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Medical aid and covering chronic illness

How does Medical insurance cover chronic illness?

Medical insurance is a fairly new service in South Africa, and many people are more familiar with the workings of a medical aid.

All medical cover plans, including medical insurance plans, are designed to assist with the financial burden of medical emergencies. However, many people face chronic illnesses that require chronic medication, which is, in its self, a financial responsibility.

So, how does a medical insurance deal with this?

The first question that should be answered, is what is a ‘chronic’ illness?

Well, according to the Better Health Channel, a chronic or long-term illness means having to adjust to the demands of the illness and the therapy used to treat the condition. There may be additional stresses, since chronic illness might change the way you live, see yourself and relate to others.

Certain chronic conditions are life-threatening, such as heart disease and stroke. Other chronic ailments require intensive management, such as diabetes. Most chronic illnesses persist throughout a person’s life, but are not always the cause of death, but instead impacting quality-of-life instead.

Of course, a lifetime illness can be a liability to a healthcare provider.

Affinity health offers an optional chronic medication booster, with cover for over 23 different chronic conditions. Pre-Existing Conditions are subject to a 12 month waiting period from Commencement Date.

Usually, health insurance policies deem any medical condition that occurred during the five years prior to the inception of your policy to be excludable for the first two years your policy.

Many providers provide access to treatment for a list of medical conditions under the Prescribed Minimum Benefits (PMBs).

The most common condition that are covered by medical insurers are, but are not limited to asthma, bipolar mood disorder, cardiac failure, cardiomyopathy, chronic obstructive pulmonary disease, chronic renal disease, coronary artery disease, Crohn’s disease, diabetes insipidus, diabetes Type 1, diabetes Type 2, dysrhythmia, epilepsy, glaucoma, haemophilia, HIV, hyperlipidaemia, hypertension, hypothyroidism, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, schizophrenia, and systemic lupus.

Once approved, most insurers fully cover the needed medicine for chronic illness.

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