SchemeBook / Covered conditions / 168S
# HIV-infection
DTP code 168S · Haematological, Infectious And Miscellaneous Systemic Conditions
What the DTP says
Minimum treatment
# HIV voluntary counseling and testing Co-trimoxazole as preventative therapy Screening and preventative therapy for TB, Diagnosis and treatment of sexually transmitted infections Pain management in palliative care Treatment of opportunistic infections, Prevention of mother-to-child transmission of HIV Post-exposure prophylaxis following occupational exposure or sexual assault Medical management and medication, including the provision of anti-retroviral therapy, and ongoing monitoring for medicine effectiveness and safety, to the extent provided for in the national guidelines applicable in the public sector
What this record tells you
Diagnosis / condition
# HIV-infection
Clinical category
Haematological, Infectious And Miscellaneous Systemic Conditions
Minimum treatment descriptor
# HIV voluntary counseling and testing Co-trimoxazole as preventative therapy Screening and preventative therapy for TB, Diagnosis and treatment of sexually transmitted infections Pain management in palliative care Treatment of opportunistic infections, Prevention of mother-to-child transmission of HIV Post-exposure prophylaxis following occupational exposure or sexual assault Medical management and medication, including the provision of anti-retroviral therapy, and ongoing monitoring for medicine effectiveness and safety, to the extent provided for in the national guidelines applicable in the public sector
What it does not settle on its own
- Whether your exact clinical presentation satisfies the PMB descriptor.
- Which designated service provider or network rules apply to your option.
- Whether pre-authorisation, referral or clinical motivation is required.
- The provider's current charge, the scheme tariff, or your final out-of-pocket amount.
- How an individual dispute will be decided.
Questions to ask your scheme
- Does my diagnosis meet this DTP descriptor for PMB purposes?
- What treatment and public-sector protocol are you applying?
- Which DSP or network provider should I use, and when may I use another provider?
- What authorisation, referral, motivation or supporting records do you need?
- Please confirm the funding decision and any member payment in writing.
Plan the care and cost side separately
The DTP describes minimum PMB treatment; it is not a provider quote. For planned care, ask the provider what will be billed and ask your scheme how it will fund the exact service, codes, facility and providers involved.
Source and legal context
Council for Medical Schemes — PMBs ↗ · CMS PMB conditions list ↗