The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Got itHIV (Human immunodeficiency Virus) is a virus that attacks the body's immune system. There is currently no cure for HIV, however, with access to effective HIV prevention, early diagnosis and treatment and care it can be managed. If HIV is not treated it can progress to AIDS.
AIDS (acquired immunodeficiency syndrome) is an advanced stage of HIV. This is where HIV is on final stage of progression.
The HIV Care Programme, together with your nominated GP in the Discovery Health GP network, will help you actively manage your condition. The programme gives you and your doctor access to various tools to monitor and manage your condition and to ensure you get high-quality coordinated healthcare and the best outcomes.
When you are enrolled in the HIV Care Programme by your nominated GP in the Discovery Health GP network, you and your doctor can actively manage your condition to make sure you have access to the best healthcare outcomes.
You also have access additional benefits when your GP is part of the Premier Plus GP Network. Your nominated GP must be on the Premier Plus GP network and can enroll you on the HIV Care Programme through HealthID provided you have given consent to do so. Members who are enrolled on the HIV Care Programme through their nominated Premier Plus GP will have access to one additional social worker consultation.
The HIV Care team will only speak to you, the patient, or your treating doctor about any HIV-related query. You can register on the Discovery HIV Care Programme by:
HIV Care Programme application form (PDF)
HIV member brochure
When registered for the HIV Care Programme, you have cover for:
Four GP consultations with your nominated GP and one specialist consultation for HIV per person, each year
HIV-specific blood tests, up to a defined annual limit
Antiretroviral medicine that is on our HIV medicine list (formulary). Additionally, we will fund for supportive medicine when conditions meet our requirements for cover
We cover certain out-of-hospital treatments related to HIV infection as a Prescribed Minimum Benefit. You can ask for additional cover, if your condition requires this, through an appeals process. We will review the individual circumstances of the case, however it is important to note that this process does not guarantee a positive outcome and neither does it change the way Discovery Health Medical Scheme covers PMBs.
Request for additional Prescribed Minimum Benefit cover for HIV
You have full cover at your nominated GP in the Discovery Health GP Network and specialists who have a payment arrangement with us. We will pay the account up to the agreed rate. If you don't use a healthcare provider who we have an arrangement with, you will be responsible for any shortfall between what the provider charges and what Discovery Health Medical Scheme pays.
Executive Plan
You can see any GP in the Discovery Health GP Network.
Comprehensive, Priority, Saver and Core plans
You must consult with your nominated Discovery Health Network GP to manage your condition to avoid a 20% co-payment.
Smart plans
You must consult with your nominated Smart Network GP to avoid a 20% co-payment.
KeyCare plans
If you are on a KeyCare Plus plan or KeyCare Start Plan, you must consult with your nominated KeyCare or KeyCare Start Network GP to avoid a 20% co-payment.
If you are on a KeyCare Core Plan, you must consult with your nominated KeyCare Network GP to avoid a 20% co-payment.
If you are on a KeyCare Start Regional Plan, you must consult with your nominated KeyCare Start Regional Network GP to avoid a 20% co-payment.
By getting the treatment that is tailored for you, you save time and money. Each time you go to a new doctor, you have to fill in a form explaining your medical history which includes what medicine you take and what medical conditions you have. Nominating a primary care GP makes sure your doctor has this information and can manage your health knowing what has worked for you in the past. Nominate your doctor now.
You have full cover for approved medicine on our HIV medicine list (formulary) if your healthcare provider charges the Discovery Health Rate for medicine and if you use a designated service provider (DSP).
The designated service providers (DSPs) for HIV medicine are pharmacies in our HIV Network for non-formulary medication. Pharmacies that form part of the HIV Network can be found by logging in to the Discovery website. If you don't use a designated service provider (DSP) for your monthly chronic medicine orders, a 20% co-payment will apply, which means you will have to pay this amount. The co-payment applies to HIV antiretroviral medicines only. Members on a KeyCare plan can also get their HIV medicine from their dispensing KeyCare GP, where applicable.