Medical Aid Schemes that Cover Hypertension

hypertensionHypertension, or high blood pressure, is a common condition that affects one in five adults South Africans. It's a dangerous disease that, if left untreated, can lead to stroke, heart attack and renal failure.

A management programme that incorporates a healthy diet, regular exercise, lifestyle changes and prescription medications has proved the most effective in treating hypertension.

One or more tests may have to be performed to confirm a diagnosis of hypertension. Multiple blood pressure readings, taken over several appointments, usually suffice. Additional diagnostic tools include urinalysis, blood tests, cholesterol tests and electrocardiograms.

Common hypertension medications

Once a diagnosis is made, one or more of the following medications may be prescribed for hypertension:

  • diuretics
  • alpha blockers
  • alpha-beta blockers
  • beta blockers
  • ACE inhibitors
  • receptor blockers
  • calcium channel blockers
  • nervous system inhibitors
  • vasodilators.

What do medical aids cover?

Medical aid schemes in South Africa are obliged to cover the costs associated with the diagnosis, treatment and care of hypertension. This is because hypertension is listed as one of several Chronic Disease List (CDL) conditions that automatically qualify for chronic and Prescribed Minimum Benefits (PMBs) after any applicable exclusions.

Premium medical aid plans usually cover an extensive list of medicines, known as a formulary, that includes both branded and generic versions of medications. They also provide day-to-day cover for GP and specialist consultations, pathology and radiology, and often allow members to use any healthcare providers.

Entry-level medical aid options, on the other hand, provide more restricted formularies, often including the generic versions of drugs. Members may be required to make co-payments if they choose to use non-generic or out-of-formulary medication. Also, a medical aid plan may cover the cost of a medicine only up to a defined limit, known as the reference price. Consultations, blood tests and radiology are usually limited to PMB conditions only, at a state or network provider.

Resolution Health cover for hypertension

As an example, Resolution Health offers the following benefits for members with hypertension across all plans, provided qualifying criteria have been met:

  • 2-3 GP visits and 2 specialist visit per year, post-diagnosis, to monitor blood.

Discovery Health cover for hypertension

Discovery Health prides itself on offering cover that far surpasses government requirements or PMBs. Claims are paid out according to PMB treatment guidelines and only after the condition has been approved on the chronic illness benefit.

With Discovery Health, defined blood tests, diagnostic procedures and the on-going management of hypertension are automatically covered on all options based on approval.

In addition, Discovery Health covers the cost of four GP consultations per annum across all its plans, from the chronic illness benefit. In mid to low-level plans, members may be restricted to using network providers and co-payments may apply when there's no agreement between scheme and provider.

Specialist consultations are covered at up to:

  • 300% of the scheme rate in the Executive plan
  • 100% of the scheme rate in the Comprehensive, Priority and Saver plans, although co-payments may apply
  • 100% of the scheme rate in the Core and KeyCare plans at network specialists only.

Discovery Health covers an exhaustive list of medicines that are commonly prescribed to treat the symptoms of hypertension, up to a set amount known as the Chronic Drug Amount (CDA) however, Key Care options are restricted to the formulary unless highly motivated.

The CDA may vary according to the level of cover, with members of high-end plans benefitting from a higher cash amount. Certain, more expensive branded medications may be covered only on the Executive or Comprehensive plans and is still subject to approval.

Top-tier specialised medications for hypertension & other illnesses:

Hypertension and other chronic conditions: medications that are covered only on the Executive and Comprehensive plans include:

  • Revellex, MabThera, Enbrel, Actemra, Simponi, Orencia, Renagel, Sensipar, Pegasys, Tobi, Bariatric surgery, Balloon Sinuplasty, Pradaxa, Victoza, Tysabri, Xarelto, Byetta and Fosrenol.

Contact us to learn more about the chronic hypertension benefits offered by leading medical aid schemes in South Africa, or to find the appropriate medical aid plan for your budget.