Gap Cover for HIV-Positive Individuals

By law, South African health cover brokers offer some benefits relating to HIV and Aids. Also, they must provide gap cover for HIV-positive people.

This means that your medical aid must pay for diagnosis and treatment of the disease, regardless of the package you select.

Basic benefits

The benefits not only cater for in-patient treatment but also for other procedures prescribed under the PMB. The policy is normally comprehensive as long as you abide by the approved network providers.

Thus, you must make a co-payment if you decide to seek assistance outside of the network.

Most of the South African health policies offer benefits beyond the minimums. They cater for HIV test, and may also cover the costs of treating side effects brought about by the virus.

Gap Cover for HIV and Aids

Most members have management plans that provide a bonus.

The thought behind this is to ensure the affected clients are healthy.

But for members to enjoy the perks, they must notify the health scheme of their HIV status. They then have access to:

  • gap cover for HIVAnti-retrovirals
  • Preventive treatment to avert further infections
  • Monitoring program to check the effectiveness of the medication, and check for side effects.
  • Access to a team of doctors who have specialised in handling the disease.
  • Telephone assistance 24 hours a day.

Below are the top two insurance brokers:

Discovery Health Gap cover for HIV and Aids 

Perks include HIV covers with regards to the PMB, relating to medication for blocking the passing on of the disease from mother to child.

Also, all the plans provide cover for sexual assault and accidental exposure.

Discovery HIV/Care program enables members to get in-hospital cover concerning PMB without limits.

They also cover members for blood tests and consultations. Further, they receive formula to feed their babies to prevent mother to child transmission.

Momentum Health

All policies in Momentum have benefits that cover treating side effects caused by HIV. The cover also extends to AIDS and anti-retroviral treatment. But, the level of the cover depends on the plan you choose.

Members can also access program that helps prevent the disease, early detection, management, support, and education.

The management plan covers PMB for medication, doctors’ fee, pathology, and psychology.

Additional gap cover for HIV positive people

The main idea is that the policy is founded on PMB. Meaning they will pay out as long as the doctors charge standard health cover rates.

If the need arises to seek help outside the cover, or you have exceeded the limits, you will be required to pay for the shortfall.

Thus, depending on the treatment it could run to thousands of Rands that you will be needed to pay from your pocket.

The `gap cover for HIV patients pays the shortfall that could arise between what doctors charge and what the health insurance pays.

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All info was correct at time of publishing