Do Medical Aids Cover Asthma Treatment?

The law that governs medical schemes in South Africa is overseen by the Council for Medical Schemes. This council has drawn up a list of twenty six chronic conditions including asthma treatment that must be covered by all medical schemes, regardless of the plan chosen or the premium paid. This list is known as the Prescribed Minimum Benefits, or PMB for short. Asthma is one of those conditions that must receive treatment. The answer is therefore “yes”. Medical aids must cover all the treatments - the management of the condition, medication, tests and visits to the doctor.

What exactly is asthma?

Asthma is a lung disease and the very fact that it is on the list of chronic diseases means that it is a lifelong condition that cannot be cured, but that can be managed. The wall of the airways become inflamed, making it difficult to breathe and allowing less oxygen to reach the lungs. When the airways constrict the muscle groups around the bronchi contract and phlegm is produced. Many people suffer only a mild form of the condition but it can become very serious and may even require hospitalization. With proper care the condition can be managed and sufferers are normally able to lead normal lives.

What are the causes of asthma?

Asthma can afflict people at any age and from all walks of life, although it is usually diagnosed at an early age. The causes are not known, but hereditary and environmental factors are thought to play a big role. The disease is normally triggered by a specific stimuli or a combination of such triggers. They differ from person to person but often include the following:

• ·            Tobacco smoke 
• ·            High stress levels and anxiety 
• ·            Preservatives and colorants found in certain food 
• ·            Some medicines 
• ·            Excessive exercise or tiredness 
• ·            Certain types of food such as peanuts and seafood 
• ·            Animal hair, pollen and mould 

What are the symptoms?

Sufferers often experience coughing fits, wheezing and they are short of breath. When these symptoms manifest the result is called an asthma attack and in severe cases the fingernails can turn blue, the pulse races and the patient often feel agitated. If these symptoms occur, it may be wise to undergo tests to determine whether it is asthma. The symptoms do not definitely indicate asthma because there may be many other reasons but it is certainly best to make sure. The tests conducted by doctors include the following:

•             An analysis of the family medical history. If other members of the family suffers from asthma the likelihood of developing increases. 
•            Special tests that measure the flow of air into and from the lungs 
•            Tests that measure the quantity of air breathed with every breath. 
•            A lung diffusion capacity test that measures the way in which oxygen is absorbed in the blood. 

The condition is more widespread that thought before. It is the most common lung disease in the world and almost four million South Africans suffer from the condition. Medication is combined with informed lifestyle changes and in this way the condition can be managed and the onset of symptoms prevented.

Once diagnosed with asthma it is important to inform the medical scheme of the fact and to ask that chronic benefits are activated. No medical aid may refuse asthma treatment and if they do, recourse can be sought from the Council for Medical Schemes. © Medical Aid Plan

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NOTES:

Your medical aid quote will include options to suit your pocket. Please ensure that the cover you select is exactly what you need and that you understand exactly what insurance you are buying. Do not hesitate to ask questions about the medical aid or hospital cover you choose.