What is the HIV Care Programme?

HIV and AIDS can be a sensitive matter, whether one has the condition or not. Our skilled and professional consultants respect your right to privacy and will help you get access to clinically sound and cost-effective treatment for your individual case. We will always deal with each case with complete confidentiality.

The HIV Care Programme, together with your Premier Plus GP, will help you actively manage your condition. The programme gives you and your Premier Plus GP access to various tools to monitor and manage your condition and to ensure you get high-quality coordinated healthcare and the best outcomes.

When you register for our HIV Care Programme and choose a Premier Plus GP to manage your condition, you are covered for the care you need, which includes additional cover for social workers.

Registering for the HIV Care Programme

The HIV Care team will only speak to you, the patient, or your treating doctor about any HIV-related query. You can register on the Discovery HIV Care Programme by:

  • Calling us on: 0860 99 88 77
  • Emailing us on: HIV_Diseasemanagement@discovery.co.za
HIV Care Programme application form (PDF)

What does the HIV Care Programme cover?

When registered for the HIV Care Programme, you have cover for:

Four GP consultations and one specialist consultation for HIV per person, each year

HIV-specific blood tests, up to a defined annual limit

Antiretroviral medicine that is on our HIV medicine list (formulary). Additionally, we will fund for supportive medicine when conditions meet our requirements for cover

Nutritional feeds for babies born to HIV-positive mothers from the date of birth and up to six months

Please refer to the HIV Care Programme benefit guide.

Additional Cover

We cover certain out-of-hospital treatments related to HIV infection as a Prescribed Minimum Benefit. You can ask for additional cover, if your condition requires this, through an appeals process. We will review the individual circumstances of the case, however it is important to note that this process does not guarantee a positive outcome and neither does it change the way Discovery Health Medical Scheme covers PMBs.

Request for additional Prescribed Minimum Benefit cover for HIV (PDF)

Designated Service Providers (DSP), GP and Specialist Consultations

You have full cover for GPs who are on the Premier Plus HIV GP Network and specialists who have a payment arrangement with us. If you don’t use a healthcare provider who we have an arrangement with, you will be responsible for any shortfall between what the provider charges and what Discovery Health Medical Scheme pays.

Executive and Comprehensive Plans

You will need to pay any shortfall between what Discovery Health Medical Scheme pays for and what your doctor charges

Priority, Saver and Core Plans

You must use a Premier Plus HIV Network GP to manage your condition to avoid a 20% co-payment

Smart Plans

You must choose a doctor who is on both the Smart and Premier Plus HIV Network to avoid a 20% co-payment

KeyCare Plans

You must choose a doctor who is on both the KeyCare and Premier Plus HIV Network to avoid a 20% co-payment

We encourage all eligible providers to partner with us on the Premier Plus networks. Please confirm with your treating healthcare professional if they have contracted onto the network to avoid co-payments.

Find a Premier Plus GP near you

Medicine

You have full cover for approved medicine on our HIV medicine list (formulary) if your healthcare provider charges the Discovery Health rate for medicine and if you use a DSP.

The designated service providers for HIV medicine are pharmacies in our HIV network for non-formulary medication. Pharmacies that form part of the HIV network can be found by logging in to the Discovery website, or alternatively make use of MedXpress. Approved non-formulary medicine obtained from a pharmacy that is not in the HIV network will fund at 80% of the reference price.

  • Members on KeyCare Plus and KeyCare Start plans have the option to get their HIV medicine form their dispensing KeyCare GP.
  • The DSP for KeyCare Start plan members is a state facility.
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