Covid-19

Prime Cure will fund COVID-19 confirmed positive claims on submission of the confirmed positive test result and claims accompanying the approved ICD-10 codes. Prime Cure will also fund a negative test if your referral meets the clinical entry criteria as defined by the CMS PMB Guidelines for COVID-19 for all members.

Covid-19 Documents

Covid-19 Benefit Information for Value Care Plan Members

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Knowledge, Support and Advice - Kaelo Prime Cure COVID-19 Medical Line

Should you suspect that you have COVID-19, please contact our COVID-19 Medical Line for medical-related advice on prevention, diagnosis and treatment.

Call 0861 493 587 and select option two (2) for member and then select option seven (7) for patient management/COVID-19.

General Practitioner (GP) Consultation	The Member is to consult with the Allocated or Contracted General Practitioner (GP) who upon suspecting COVID-19 infection will: Screen the Member by completing the necessary COVID-19 Person Under Investigation (PUI) form. Refer the Member to the contracted pathologist.
General Practitioner (GP) Consultation	GP Consultations will be paid subject to available limits and provided a Contracted and an Allocated Provider or nominated GP is used.
Claims	All COVID-19 positive claims are paid upfront when received from pathologist at agreed rates. The Member will pay the facility upfront for pathology/discretion of the pathologist. Positive and negative results meeting the clinical entry criteria will be refunded fully if the Member has paid up to and including R850 should the Member have paid the cost. COVID-19 anti-body tests are not covered by the benefit. Members are liable for the cost.
Claims	Refund Process: Send the following documents to refunds@primecure.co.za or clinicalreview@primecure.co.za: Completed refund form, download this from the Prime Cure website or by clicking here. A copy of the positive results as well as proof of payment. Proof of payment for pathology. Complete invoice with tariff codes from the pathologist If the claim is not paid by the Member, it will be sent back for processing to pay the pathologist or provider at agreed rates.
Medication	All Medication prescribed for Treatment of symptoms for COVID-19 as an out-patient are subject to referral from a Contracted or Allocated Provider and subject to Prime Cure Acute Medication Formulary click here to view.
Follow Up Care for COVID-19 positives	Follow up consultations, additional pathology and radiology as per Prime Cure formulary and subject to the CMS PMB guidelines and Prime cure clinical protocols
Hospital Admission	All admissions for COVID-19 will be funded subject to Prime Cure protocols and as per the CMS PMB Guidelines. Routine testing and pre-admission testing will not be funded.
Emergency Admission	Emergency Admission may be screened prior to surgery or further management. The funding decision will remain as per above conditions.
Reverse Barrier Nursing	Fund Reverse Barrier Nursing for positive COVID-19 patients that meet the clinical criteria for Barrier Nursing e.g. Immunosuppressed patients with COVID -19 with co-infections that can spread to other patients and cause significant mortality.

Basket of care for COVID-19 Positive members

Hospitals shall obtain a motivation for the necessity of accommodation in a private ward, including reverse barrier nursing, from the attending practitioner, and such a motivation shall be forwarded to the Clinical Review team for pre-authorisation. These are reviewed on case to case merits by the relevant Clinical Panel.

The regular funding of oxygen remains and no additional charges will be considered.
Screening recommendations for booked elective surgical procedure:

Do your testing with the contracted GP three (3) days prior to the procedure (Negative results not funded).
Stay safe, until procedure day.
Take a copy of recent negative results on admission day.
On procedure dates you have recent COVID-19 negative results.
Wear your facial mask at all possible times.
Maintain all social distancing recommendations.
Avoid large crowds.
Wash your hand with soap and water frequently.
Sanitise your hands regularly.

Covid-19

Covid-19 Documents

Knowledge, Support and Advice - Kaelo Prime Cure COVID-19 Medical Line

Basket of care for COVID-19 Positive members

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