Living with a health condition? We have a care programme just for you!
What if you could access exactly the right support and cover for your health condition? Well, that's exactly what Retail Medical Scheme's specialised care programmes are there for - to offer enhanced support and extra benefits to members living with diabetes, heart disease, kidney disease, depression and HIV.
If you live with a health condition, you're not alone. Conditions, such as hypertension and diabetes, are becoming more common in South Africa and across the world. These conditions can seriously affect our health and quality of life if we aren't managing them well. At Retail Medical Scheme, we understand that having the right support makes a big difference in helping you to manage your condition. That is why our specialised care programmes help you and your doctors to actively manage and monitor your conditions by giving you more support and benefits. Here's what you need to know about our care programmes.
Remember: If you visit a doctor who is not part of the Premier Plus Network for a chronic condition, you may have to pay part of the cost. To avoid any co-payments, please make use of the services of a network doctor and make sure we always know who your network doctor is. Let us know if anything changes so we can update our records.
To update your doctor on our system:
Call: 0860 444 439
Email: Members_DCP@retailmedicalscheme.co.za
Diabetes Care Programme
The Diabetes Care Programme is based on established clinical and lifestyle guidelines. The programme will help you and your Premier Plus GP to actively manage your diabetes.
You can join the Diabetes Care Programme by following these easy steps:
1. Register for the Chronic Illness Benefit. You and your nominated Premier Plus GP must complete and send us a Chronic Illness Benefit application form to register you on the Chronic Illness Benefit for type 1 or type 2 diabetes. Your doctor can also apply for cover online, using HealthID at the time of your diagnosis. Through the Chronic Illness Benefit, you will have cover for:
- Approved medicine
- Certain tests such as blood tests to monitor your condition
- Consultations with your GP and certain specialists
2. Your GP can then enrol you on the Diabetes Care Programme using HealthID.
This will unlock extra benefits unique to your journey, including:
- A diabetes educator who will guide you on key areas that include daily glucose monitoring and the correct time to take your medicine.
- Extra blood glucose test strips per year
- A biokineticist consultation to help tailor your nutrition, activity and medicine.
- Extra dietitian consultations to assist you with proper nutrition.
For more information and option-specific details, visit the Diabetes Care Programme benefit page.
Cardio Care Programme
What is cardiovascular disease?
Heart disease also called cardiovascular disease (CVD), is one of the biggest causes of death around the world. People who are at risk often have health problems like high blood pressure, high sugar levels, high cholesterol, or they may be overweight.
Four everyday habits can make heart problems much worse and even life-threatening. These are:
- Smoking or using tobacco
- Not getting enough exercise
- Eating unhealthy foods
- Drinking too much alcohol
The Cardio Care Programme
The Cardio Care Programme is here to help you get the best quality care and outcomes. The Cardio Care Programme enables your chosen Premier Plus GP to diagnose and start the appropriate treatment while managing your risk factors with the support of a team of healthcare professionals.
How to access the Cardio Care Programme
You must consult with a chosen Premier Plus GP to access the Cardio Care Programme, as well as be registered for at least one of the following conditions as part of the Chronic Illness Benefit (CIB):
- Hypertension
- Ischaemic heart disease
- Hyperlipidaemia
Your GP can then enrol you on the Cardio Care Programme using HealthID.
This will unlock extra benefits unique to your journey, including:
- An extended consultation (annually) with your chosen primary care provider. The Scheme will fund this longer consultation annually that allows for more additional time for activities like learning more about the condition, counseling, lifestyle modification guidance, and detailed treatment plan discussions.
- You qualify for Health Coaching. A health coach is someone who helps you stay on track with your care. They'll check in with you, remind you about your doctor's advice, and support you in making healthy changes - like eating better, staying active, or taking your medicine regularly.
Kidney Care Programme
The Kidney Care Programme makes it easier for our members on chronic dialysis to manage their condition and treatment.When starting chronic dialysis, your treating specialist must make sure that you have applied for all your medicine through the Chronic Illness Benefit. Your treating doctor must also submit a Prescribed Minimum Benefit application detailing which mode of chronic dialysis you are using.
When starting chronic dialysis, your treating specialist must make sure that you have applied for all your medicine through the Chronic Illness Benefit. Your treating doctor must also send us a Prescribed Minimum Benefit application telling us which type of chronic dialysis you are using.
This will give you access to a yearly, calendar-based basket of care for chronic dialysis which will cover all the blood tests that you need while on chronic dialysis. The Kidney Care Programme will give you extra support, which will include:
- Yearly confidential medical reports based on your blood tests.
- Educational material and information to help you better understand and manage your condition and treatment.
Mental Health Care Programme
The Mental Health Care Programme is for memberswho've been diagnosed with episodes of depression. Your chosen Premier Plus GP or a psychologist in our network can enrol you on the Programme.
The Mental Health Care Programme runs over a period of six to twelve months and unlocks the following extra benefits to monitor and manage your condition:
- Up to three consultations (virtual or face-to-face) with your nominated Premier Plus GP
- Individual psychotherapy sessions or group therapy sessions with a Mental Health Care Programme network psychologist. Psychotherapy sessions in the Mental Health Care Programme are paid up to a total cover amount of R3 479 per person per year.
- Members 18 years and older also have access to one internet-based Cognitive Behavioural Therapy (iCBT) course when referred by your enrolling Premier Plus GP or network psychologist. iCBT will be paid up to the Discovery Scheme Rate, from the psychotherapy consultation cover amount stated above.
- Additional funding for antidepressant medicine
HIV Care Programme
The HIV Care Programme gives comprehensive support to members living with HIV and AIDS to help them better manage their condition.
You can join the HIV Care Programme by following these easy steps:
- Your nominated Premier Plus GP or a GP in the Scheme's GP Network must register you for the condition by completing the HIV Care Programme application form first
- Give your Premier Plus GP consent on HealthID to be enrolled on the Programme
- Your Premier Plus GP can now enroll you on the HIV Care Programme
Once you are enrolled on the HIV Care Programme, you and your Premier Plus GP can agree on key goals and track your progress.
Members who are enrolled on the HIV Care Programme through their nominated Premier Plus GP will have access to additional benefits, one annual social worker consultation and one extended GP consultation paid from Scheme benefits.
Disease Prevention Programme for those at risk of diabetes or cardiovascular disease
The Disease Prevention Programme supports Retail Medical Scheme members who are at risk of developing diabetes. The goal of the programme is to reduce your risk of developing type 2 diabetes.
We use your screening results - like blood pressure, BMI, waist size, and family history - to check your risk. If you qualify for the Disease Prevention Programme, your chosen Premier Plus GP can enrol you. A health coach will then get in touch with you to explain how the programme works.
Once you are enrolled on the programme, you have access to:
- An additional consultation for your Premier Plus GP.
- Two consultations with a network dietitian for personalised nutrition advice.
- A defined set of blood tests for monitoring your progress in reducing your risk.
- Medicine, if prescribed.
- A health coach for tracking and improving your health.
Your health condition need not be a life sentence. With our Care Programmes you are able to live a full, healthy life with the support and guidance of professionals.