You have access to clinically sound and cost-effective treatment
We base the Remedi Medical Aid Scheme HIVCare protocols on the Southern African HIV Clinicians’ Society and South African Department of Health guidelines. Approval of HIV- related services is subject to Prescribed Minimum Benefit guidelines and your benefits.
We deal with each case with complete confidentiality
HIV or AIDS is a sensitive matter, whether one has the condition or not. Our HIV healthcare team respects your right to privacy and will always deal with any HIV- and AIDS-related query or case with complete confidentiality.
No overall limit for hospitalisation for members who register on the HIVCare Programme
For members who register on the HIVCare Programme, on all benefit options, there is no limit to the hospital cover. Subject to pre-authorisation and Remedi Medical Aid Scheme rules.
We cover a specified number of consultations and HIV-specific blood tests for your condition
If you’ve had claims because of a motor vehicle accident, please call us on 0860 116 116 as there may be a third party claim against the Road Accident Fund.
How to claim if you’re injured at work
For members who are registered on the HIVCare Programme, we pay for four (4) GP consultations and one (1) specialist consultation for the management of HIV.
We also pay HIV-specific blood tests for members who are registered on the HIVCare Programme. These tests are a measure of the extent of the HI virus and are instrumental in managing the patient’s response to treatment. The specific tests are listed in the Benefits available for your Option.
Use a healthcare provider in our approved network
You have full cover for using healthcare providers that are in our network, including GPs and specialists. Remedi Medical Aid Scheme will pay the account up to the agreed rate. If you don’t use a healthcare provider in our network, you will be responsible for any shortfall between what the provider charges and what Remedi Medical Aid Scheme pays.
The preferred provider is a GP in the Premier Plus HIV Network to manage your condition, you are covered for the care you need, which includes cover for social worker consultation.
We cover antiretroviral medicine from our HIV medicine list up to the Remedi Rate
Members who test positive for HIV have cover for antiretroviral medicine that are on our HIV medicine list (formulary). This includes treatment for prevention of mother-to-child transmission, treatment of sexually transmitted infections and HIV-related (or AIDS-defining) infections. We will fund for supportive medicine whose conditions meet our requirements for cover (clinical entry criteria). Our case managers will coordinate HIV medicine applications and monitor the member’s use of antiretroviral treatment to ensure the treatment is effective.
For preventive treatment in case of sexual assault, mother-to-child transmission, trauma or workman’s compensation, any HIV waiting periods do not apply to preventive medicine. Cover is subject to national treatment guidelines and benefit confirmation. Members do not need to register on the HIVCare Programme for this preventive treatment.
Get your medicine from a healthcare provider who is part of our network
Pharmacies in the HIV pharmacy network are the Scheme’s Designated Service Provider (DSP) for dispensing HIV antiretroviral medicine. Remedi Medical Aid Scheme members who do not use a HIV pharmacy network for their HIV antiretroviral medicine will have to pay a 20% co-payment on their monthly HIV medicine.
We cover nutritional feeds to prevent mother-to-child transmission
Nutritional feeds are covered for babies born to HIV-positive mothers, up to six months old from date of birth, we approve the first month upfront however the infant needs to be registered on your health policy in order to qualify for the remaining five months as per Nutritional and Mother to child prevention milk formula list (formulary).