HIV Care Programme

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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 nominated Premier Plus GP or GP in the Discovery Health GP network, will help you actively manage your condition. The programme gives you and your doctor 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 are enrolled in the HIV Care Programme by your nominated Premier Plus GP or a GP in the Discovery Health GP network, you and your doctor can actively manage your condition to make sure you have access to the best healthcare outcomes.

You also have access additional benefits when your GP is part of the Premier Plus GP Network. Your nominated GP must be on the Premier Plus GP network and can enrol you on the HIV Care Programme through HealthID provided you have given consent to do so. Members who are enrolled on the HIV Care Programme through their nominated Premier Plus GP will have access to one additional social worker consultation.

  • Your nominated Premier Plus GP can enrol you on the HIV Care Programme through HealthID, provided that you give consent.
  • Members on KeyCare Plans must be enrolled by their nominated Premier Plus doctor who is also a participating GP in the KeyCare GP Network
  • Members on Smart plans must be enrolled by their nominated Premier Plus doctor who is also a participating GP on the Smart GP Network

We outline the details for you in this guide.

Enrolling 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 with your nominated GP 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

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

Designated Service Providers (DSP), GP and specialist consultations

You have full cover at your nominated GP in the Premier Plus HIV GP Network or Discovery Health GP Network and specialists who have a payment arrangement with us. We will pay the account up to the agreed rate. 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 Plan

You can see any GP in the Discovery Health GP Network.

Comprehensive, Priority, Saver and Core plans

You must consult with your nominated Premier Plus HIV Network GP or a Discovery Health Network GP to manage your condition to avoid a 20% co-payment.

Smart plans

You must consult with your nominated Premier Plus GP or Smart Network GP to avoid a 20% co-payment.

KeyCare plans

If you are on a KeyCare Plus plan or KeyCare Start Plan, you must consult with your nominated KeyCare or KeyCare Start Network GP to avoid a 20% co-payment.

If you are on a KeyCare Core Plan, you must consult with your nominated KeyCare Network GP to avoid a 20% co-payment.

If you are on a KeyCare Start Regional Plan, you must consult with your nominated KeyCare Start Regional Network GP to avoid a 20% co-payment.

Nominate one primary care doctor who knows you

By getting the treatment that is tailored for you, you save time and money. Each time you go to a new doctor, you have to fill in a form explaining your medical history which includes what medicine you take and what medical conditions you have. Nominating a primary care GP makes sure your doctor has this information and can manage your health knowing what has worked for you in the past. Nominate your doctor now.

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 designated service provider (DSP).

The designated service providers (DSPs) 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. If you don't use a designated service provider (DSP) for your monthly chronic medicine orders, a 20% co-payment will apply, which means you will have to pay this amount. The co-payment applies to HIV antiretroviral medicines only. Members on a KeyCare plan can also get their HIV medicine from their dispensing KeyCare GP, where applicable.

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