COVID-19 TESTS AND CONSULTATIONS

Dear Members and Practitioners.

The COVID-19 pandemic affects each one of us anxiously not knowing how and when it may impact our lives. It is also important that we remain vigilant protecting our very own exposure including those in the health profession, family friends and colleagues. As with immediate effect the below is applicable.

1. Testing

Heritage Health will only pay for the testing of the Coronavirus under the following circumstances:

  • You present with the right symptoms.
  • You have a history to make you a high risk.
  • You have been referred by a general practitioner.
  • Your test results confirm that you have contracted Covid-19.
  • You have benefits available under your day-to-day (out of hospital) plan for the diagnosis and treatment. Should you require hospital admission then the treatment will form part of your in-hospital benefits.

Please note: This does not imply that you may not go for the tests. It merely confirms as to when your medical aid will pay for the tests.

2.  Telephone Consultations Including Repeat Prescriptions for Registered Chronic Conditions

 

Tariff Code Description Tariff Amount
0130 Telephone or e-mail consultations (all hours) Paid from day to day benefits N$288.30
0132 Consulting service for repeat prescriptions for registered chronic conditions. Paid from hospital benefits N$120.10

 

Restrictions:

1. Telephone or e-mail consultation (all hours)

  • Applicable only if the member has been a patient of the General Practitioner (patient is known to the doctor).
  • Maximum of two claims for code 0132 per beneficiary.
  • Only your General Practitioner who will be allowed to use this interim arrangement.

2. Consulting service for repeat prescriptions for registered chronic conditions by telephone/ e-mail

  • Maximum of one claim under code 0132 per registered chronic member.
  • Only your General Practitioner who knows your chronic conditions and the relating treatment medication.

Kindly note that this special arrangement under these exceptional circumstances does not imply that the terms and conditions of the Rules will not remain applicable as they will always remain applicable and the above is in addition to the Rules of the Fund for the interim period.

We remain to be of service to you and wish you good health.