How Prescription Medication Cover Works with Affinity Health

Prescription medication is an essential component of healthcare, especially for families, young professionals, and retirees managing chronic or acute conditions. Affinity Health provides cover for prescription medication as part of its day-to-day and combination plans, making it possible for more South Africans to receive necessary treatment without bearing the full out-of-pocket costs.

Day-to-Day and Combined Plan Prescription Benefits

Affinity Health’s Day-to-Day Plan and Combined Plan both provide defined allowances for prescription medicines. These benefits help manage costs for acute illnesses like infections, as well as ongoing treatment for high blood pressure or diabetes, within specified limits.

• Most plans offer a monthly limit for prescription medicines filled at registered pharmacies.
• Acute conditions (such as infections or pain management) and ongoing chronic needs may be supported, depending on the plan you select.
• Prescriptions must be issued by an authorised healthcare practitioner and are subject to specific benefit rules.

What’s Typically Included?

Different Affinity Health plans include varying levels of prescription medication cover. Generally, plans for adults, children, and seniors feature:

• Out-of-hospital cover for registered medications prescribed during routine consultations.
• Medication for both short-term illnesses and certain chronic conditions within the plan’s benefit limits.
• Easy access through partnered pharmacies nationwide.

Is Hospitalisation Medication Included?

If you require medication during an approved hospital stay, Affinity Health’s Hospital Plan covers in-hospital drugs prescribed by an attending healthcare practitioner, distinct from the day-to-day benefits provided out of hospital.

Choosing the Right Plan for Your Medication Needs

Selecting an Affinity Health plan that adequately covers your prescription medication needs requires understanding your current and anticipated health profile. For families with children, frequent doctor visits and prescriptions for childhood illnesses are typically better managed with a Combined Plan. Retirees and individuals with chronic illnesses may benefit from higher day-to-day allowances designed to support ongoing medication requirements.

• Affinity Junior Cover supports children with routine healthcare and essential medicines.
• Affinity Senior Cover is designed for adults, with cover that reflects the greater likelihood of ongoing medication use.
• For working-age adults, the Innovator Range introduces additional options for those managing both routine wellness and occasional hospital needs.

How to Access Your Benefits

1. Consult a healthcare practitioner within the Affinity Health network.
2. Receive your prescription and fill it at a registered network pharmacy.
3. Present your membership information for claim processing at the point of sale.

Sources

• Affinity Health - Day-to-Day Cover
• Affinity Health - Policy Options and Rates
• Affinity Health - Provider Finder
• South African National Health Insurance Policy White Paper
• Council for Medical Schemes: CMScript on Medicine Benefits