Medical aid cover is open to a person who has been diagnosed as HIV positive and in most instances, there is no additional cost for the benefits. Most medical aids in South Africa do have strict exclusion policies where any pre-existing chronic condition will not be covered in the first year of joining the medical aid – the same may apply for HIV/AIDS. However, after this exclusion period, you will enjoy the full benefits of medical aid cover with special programs for HIV/AIDS patients ensuring that you get the best care.
As medical aids in South Africa tighten their belts, many new policies will be implemented that may upset some of its members. The GP-specialist referral system is one of those policies as many medical aids now restrict their members from visiting a medical specialist directly without a referral from their GP. Despite objections from medical aid members, many schemes are forced to implement this system not only for monetary reasons but also to offer the patient a complete managed healthcare service.
Under certain conditions, your membership of a medical aid may be suspended. In the event that this occurs, you should contact your medical aid immediately and find out why they have suspended your membership If they have a valid reason then you should follow their instructions to get your membership reinstated. If your membership was suspended unfairly, then you can contact the Council of Medical Schemes and lodge a complaint against the medical aid company.
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Most medical aids in South Africa will accept any applicant wishing to join their scheme without requesting blood tests to verify diseases or medical disorders. However, applicants are requested to divulge all their pre-existing conditions or significant past medical history to the medical aid upon application. Failure to do so could have serious implications in the future should you or your health care provider attempt to claim from your medical aid.
