HIV and AIDS Healthcare Programme | LifeSense

Care

HIV and AIDS

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By affecting your immune system, this virus interferes with your body’s ability to fight organisms that cause infection and other diseases.

HIV is a sexually transmitted infection. It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medicine, it may take years before HIV weakens your immune system to the point where you have full-blown AIDS.

The Programme

Bestmed implemented the HIV/AIDS disease management programme to help members and their dependants living with HIV to remain healthy and to live a productive life. This is done by managing the disease as efficiently as possible.

The aim of the programme is to improve the member’s quality of life by ensuring that the correct medicines are prescribed (according to the stage of infection).

The treatment programme covered by the Scheme is based on HIV/AIDS funding guidelines and approved treatment depends on the clinical parameters of each individual. The stage of the disease and the results of blood tests determine what treatment will be covered and how often the individual must be followed up on. Cover is also provided for mother-to-child transmission in pregnancy and post-exposure prophylaxis.

How to qualify

To qualify for HIV-related prescribed minimum benefits (PMBs), members have to register their condition with Bestmed by calling +27 (0)86 000 2378 and submitting proof of their diagnosis.

Once a HIV/AIDS diagnosis has been confirmed with the Scheme, members can submit a treatment plan from their doctor to Bestmed for approval. In addition to the PMBs, Bestmed also offers an HIV/AIDS managed care programme with LifeSense that members can register for to receive additional support and guidance for living with the condition.

Downloads

Documents

Consent Forms

Benefits

The benefits provided by the HIV/AIDS disease management programme will be determined by your stage of infection.

Depending on the stage of infection, benefits could include the cost of pathology tests, consultations by your treating doctor and prescribed medicine, as well as hospital treatment.

Our disease management programme has been specifically designed to treat HIV/AIDS as a chronic disease by using effective anti-retroviral therapy to control viral replication. This treatment can have dramatic life-changing results for the infected person but it’s imperative that the treatment is taken in a controlled manner.

Therapy compliance is crucial for your recovery success and general well-being. This is achieved through close monitoring and working alongside the treating physician to ensure the best possible outcome. The process will effectively control access to benefits paid for by the Scheme.

Members will not incur co-payments for PMB medications that are on the formulary for which there is no generic alternative.

Counselling and support

LifeSense has qualified psychologists and highly skilled counsellors who engage with members to determine treatment readiness.

Our dedicated case management personnel take responsibility for individual cases within the programme from start to finish, providing a personalised service and ensuring the highest level of confidentiality. Our primary goal is not to commence with treatment prematurely, resulting in nonadherence as treatment readiness was not established. In many cases, treating/referring doctors do not have the time to facilitate this; a factor which contributes to failed outcomes.

Confidentiality

LifeSense acts on behalf of Bestmed, and you can be assured that your status, as well as your personal and medical information will always be kept confidential and will not be shared with anyone without your permission.

Additional programme information

Once registered on the programme, you will be monitored for compliance on a continuous basis
You may only make use of the DSPs selected by Bestmed. These include medical practitioners, pharmacy networks and hospitals
Should the unfortunate situation arise where you must involuntarily utilise the healthcare services of a non-DSP hospital, no co-payment will be applicable. To gain clarity on which instances will be considered as involuntary use of a non-DSP, please refer to Bestmed rules.
Should you voluntarily choose to make use of a hospital outside of Bestmed’s DSP network (non-DSP), you will be liable for the difference of any amount exceeding the contracted DSP rates

Important information

Please note: To manage your HIV/AIDS successfully, blood tests are required every 6 months.

Please ensure LifeSense receives your blood test results timeously.

Your HIV/AIDS medicine should be reviewed by your treating doctor every 6 months. Failure to do so may result in you not receiving your monthly medicine on time.

Register

To register on the LifeSense HIV/AIDS managed healthcare programme, members simply have to phone the LifeSense helpline on +27 (0)86 050 6080. LifeSense will send you an application form, which must be completed by you or your dependant and the treating doctor.

The doctor will submit your form to LifeSense together with your blood test results
LifeSense will approve a treatment plan based on the information they’ve received
Once enrolled, LifeSense will forward a treatment plan to your doctor
The LifeSense disease management case manager will, from this point onwards, keep in regular contact with you. The case manager will give assistance and support and emphasise the importance of using your medicine correctly
If you’re responding satisfactorily, your medicine will be continued
If you’re not responding satisfactorily to your treatment, LifeSense will review and make appropriate recommendations to your doctor to change your treatment
Any member receiving medicine for TB, or diagnosed with TB, must inform LifeSense about this
You will have to choose a designated service provider (DSP) pharmacy, either a courier or retail pharmacy, to dispense your anti-retroviral therapy (ART)
- Your choice needs to be communicated to LifeSense for them to know which pharmacy needs to receive documentation and communication
- The list of pharmacies is here