to this, they also provided some insights into how this disease would be managed within the PMB framework. For ease of reference, I copy the CMS communication, verbatim, herein:
“Diagnosis and management of uncomplicated COVID-19 infection is not included in the Prescribed Minimum Benefits (PMBs).
COVID-19 infection may, however, result in various complications as listed above. Most of the complications are included in the PMBs and should be treated as specified for the specific condition.
One of the most common complications of COVID-19 infection – Pneumonia – is a prescribed minimum benefit (PMB) condition under the Diagnosis and Treatment Pair (DTP) code 903D. This DTP refers to “Bacterial, viral, fungal pneumonia”. The treatment component for this condition is specified as “Medical management, ventilation”.
All medical schemes are required by law to pay for the diagnosis, treatment and care costs for this condition in full irrespective of plan type or option. Medical schemes are not allowed to fund PMB conditions from a member’s Medical Savings Account, as this is not in line with the PMB Regulations. In cases of uncomplicated COVID-19 infection where are no PMB-eligible conditions, the scheme may fund all health care costs as per scheme rules”.
At Sirago, we will apply normal policy rules and protocols related to the claims received for this virus. If it is a PMB related claim, then it must be referred back to the scheme. If it is an uncomplicated diagnosis, then normal protocols related to consultations, etc will apply.
Thank you for understanding our position as well as your ongoing support of Sirago.
CEO Sirago Underwriting Managers