South African medical aids do not refuse membership to any person irrespective of their health status and pre-existing conditions. HIV positive people are often concerned about whether they qualify for medical aid membership in South Africa. The bottom line is YES. A person with HIV and AIDS can become a member of a medical aid. However, there may be some restrictions for a period of time regarding to cover for medical bills related to these conditions.
Pre-Existing HIV Infection and AIDS
If you are HIV positive at the time of joining a medical aid, you should declare your status in the application. It will be considered as a pre-existing condition and subject to certain restrictions. However, you will still be covered by the medical aid. South African law ensures that no person can be discriminated against by a medical aid for membership. It is not only for HIV and AIDS. The same principle applies to a person with any medical condition, including diabetes mellitus, hypertension (high blood pressure) and heart disease.
Disclosure of Pre-Existing Conditions
Failure to disclose your pre-existing disease at the outset can however, complicate the terms of your membership. In this regard the medical aid can refuse to pay for any bills accrued for medical care related to these conditions due to non-disclosure. In the end the patient will then have to pay cash to the medical service provider. It is important to remember that medical aid offers financial protection against the exorbitant private healthcare costs in South Africa. Medical schemes have to look after the interest of all its members and non-disclosure of a pre-existing condition is essentially committing fraud.
Waiting Period for HIV and AIDS
There is no difference in the waiting period for HIV positive people as there is for other pre-existing conditions. There is a 3 month general waiting period for all healthcare costs. This means that you will not be covered by the medical scheme in the first 3 months of your membership but you still have to pay the monthly contribution. It does not matter what the reason for your claim – this 3 month general waiting period applies across the board.
Then there is a 12 month (one year) waiting period for pre-existing diseases. This means that in the first year of membership you will not be covered for medical care for any condition that has existed prior to joining the medical scheme. This is not specific just for HIV and AIDS. It applies to other pre-existing diseases as well. A person who previously belonged to a medical aid and is simply switching from one scheme to another is usually not subjected to either the 3 month or 12 month waiting period.
Rates for HIV Medical Aid
There is no different in rates for medical aid cover when you are HIV positive, have AIDS or are other diseases. A healthy person essentially pays the same as unwell person when joining a medical aid. The only difference in rates lies with your age. If you join a medical aid after the age of 35 years then you are subject to a late joiner fee. This is added to your monthly medical aid contribution for life. It protects the medical aid from some people who sign up for medical only later in life when they are more likely to fall ill. Ultimately younger and healthier members are disadvantages by these late joining medical aid members. So if you are HIV positive and over 35 years of age, then you will pay a late joiner fee but not due to you HIV status. Instead it is an issue with your age.
HIV and AIDS Benefit
Most medical aids in South Africa have a separate benefit for managing the costs associated with HIV and AIDS. The reality is that HIV and AIDS requires vast medical resources for long term management and the treatment of infections and cancers that arise with the disease among other complications. Should the HIV positive member solely use the standard benefits, they will quickly exhaust their funds. If there are other members on the medical aid then it will disadvantage them as they will be without cover since the HIV positive person used all the benefits very early in the year.
Medication and Treatment for HIV/AIDS Management
HIV positive people on a medical aid are therefore encouraged to inform their medical aid of their status. By doing so, the scheme can allocate necessary medical expenses to this HIV/AIDS benefit. In addition, medical aids have various wellness and management programs to ensure that HIV positive members are getting the best possible care. The key to living with HIV and AIDS is frequent immune monitoring, quick and effective treatment for opportunistic infections, specialist medical care and antiretroviral drugs (ARVs).