What You Need to Know About Medical Aid and HIV

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Being infected with HIV/AIDS affects one’s life in more ways than one. Emotionally, you need to adjust to the challenges you might be facing, but also, your decision on the most appropriate medical aid for this specific need is a VERY important factor. 

Let’s look at what it means for someone living with HIV/AIDS to get on a medical aid (if not already on one).

For this purpose, we’ll look at 2 medical aid scenarios:

1) What to do if you’re diagnosed with HIV and you’re already on a medical aid
2) What to do if you’re diagnosed with HIV and you’re NOT on a medical aid 

Medical Aid Scenario 1

What to do if you’re diagnosed with HIV and you’re already on a medical aid:

If you’re already on a medical aid, you’re one of the lucky ones. The medical aid option that you are on (no matter which scheme or option) WILL provide you with some form of HIV treatment and cover.

If you aren’t satisfied with the cover on your option, you can look at upgrading your option at the end of the year to one that might provide better cover. 

Your HIV cover will be effective “virtually” immediately, as long as you’ve gone through the required application process and comply with the scheme’s criteria to obtain the benefits. 

Medical Aid Scenario 2

What to do if you’re diagnosed with HIV and you’re NOT on a medical aid:

This scenario could be somewhat more complicated, depending on when last you were on a medical aid. 

(a) If you have been on a medical aid for more than 24 months with a break of LESS than 90 days, should you join a new scheme, the scheme may not exclude HIV or any other existing condition. However, a 3-month general waiting period may be applied, in which time you cannot claim for your HIV treatment. 

(b) If you have been on a medical aid for more than 24 months with a break of MORE than 90 days, then  HIV or any other existing condition will be excluded for 12 months, after which time you will be covered. 

(c) If you have NEVER been on a medical aid before, then HIV or any other existing condition will be excluded for 12 months, after which time you will be covered. 

HIV Cover Offered by South African Medical Aid Schemes 

According to the Prescribed Minimum Benefits, you have the right to get a basic level of cover for a list of medical conditions and treatments. 

Medical aid schemes must provide cover for the diagnosis, treatment and costs of the ongoing care of these conditions.

HIV infection is classified as a Prescribed Minimum Benefit condition for members who qualify for cover.

Below is listed a summary of Discovery Health and Momentum Health’s HIV cover. 

Scheme

Discovery
(NOT registered on HIV programme)

Discovery
(registered on HIV programme)

Momentum

Programme HIVCare Programme HIVCare Programme Lifesense
Hospital Cover R35000 limit for the year Unlimited Cover for HIV/Aids-related admissions R49700 
Consultations Paid from your savings or your own pocket 4 GP Visits1 Specialist Visit  –
Blood Tests Paid from your savings or your own pocket Specified blood tests will be covered  –
Antiretroviral Medication If listed on Medicine List it will be covered in full If listed on Medicine List it will be covered in full Unlimited at preferred provider
Terminal Care On approval cover for costs up to R25250 On approval cover for costs up to R25250 On approval cover for costs up to R35000

 

Below is a list of other medical schemes that also make use of Lifesense HIV management programme:

  • CAMAF
  • Commed Medical Fund
  • Hosmed Medical Scheme
  • KeyHealth Medical Scheme
  • Medshield
  • Momentum
  • Suremed Health


[tip title=”Did You Know?”]Discovery Health provides cover for nutritional feeds to prevent mother-to-child transmission of HIV. Nutritional feeds are covered for babies born from HIV-positive mothers up to six months old from date of birth.
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For more details on the HIV cover offered under your medical aid, please contact your scheme directly or if your medical aid scheme makes use of Lifesense you can contact their call centre on 0860 50 60 80 for more details. 

Please note: the above rates and figures were accurate at the time of publishing and are subject to change. Please check with each medical scheme for further details.

Not on a medical aid yet? Complete the form below to get a quick hassle-free medical aid quote:

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About Author

Nelda Celliers is a medical aid advisor based in Cape Town. She has a Higher Certificate in Insurance through the Insurance Institute of South Africa. Nelda obtained her licenses from the Financial Services Board and Council for Medical Schemes to operate her own medical aid practice, Medical Benefit Advisors.