HIV cover: The benefits from Affinity

Affinity Health, South Africa’s leading medical insurance provider, has an HIV Management Programme. The programme assists members with managing their condition by giving them the proper tools. Affinity ensures that members receive quality and coordinated healthcare.  

The treatment is affordable and accessible and prepared in accordance with the Southern African HIV Clinicians Society. The guidelines are also from the South African Department of Health. Approval for the programme is subject to the Annual Benefits Limits and managed care protocols, clinical guidelines, and policy type benefits. 

Members must call 0861 22 22 73 or email hivmanagement@affinityhealth.co.za to receive day-to-day cover as a patient. You must register by calling the HIV Management Team and follow a chronic application process. The application offers a full range of benefits. 

Benefits are available by policy type – Standard (Combined, Hospital, Day-To-Day), Senior (Combined, Hospital, Day-To-Day) and Junior (Combined, Hospital, Day-To-Day).

What is HIV?

HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS.

The immune system is the body’s biggest defence system. At the same time, one’s immune system can control many viruses. HIV targets and infects our same immune system’s protective cells, a type of white blood cell called CD4 cells (sometimes called T cells), explains The Well Project.

HIV takes over CD4 cells and, in turn, produces millions of copies of the virus if unmedicated. As the virus makes copies, it damages or kills the CD4 cells, weakening the immune system. This is how HIV causes AIDS.

Here are the two main types of HIV:

HIV-1: most common type worldwide

HIV-2: mainly found in West Africa, Asia, and Europe

• If HIV is left untreated, the immune system will only get weaker. Eventually, it will no longer be able to fight off life-threatening illnesses.
• With treatment, people living with HIV can live a long life.
• AIDS is developed at the final stage of HIV infection if left untreated.
• Test regularly for HIV. You can get antiretroviral treatment on time to avoid deteriorating. 

Preventing HIV

• Using male condoms or female condoms during sex is the best way to prevent HIV. It also prevents loads of other sexually transmitted infections.
• Always use a clean needle if you take drugs. Do not share equipment or paraphernalia, especially if it pierces the skin.
• If you’re pregnant and living with HIV, the virus could pass into your baby’s body. You can also infect your baby during birth or through breastfeeding. Taking HIV treatment correctly during pregnancy and breastfeeding can virtually eliminate this risk.

Consultations from the health medical staff

Affinity Health guarantees that registered members will receive necessary consultations. The insurance provider also offers unlimited access to the HIV Telehealth Management Team. 

GP consultations are covered to the maximum limit each year, as well as with visits to specialists. We provide critical care support after-hours. 

Blood tests 

HIV-specific blood tests will be paid for by Affinity Health. This is only for registered members under the Affinity Health HIV Care Programme. The blood tests determine your viral load and what management and treatment you will need. 

Registered members will also have paid access to tests including CD4 count, full blood count, fasting lipogram, fasting glucose and urea and electrolytes. Your pathology benefit will cover these tests up to the Affinity Health Rate. You will be liable for any extra costs which go above the Affinity Health Rate. 

If you have tested positive for HIV and registered for the programme, your antiretroviral medicine is covered. This is listed on the formulary (HIV medicine list). You can find the formulary on the website: www.affinityhealth.co.za. This includes the medication in the Member’s Medication Benefit, capped at R500 per member per month. 

Reduce copayments with designated service providers (DSPs)

Dischem or Mediscor linked pharmacies are DSPs. DSPs may charge more than the Affinity Health Rate. Your treatment from a provider that is not a DSP may require a copayment. This means that the healthcare provider charges more than Affinity is willing to cover. 

GPs who are not on Affinity Health’s GP network are partially covered too. Following a payment arrangement, Affinity will partially cover specialist appointments. Affinity Health will pay the account according to the agreed Affinity Health Rate. A provider can be found on Affinity Health’s website or under “Find a Healthcare Provider” on the Affinity app. 

Medication needs approval first.

Approved Medication Members can claim for approved medicine on the formulary. There are maximum monthly and annual limits. Affinity Health will partially cover medication that is not on the list. The drug must be part of the mainstream evidence-based medicine list.

You will be required to pay any shortfall for medication that is not on the formulary. This includes pharmacies where the Affinity Health Rate is not evident. Find medication from DSP pharmacies on Affinity Health’s website in the Pharmacy Network. 

Affinity Health will pay for your treatment upon approval. You are required to follow the treatment plan provided. Inform Affinity Health of any changes with your treatment, as well as follow-up tests and results. 

Members of the Affinity Health HIV Management Programme can submit any complaints via the insurance provider’s complaint process. The Internal Complaints Resolution Policy is available on Affinity Health’s website. 

Affinity Health will ensure that all complaints receive fair, non-biased treatment and complete transparency and visibility between the company and the client.