Diabetes mellitus, commonly referred to as sugar diabetes, is a growing problem in South Africa. It requires proper medical treatment and lifelong management and without medical aid, diabetic care at government hospitals and clinics would be the only option. Diabetes management is expensive as it requires constant medication, monitoring and pricey procedures like dialysis once complications arise. Medical aid fortunately makes diabetic care in the private health sector affordable.

Do medical aids cover diabetes?

Yes. Medical aids in South Africa cover the diagnosis and treatment of diabetes mellitus. Many people confuse medical aids with other financial products like life insurance policies, most of which may refuse cover for a diabetic. Medical aids do not. However, medical aid will not pay for any services related to diabetic care if it is a pre-existing condition for a period of 12 months. This means that if you have diabetes at the time of joining the scheme then it will be excluded from cover for one year.

However, after this waiting period, diabetics can rest assured of full cover. Similarly there is a 3 month general waiting period when joining a new scheme. This means that if you are diagnosed with diabetes and need treatment for it within the first 3 months after joining the medical aid, then you will have to pay for these services in cash.

Limits for Diabetic Medicines

The chronic cover ensures that diabetic members can access essential drugs like metformin or even insulin on a constant basis. Now that diabetes mellitus is considered a Prescribed Minimum Benefit (PMB), members can rest assured that they can still access medicines for the entire year beyond the chronic limit if it is exhausted.

However, medical aids may only agree to cheaper generics rather than the brand name ethicals of these diabetes drugs as part of the unlimited cover. Nevertheless these generics have been clinically proven to be effective and diabetics can at least be assured of constant medication throughout the year.

What do medical aids cover for diabetes?

Diabetes is not just about taking chronic medication. The condition needs to be monitored on an ongoing basis to assess the patient’s responsiveness to medication and progression of the disease. Furthermore the complications of diabetes needs to be treated quickly and effectively. Medical aids cover all of these essential services. Some of these services are paid from the chronic benefit and others from the day-to-day or hospital cover.

Medical aids are focussed on managed healthcare and some have special programs in place with CDE (Centre for Diabetes and Endocrinology) clinics to ensure that its members get the best ongoing care. In addition patients will be able to get a glucose monitoring home device and the sticks for these meters. This allows the patient to monitor their blood glucose levels and provide feedback to their doctor as part of the ongoing management. The aim of this high level of diabetic care is to prevent complications before it arises because some of these complications are life threatening.

Dialysis for Diabetics

Kidney failure as a result of diabetes is known as diabetic nephropathy. At this point the kidneys cannot filter the blood of wastes and excrete it in the urine. Instead artifical “blood cleansing” methods are necessary, such as dialysis. It is needed on an ongoing basis, between 2 to 3 times a week. Medical aids do pay for dialysis treatments up to a certain limit. Prescribed minimum benefits (PMBs) may be applicable in this regard. Some medical aid plans provide unlimited dialysis cover but are usually the higher more expensive plans. These lifesaving sessions are only a temporary measure until kidney function returns or a new kidney is acquired for transplantation.