Gap Cover for HIV and Aids Sufferers

December 19, 2021

Legally speaking in South Africa, medical schemes have to provide clients with certain benefits relating to HIV and Aids. By the same token, insurance companies must provide gap cover for HIV and Aids sufferers.

What this means to you is that the medical aid must pay for diagnosing the disease and treating the disease. It doesn’t matter what plan you have; you will have some cover.

Your Basic Benefits

These basic benefits cover not only treatments in hospital but also treatments that fall under the Prescribed Medical Benefits (PMB) regulations.

The cover would normally be in full as long as you stick to the preferred network providers. If you decide to go outside of this network, you may be liable for a co-payment.

A lot of South African medical schemes offer benefits in addition to the basic minimums. They will usually cover tests for HIV and may also cover the costs of treating immune deficiencies caused by the virus.

Programs to Manage the Disease

Most insurers do have basic management programmes that they offer as a complimentary bonus.

Gap Cover for HIV and Aids Sufferers

The idea behind this is to keep their affected clients as healthy as possible.

To enjoy these benefits, the customers must notify the medical aid of their HIV status. Once they do so they should have access to:

  • Anti-retroviral medicines
  • Preventative treatments to prevent further infections
  • A monitoring program to see how the disease is progressing and whether or not the treatment is effective. Side effects of the treatments will also be noted.
  • Access to a group of medical professionals specializing in the treatment of the disease
  • Telephonic support twenty-four hours a day.

Here are what two of the top insurers offer:

Discovery Health Gap Cover for HIV and Aids Sufferers

Every plan offered by Discovery does include cover in accordance with the Prescribed Minimum Benefits (PMB )when it comes to medications for the prevention of transmission of the disease from mother to child.

All plans also include cover in accordance with the PMB when it comes to sexual assault and accidental exposure.

All plans also have a chronic benefit when it comes to the treatment of the disease regarding the PMB.

The Discovery HIV/ Care Programme allows members to avail of cover in hospital regarding PMB without limits overall. Hospital stays do have to be authorised in advance, however.

Those who are part of the programme will also get cover for some blood tests and consultations. They will and also receive medications and formula to feed babies to prevent the transmission of the disease from the mother to child.

Momentum Health

All plans in the Momentum stable have benefits that cover the treatment of immune deficiencies as a result of HIV. The cover is also offered for AIDS and anti-retroviral treatments. The level of the cover depends on the plan you are on.

Members are also able to access a program that helps with the prevention of the disease, detection of the disease early, management of it, support and education.

The management programme covers PMB for medication, psychology, doctor’s fees and pathology.

Additional Cover

The key here is that the cover is based on PMB. What that essentially means is that they will pay out as long as the medical professional charges in accordance with standard medical aid rates.

Should you need to see someone outside of the preferred provider network, or if you have reached your limits, you will need to pay the shortfall. Depending on what treatment you need, this could amount to thousands of Rands that you have to pay out of your pocket.

Medical gap cover for HIV and Aids sufferers will pay out the shortfall between what the doctor charges and what the medical aid pays. Rather than worrying about paying outstanding medical bills, you will be able to concentrate on getting better.

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All info was correct at time of publishing