What is the WHO Global Outbreak Benefit?
The WHO Global Outbreak Benefit is available to all members of Discovery Health Medical Scheme during a declared outbreak period. The benefit provides cover for the COVID-19 vaccination as well as a defined basket of care for out-of-hospital healthcare services, related to the outbreak disease.
The following criteria need to be met before claims will be paid from the WHO Outbreak Benefit:
- The disease needs to be a WHO recognised outbreak disease;
- Cover is for diseases during a declared outbreak period
- May be subject to use of preferred providers, where applicable;
- Subject to completing the Scheme’s risk assessment and referral process for testing;
- Subject to the Scheme’s treatment guidelines and protocols.
What’s covered?
These healthcare services are covered from the WHO Global Outbreak Benefit up to a maximum of 100% of the Discovery Health Rate. This cover does not affect your day-to-day benefits. Note that your plan’s prescribed networks still apply (so you still need to use the hospital on the network list, if that’s applicable to your plan).
- COVID-19 vaccine and the administration thereof, in accordance with the National Department of Health COVID-19
vaccination roll-out plan and guidelines - Screening consultations with a network GP (either virtual consultations, telephone or face-to-face) and personal protective equipment (PPE) used during a COVID-19 consultation
- COVID-19 PCR screening tests if referred by appropriate healthcare professional. You have access to two Rapid Antigen tests at a network provider and two COVID-19 PCR tests per person per year, regardless of the outcome of the test. Unlimited where approved as Prescribed Minimum Benefits (PMBs).
- A defined basket of pathology tests for COVID-19 positive members
- A defined basket of x-rays and scans for COVID-19 positive members
- Supportive treatment, including medicine and a home monitoring device to track oxygen saturation levels for at
risk members who meet the clinical entry criteria
Long Covid
Long COVID disease is diagnosed when symptoms of an acute COVID-19 infection persist after 28 days of receiving a positive test result. For the treatment of long COVID the benefit includes the following based on the severity of the diagnosis, for 6 months:
- A defined number of face-to-face and/or online consultations
- A defined basket-of-care for relevant pathology and radiology tests
- Appropriate supportive treatment for symptoms and rehabilitation, where necessary.
You may apply for additional cover from the Scheme, where clinically appropriate.
Any recommended treatment and healthcare services that are not included in the above basket of care are covered according to the benefits available on your chosen health plan or in accordance with Prescribed Minimum Benefits where applicable. In-hospital treatment related to COVID-19 for approved admissions is covered from the Hospital Benefit based on your chosen health plan and in accordance with Prescribed Minimum Benefits (PMB) where applicable.
Waiting Periods
Members who are diagnosed with COVID-19 after joining Discovery Health Medical Scheme will have access to cover for COVID-19, even if they are subject to a waiting period at the time of being diagnosed with COVID-19.
Members that are diagnosed with COVID-19 before joining the Scheme will not have access to the cover.
