• Everyone is different


AIDS (Acquired immune deficiency syndrome or acquired immunodeficiency syndrome)

AIDS is not a virus, but a set of symptoms (or syndrome) caused by the HIV virus. A person is said to have AIDS when their immune system is too weak to fight off infection, and they develop certain defining symptoms and illnesses. This is the last stage of HIV, when the infection is very advanced, and if left untreated will lead to death.

Treatment for HIV means that more people are staying well, with fewer people developing AIDS. Although there is currently no cure for HIV with the right treatment and support, people with HIV can live long and healthy lives. To do this, it is especially important to take treatment correctly and deal with any possible side-effects.

CD4 count

It is a lab test that measures the number of CD4 T lymphocytes (CD4 cells) in a sample of your blood. In people with HIV, it is the most important laboratory indicator of how well your immune system is working and the strongest predictor of HIV progression

Designated Service Provider

A Designated Service Provider (DSP) is a healthcare provider/s selected, by the funder concerned, to provide healthcare services to its beneficiaries. This may apply to pharmacies, doctors and hospitals. Your funder may apply a co-payment on services obtained from a provider that is not a DSP. Refer to your funder rules for more detail.


Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood.

It can present itself in various forms, namely:

Type 1: The body stops producing insulin or produces too little insulin to regulate blood glucose level.

Type 2: Although the pancreas still secretes insulin, the body of someone with type 2 diabetes is partially or completely incapable of responding to insulin.

Pre-diabetes: In people with prediabetes, the blood sugar level is higher than normal but not yet high enough to be considered diagnostic of diabetes.

Generic medicine

The World Health Organization defines a generic medicine as a pharmaceutical product that is intended to be interchangeable with an innovator product. The generic product is manufactured without a license from the innovator company and marketed after the expiry date of the patent or other exclusive rights.

A generic medicine has the same active ingredients as the originator medicine. Generic medicine is the same as the originator medicine in terms of:

  • Dosage
  • Safety
  • Strength
  • Quality
  • The way it works
  • The way it is taken
  • The way it should be used.

HIV (Human Immunodeficiency Virus)

HIV is a virus that attacks the immune system, which is our body’s natural defense against illness. The virus destroys a type of white blood cell in the immune system called a T-helper cell, and makes copies of itself inside these cells. T-helper cells are also referred to as CD4 cells.

As HIV destroys more CD4 cells and makes more copies of itself, it gradually breaks down a person’s immune system. This means someone living with HIV, who is not receiving treatment, will find it harder and harder to fight off infections and diseases.

If HIV is left untreated, it may take up to 10 or 15 years for the immune system to be so severely damaged it can no longer defend itself at all. However, the speed HIV progresses will vary depending on age, health and background.

Prescribed Minimum Benefits (PMBs) and the Chronic Disease List (CDL)

PMBs are a set of minimum benefits which, by law, must be provided to all members by their medical schemes. PMBs must be provided regardless of the benefit option that a member has selected. The medical scheme must pay for the costs of diagnostic tests, treatment and ongoing care.

The Council for Medical Schemes has compiled a list of conditions, known as the CDL, for which appropriate medicines and other treatments have been specified. Medical schemes must cover the costs of the specified treatment of CDL conditions from PMB benefits. The medical scheme may make use of clinical protocols, medicine formularies and designated service providers to manage PMB benefits.

The CDL consists of:

  • Addison disease
  • Asthma
  • Bipolar mood disorder
  • Bronchiectasis
  • Cardiac failure
  • Cardiomyopathy
  • Chronic renal disease
  • Chronic obstructive pulmonary disease
  • Coronary artery disease
  • Crohn disease
  • Diabetes insipidus
  • Diabetes mellitus type 1
  • Diabetes mellitus type 2
  • Dysrhythmias
  • Epilepsy
  • Glaucoma
  • Haemophilia
  • Hyperlipidaemia
  • Hypertension
  • Hypothyroidism
  • Multiple sclerosis
  • Parkinson disease
  • Rheumatoid arthritis
  • Schizophrenia
  • Systemic lupus erythematosus
  • Ulcerative colitis.

Besides the conditions on the CDL, medical schemes must also cover the costs of the diagnosis and treatment of emergencies and 270 other specified conditions from PMB benefits. More details about PMBs can be found on the CMS website at http://www.medicalschemes.com/medical_schemes_pmb/index.htm

Pre-exposure prophylaxis (PrEP)

PrEP involves the use of antiretroviral (ARV) medications to prevent HIV infection. PrEP may be used during periods of perceived high risk of HIV acquisition (for example with sero-discordant couples – one partner positive and the other negative). PrEP is recommended for use intermittently, as may be required, and not life long as with HIV positive patients.

Post Exposure Prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is a short-term (one month) antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure, either occupationally (needle injury or sexual assault) or through unprotected sexual intercourse.


Substitution can be either:

Generic substitution:  is a medicine with the same active ingredients as that which has been prescribed. It is identical in dose, strength, route of administration, safety and efficacy as the prescribed drug. There will be a cost and an originator difference consequence. A generic substitution may be discussed with the beneficiary and it can then be changed with the beneficiary’s consent.

Therapeutic substitution:  is where a prescription medicine is replaced with a chemically different medicine that is expected to have the same clinical effect. The medicine is within the same or similar medicine class as the prescribed medicine. A therapeutic medicine substitution must be discussed with and approved by your doctor.

Viral load

It is the term used to describe the amount of HIV in your blood. Viral load tests measure the amount of HIV’s genetic material in a blood sample. The results of a viral load test are described as the number of copies of HIV RNA in a millilitre of blood.