Medical aid is available to all South Africans, irrespective of health status. This includes people who are living with HIV or now have AIDS. At a time when more health care is needed, medical aid can help in accessing private health services. Most medical schemes have HIV/AIDS programs in place to ensure that members get access to the best services, including regular monitoring of CD4 levels and ARVs.

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Can medical aids refuse membership for HIV?

Medical schemes in South Africa cannot discriminate against with people with HIV/AIDS. However, there are certain restrictions that may be in place, albeit temporarily. Waiting periods are one such restriction that applies to HIV positive people who join a medical scheme. However, these waiting periods are not unique to HIV or AIDS. It applies to all people with a pre-existing disease, as is the case with medical aid for diabetes or any other condition.

Many South Africans are tempted to not disclose their HIV status. This is a mistake. Full disclosure is a requirement when signing up for medical aid cover. In the event that a medical scheme discovers that a member was untruthful at the time of joining the medical aid, the scheme can take action. This may include refusing to pay for healthcare services that fall within the waiting period or even terminating membership.

HIV Waiting Periods for Medical Aid

There is a general waiting period of 3 months and a pre-existing condition waiting period of 12 months that applies to new medical aid members. As previously mentioned, the 12 month waiting period applies to all pre-existing conditions and only to HIV/AIDS. However, if a person was a member of another medical scheme without any pending restrictions then the pre-existing condition waiting period will not apply.

The medical aid will not pay for relevant healthcare bills during the waiting period. Cover only takes effect once the respective waiting period has elapsed. This means that people living with HIV/AIDS who join a medical scheme will have to cover their own healthcare costs for the first 12 months. Once the waiting period elapses then the medical aid will pay for relevant bills according to medical aid tariffs.

HIV Medical Aid Program Benefits

Most medical schemes have dedicated programs to manage HIV/AIDS. These programs have numerous benefits. It is therefore advisable that medical aid members disclose their HIV status to their scheme. Depending on the individual scheme and its HIV/AIDS program, it should cover regular monitoring of immune status (CD4 levels as well as viral load) with an HIV physician (specialist).

The program would also include antiretrovirals (ARVs) and HAART (highly active antiretroviral therapy). Most of these programs would not drain the day-to-day medical aid benefits of the member. Instead it may be paid from a separate HIV program benefit. Furthermore, medical aid members can rest assure of uninterrupted care by disclosing their HIV status.

Infection with human immunodeficieny virus (HIV) is a prescribed minimum benefit (PMB) according to the Council of Medical Schemes ¹. Therefore medical schemes are required by law to pay for the diagnosis, treatment and care of people living with HIV. Ongoing care can improve the quality of life and even prolong the life of a person who has HIV/AIDS.

While there is no medical aid for HIV positive people specifically, all medical schemes can ensure that people with the virus can rest assured of access to private healthcare. This is otherwise expensive without medical aid cover and most South Africans cannot afford HIV care in the private medical sector.

References:

  1. Human Immunodeficiency Virus (HIV) is a PMB condition. Council of Medical Schemes
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